Dimensions of Choice: How Black Women in the South Navigate PrEP Decision-Making Open Access
Mekonen, Hayat (Spring 2025)
Abstract
Background
Despite making up only 15.3% of the total population of women in the United States (U.S.), Black women represent 54% of new HIV diagnoses; the largest proportion of new diagnoses of any racial group among women. In the Southern U.S., HIV prevalence is high- Black cisgender women account for 67% of new HIV infections among women. When taken directed, Pre-exposure Prophylaxis (PrEP) can reduce the risk of contracting HIV from sex and injection drug use by up to 99% and at least 74%, respectively. Despite the effectiveness of PrEP, less than 2% of eligible Black cisgender women are taking it. Additionally, the Southern population accounts for just 27% of PrEP users. At the intersection of race, gender, sexuality, and geographical region, Black women in the South face unique barriers to PrEP access.
Methods
This project is a secondary mixed methods analysis of the second component of a hybrid type 1 effectiveness implementation study titled Planning4PrEP. This analysis aims to better understand how the factors that influence PrEP uptake are considered and prioritized by Black women in the South when making a decision about PrEP for HIV prevention. One hundred and one women consented, enrolled, and completed self-administered and staff-administered surveys at baseline, 3-months, and 6-months. Clinic-based enrollment revealed low PrEP interest and uptake among participants. In-depth interviews were added post-hoc to better understand the decision-making process. This analysis focuses on the 17% (18 total) of women who self-identified as Black women and completed both surveys and an in-depth interview.
Results
The side effects of PrEP and potential interactions with birth control/other medications, both in the short- and long-term, were the most prioritized concerns expressed by participants when considering PrEP for HIV prevention, followed by the cost of PrEP and other barriers to accessing medications/healthcare. Not knowing enough about PrEP was also a commonly expressed concern among participants.
Conclusion
Results from this study suggest a need for the following among Black women in the South: 1) culturally responsive PrEP counseling, 2) culturally responsive community-based education, 3) increased affordable PrEP options, 4) PrEP coverage across both private and public insurance plans. Future research should focus on the feasibility and acceptability of such interventions.
Table of Contents
CHAPTER I. INTRODUCTION
Background
Problem Statement
Theoretical Framework
Purpose and Significance Statement
Research Question
Definition of Terms
CHAPTER II. LITERATURE REVIEW
Introduction
HIV and PrEP Knowledge
Medical Mistrust
PrEP Counseling
HIV Stigma
Religion and HIV Stigma
Perceived Risk for HIV
Financial Barriers and Lack of Access to Care
Access
Financial Barriers
A Deeper Understanding of the Theoretical Framework
The Health Belief Model
The Transtheoretical Model for Behavior Change
Summary of the Current Problem and Study Relevance
CHAPTER III. METHODOLOGY
Description of Parent Study
Study Design and Setting
Sampling and Recruitment
Measures
Data Collection Procedures
Data Analysis Methodology
CHAPTER IV. RESULTS
Participant Demographics
Categorization of PrEP Interest in the Sample
Behavioral Indicators for PrEP Use in the Sample
HIV and PrEP Counseling and Sources of Information
PrEP Counseling
PrEP Sources of Information
HIV and PrEP Knowledge
HIV Knowledge
PrEP Knowledge
Perceived HIV Risk and PrEP Benefit
Perceived Risk for HIV
Perceived Benefit of PrEP
Prioritization of the Factors that Influenced PrEP Decision-Making
Side Effects and Medication Interactions
Cost of PrEP and Barriers to Access
Lack of PrEP Knowledge
CHAPTER IV. DISCUSSION
Introduction
Key Results
HIV Knowledge and Perceived Risk
PrEP Knowledge and Interest
PrEP Counseling
HIV Stigma and Medical Mistrust
Prioritization of the Factors that Influenced PrEP Decision-Making
Strengths and Limitations
Implications for Public Health Research and Practice
Conclusion
REFERENCES
About this Master's Thesis
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