Preexposure Prophylaxis to Prevent HIV Acquisition: Perceptions among Sexual and Gender Minority Individuals in North Carolina.

Objectives: Sexual and gender minority (SGM) communities at increased risk of human immunodeficiency virus (HIV) may be underprescribed preexposure prophylaxis (PrEP), but PrEP research on SGM communities other than transgender women and cisgender men who have sex with men is limited. We sought to better understand SGM individuals' vulnerability to HIV acquisition and awareness and perceptions of PrEP in North Carolina, with a focus on SGM groups less often included in research.

Methods: We administered a 37-item online survey to adult SGM participants, examining differences in perceived and behavioral HIV risk based on self-reported behaviors. We also compared PrEP awareness, prescriptions, and stigma between SGM identities and used logistic regression to examine associations between HIV risk and PrEP use.

Results: In total, 372 participants completed the survey. Although 30.9% reported behaviors that increase the likelihood of HIV acquisition, only 9.5% perceived their risk as elevated. Most (78.5%) were aware of PrEP, but only 15.1% had been prescribed PrEP. PrEP stigma was most pervasive among cisgender women. Nonbinary and queer participants were more likely to have experienced mistreatment by a provider (20.3%, P < 0.0001; 19.2%, P < 0.01) and avoid care fearing mistreatment (31.9%, P < 0.001; 27.7%; P < 0.001) compared with the entire sample.

Conclusions: PrEP is prescribed at low rates across many SGM communities, with misperception of HIV risk, PrEP stigma, and mistreatment in health care identified as important barriers. Healthcare providers should take steps to create a safe environment for SGM patients and ask all patients about HIV risk factors and provide information about PrEP regardless of sexual orientation or gender identity.