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Understanding PrEP Contemplation Among Black Women: Insights from a Qualitative Analysis
Amber I Sophus1, Kathryn L Braun2, Jason W Mitchell3
1Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 S.W. 8 th Street, Miami, FL, 33199, USA. asophus@fiu.edu.
Journal of Racial and Ethnic Health Disparities
|April 16, 2025
Summary
Black women in the Southern US are not engaging with pre-exposure prophylaxis (PrEP) due to relationship status and insufficient PrEP information. Tailored messaging and programs are needed to improve uptake and address health disparities.
Area of Science:
- Public Health
- Health Disparities
- Qualitative Research
Background:
- Pre-exposure prophylaxis (PrEP) engagement remains low among Black women in the Southern United States, representing a significant health disparity.
- Existing research highlights a need to understand the motivations and decision-making processes influencing PrEP use in this population.
- The PrEP Cascade framework and an integrated theoretical model guided this inquiry into barriers and facilitators of PrEP uptake.
Purpose of the Study:
- To explore the motivations and decision-making processes of Black women regarding pre-exposure prophylaxis (PrEP) engagement.
- To identify specific strategies for enhancing PrEP messaging and increasing uptake among Black women who could benefit from its use.
- To address the enduring health disparity in PrEP utilization within this demographic.
Main Methods:
- Conducted twelve semi-structured interviews via Zoom between February 2020 and March 2022.
- Participants were recruited from a larger online survey on factors associated with PrEP uptake among Black women.
- Employed quantitative descriptive statistics and directed content analysis to analyze interview data.
Main Results:
- None of the twelve interviewed women had initiated PrEP at the time of the study; two were in discussions with providers, and one planned initiation within three months.
- Key reasons for not starting PrEP included current relationship status and inadequate awareness, knowledge, and literacy regarding PrEP.
- Participants cited distrust in PrEP due to insufficient information and anticipated challenges with cost and patient-provider communication.
Conclusions:
- Significant opportunities exist to enhance PrEP use among Black women during the contemplation phase.
- Improved and tailored PrEP messaging is crucial for increasing engagement and addressing barriers.
- Development of targeted PrEP programs and interventions is necessary to improve uptake and reduce health disparities for Black women.
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