HIV Pre-Exposure Prophylaxis Use Among South Asian Sexual Minority Men in the United States: Pilot Web-Based Survey Study.

Background: South Asian American gay, bisexual, and other men who have sex with men (GBM) experience multiple minority stressors, such as internalized homophobia, racial prejudice, and homonegative discrimination, thereby elevating their risk of HIV. Due to the scarcity of HIV scientific literature focusing on South Asian American GBM, little is known about their use of pre-exposure prophylaxis (PrEP) or the upstream factors influencing its uptake. Objective: This study seeks to address this gap by describing PrEP use history among South Asian American GBM and comparing PrEP users and nonusers with respect to their demographic and behavioral characteristics, as well as PrEP knowledge, attitudes, stigma, social norms, and self-efficacy-elements that reflect key constructs of the information-motivation-behavioral (IMB) skills model. Methods: Sexually active South Asian American GBM were recruited from across the United States via social media advertising and peer referral and were administered a Qualtrics survey, for which they received a US $25 Amazon e-gift card. In addition to demographic and behavioral variables, the survey included previously validated scales to measure IMB model constructs. Fisher exact tests and Mann-Whitney U tests were conducted to compare the demographic and behavioral characteristics of PrEP users with nonusers, as well as their scores on each scale, respectively. Results: Of the 103 participants, 34 (33%) were currently using PrEP, 52 (50%) had never used it, and 17 (17%) had discontinued its use. Greater proportions of PrEP users were in open relationships (P<.001), had at least 2 male sex partners in the past 6 months (P<.001), and had condomless anal sex with at least 2 male partners in the past 6 months (P<.001). Frequently cited reasons for never using or discontinuing PrEP included being in or starting a relationship, respectively, and concern about its long-term safety. Consistent with the IMB model, PrEP users exhibited greater PrEP knowledge (P<.001), stronger motivational elements (PrEP attitudes P=.002; PrEP stigma P=.09; PrEP subjective norms P=.003; PrEP descriptive norms P=.06), and higher PrEP self-efficacy (P=.003). Conclusions: Suboptimal PrEP use among South Asian American GBM, despite high PrEP knowledge, positive attitudes, low stigma, positive social norms, and high PrEP self-efficacy, represents a disconnect between individual readiness and actual use. Future research exploring their sexual health needs through an intersectional lens could help identify possible points for intervention.