Gay Community Connectedness, Internalized Homonegativity, and HIV Pre-Exposure Prophylaxis (PrEP) Attitudes and Use Among Men Who Have Sex with Men in Georgia: A Mediation Analysis.

Georgia has one of the highest HIV diagnosis rates in the U.S., yet only 33% of Pre-Exposure Prophylaxis (PrEP) users in the Deep South live there. This study aims to determine the potential mediational role of internalized homonegativity and attitudes towards PrEP between gay community connectedness and PrEP use among men who have sex with men (MSM) living in Georgia. Participants (N = 121) completed an online survey in June 2020. PrEP use (yes/no) was defined by the question "the last time you had sex, were you taking PrEP, like Truvada?" The study also used the "8-item Identification and Involvement with the Gay Community scale", "9-item internalized homophobia scale", and a "3-item PrEP attitude scale". Path analysis was performed using Stata 17.0. After adjusting for sociodemographic characteristics, positive associations were observed between attitudes towards PrEP and PrEP use (β = 0.11; p = < 0.001), and gay community connectedness (GCC) and PrEP attitudes (β = 0.17, p < 0.001). Conversely, negative associations were found between GCC and internalized homonegativity (β=-0.71, p < 0.001), and internalized homonegativity and PrEP use (β=-.01, p = 0.031). GCC was not significantly associated with PrEP use (β=-.01; p = 0.196). However, the indirect effects of GCC on PrEP use through PrEP attitudes (β = 0.01, p < 0.001) and internalized homonegativity (β = 0.02, p = 0.041) were statistically significant. These findings indicate that PrEP attitudes and internalized homonegativity mediate the relationship between GCC and PrEP use among MSM. Thus, improving attitudes toward PrEP and reducing internalized homonegativity through fostering GCC among MSM may improve PrEP use and persistence.