Is PrEP for me? Knowledge, Attitudes, Behaviors, and Perspectives about PrEP among Black Women Living in the South

Abstract

Significant racial and regional disparities are associated with HIV incidence rates among Black women in the United States, particularly of those who live in the South. While strides to improve HIV prevention efforts with Black, heterosexual women have occurred, more is needed. Pre-exposure prophylaxis (PrEP) is a woman-controlled HIV prevention strategy that can combat high rates of HIV and be used without the need to negotiate with a sexual partner. Although Black women are at the highest risk for HIV acquisition, they have the lowest rates of PrEP uptake in the U.S. The purpose of this dissertation was to expand public health understanding of the current status of HIV and AIDS prevention interventions for Black women in the U.S., highlight key aspects of recruitment ads that appeal to Black women to improve recruitment efforts for this population, and expand PrEP-related research on population characteristics and health behaviors associated with PrEP use among Black women who live in the South. This dissertation reports on findings from three studies. Study 1 was a systematic review that provided an examination of the status of HIV/AIDS prevention interventions for Black, heterosexual women in the U.S. from 2012-2019. Findings highlight gaps in HIV/AIDS prevention interventions for Black women in the U.S., specifies sub-populations of Black women that may need more attention in terms of HIV/AIDS services and programs, and provides recommendations for current and future HIV/AIDS prevention interventions that are specified for Black women. Study 2 used formative qualitative research to examine Black women’s general likes and dislikes about women-focused ads, and their preferences for ad content and ad locations in order to gain the interest of Black women to participate in health-related research. Findings not only extend the existing literature by describing aspects of online and physical ads that may appeal to Black women but highlight a specific area of featuring Black health providers as well as patients within ads that has not yet been identified in the current literature. Study 3 used quantitative methods through the use of an online survey to identify population characteristics and health behaviors associated with general likelihood to use PrEP and whether an individual planned to start PrEP soon (i.e., in the next 3 months) among a sample of at-risk HIV-negative cisgender Black women. Findings extend current PrEP-related literature about PrEP uptake among Black women by providing insight into additional factors associated with likelihood to use PrEP and future plan to use PrEP within this population. Findings also indicate a need to further examine how PrEP stigma may affect PrEP use among Black women.Overall, findings from this dissertation highlight the need for additional programs and resources that improve HIV prevention strategies for Black women and help promote PrEP uptake within this vulnerable population.