African American cisgender women face multiple barriers to PrEP use. Among them are low risk perception, stigma, past experiences with healthcare, and partner communication that may influence their interest in using PrEP. Interventions to increase PrEP uptake among African American cisgender women need to be culturally grounded and focus on integrating HIV prevention into broader self-care and wellness.
The investigators conducted in-depth interviews with 12 African American cisgender women and three focus group discussions with 21 African American cisgender women in a metropolitan area in the southern United States. Interviews explored stigma and perceptions of HIV/PrEP, and focus groups confirmed interview findings and identified intervention preferences. They identified key themes among the interview participants through rapid qualitative analysis and a review of focus group discussion notes and transcripts.
The participants ranged in age from 19 to 53. Interview participants were aware of PrEP, but they considered it was intended for sexual minorities, sex workers, or people who use drugs. They also noted poor community perception of HIV vulnerability. Nearly all participants recalled facing stigma related to race, gender, or sexuality, and half of them reported healthcare discrimination. Several respondents identified stigma around sexual health discussions and difficulty discussing HIV prevention with their partners. Focus group discussion members were also aware of PrEP, but several had misconceptions about its purpose or their eligibility.
The women’s preferred intervention strategies included:
- Plain language messages, relatable stories, age-specific group education by gender, and race-concordant facilitators;
- Normalized HIV and STI conversations, and sexual health, including tests for sexually transmitted infections, framed as self-care;
- Acceptance of self-empowerment and cognitive behavioral techniques, such as role-playing, to reduce stigma and build resilience;
- Virtual or hybrid sessions with gender- and race-concordant PrEP providers for transparent communication about costs, side effects, and PrEP options;
- Optional sessions for the women’s support system, including partners, family, or peers; and
- Prioritized intervention towards younger, more sexually active African American cisgender women.
Reference
Ayangeakaa SD, et al. IAS 2025. E-poster E0599.
