Divergent effects of HIV and pre-exposure prophylaxis stigma on willingness to adopt preventive tools among African immigrants in the United States

African immigrants in the United States face disproportionately high HIV rates yet remain underrepresented in national PrEP uptake. This study examined how HIV-related and PrEP-specific stigma influence willingness to use PrEP among Ghanaian immigrants, one of the largest African immigrant groups in the U.S. A cross-sectional online survey of 764 participants recruited via WhatsApp between June and July 2021 collected sociodemographic data, validated stigma measures, and PrEP willingness scores. Multiple linear regression analyses assessed associations between stigma and willingness, controlling for age, gender, education, and healthcare access. Participants had a mean age of 28.9 years; 59% were male, 68% heterosexual, and 95% employed. High HIV stigma was reported by 53.4% and high PrEP-specific stigma by 49.7% of participants. Overall, 51% expressed willingness to use PrEP. Higher PrEP stigma was associated with lower willingness (β = -0.04, <i>p</i> < 0.05), while higher HIV stigma was associated with greater willingness (<i>β</i> = 0.09, <i>p</i> < 0.01). HIV-related stigma operates as a critical psychosocial determinant of prevention in this population. Efforts to reduce PrEP stigma and leverage culturally grounded, community-based approaches are essential to increase PrEP uptake and address HIV prevention disparities among African immigrants.