Exploring Violence as a Predictor for Mental Health and PrEP outcomes in Indigenous Gay and Bisexual Men in Guatemala

Abstract

Background: Indigenous gay and bisexual men (GBM) in Guatemala face a double epidemic of violence and HIV. This study seeks to understand the relationship between exposure to different forms of violence and PrEP use to inform PrEP programming in Guatemala. Methods: From June 2023- May 2024, two partner organizations administered a cross-sectional questionnaire to 395 Indigenous Guatemalan GBM. I examined the relationship between violence (physical, sexual, and police violence due to sexual orientation; forced migration and knowing someone missing, injured,or killed in the internal armed conflict; and intimate partner violence (IPV) victimization and perpetration) and PrEP use using logistic regression in R, and examined mental health as a possible mediator in these relationships. Results: In multivariate analysis, I found that participants who experienced police violence were 150% more likely to use PrEP (aOR:1.64, 95% CI: 1.03, 2.64, p=0.04). Participants who experienced forced migration during the internal conflict were twice as likely to be current users of PrEP (aOR: 2.03, 95% CI: 1.12, 3.70, p=0.02). Participants who perpetrated IPV were 80% less likely to use PrEP (aOR: 0.17, 95% CI: 0.025, 0.659, p=0.03). Mental health did not mediate these relationships. Conclusions: Indigenous GBM experience a high burden of violence which may affect their use of PrEP. Future longitudinal research should explore how violence victimization affects resilience behaviors, which may explain why Indigenous GBM who experienced violence may be more likely to use PrEP.