A Community-Based Intervention to Increase PrEP Initiation and Reduce Internalized Stigma: A Randomized Trial Among...

Human immunodeficiency virus (HIV) remains an epidemic disproportionately affecting Black sexual minority men (BSMM). Prince George's County, Maryland, a majority-Black county, bears approximately three times the national prevalence and incidence of diagnosed HIV cases. Pre-Exposure Prophylaxis (PrEP) is extraordinarily effective for HIV prevention, yet uptake among BSMM remains low. We developed a community-based intervention for HIV-negative BSMM with sexual partners and no history of PrEP use in Prince George's County, Maryland. Study participants were recruited from January through March 2025 and followed for 6 months. Intervention activities were grounded in the MPowerment model and focused on increasing PrEP knowledge and acceptability, building social connection, and reducing internalized stigma related to race, sexuality, and PrEP. We tested for differences in PrEP use and each of these factors between intervention and control groups. We recruited 147 participants, with 126 (62 control, 64 intervention) followed at 6 months (85.7% retention). PrEP use at 6 months was 15.6% in the intervention group compared with 3.2% in the control group (RR = 4.84, 95%CI 1.11-21.23). The intervention group had significantly higher levels of PrEP knowledge, self-efficacy, resilience, and PrEP communication, and lower PrEP stigma, internalized homophobia, and internalized racism. Fidelity, activity participation, and participant satisfaction were high (>90%). Our intervention demonstrated a nearly 5-fold increase in PrEP use over 6 months compared with the control. The findings from our trial highlight the initial efficacy of culturally-tailored, peer-based interventions for BSMM. Participants found activities feasible, satisfactory, and effective. Additional and longer-term interventions may further improve PrEP uptake in this community.