Critical Reflections From the Black Women First Initiative

In 2020, the Health Resources and Services Administration launched the first initiative focused on Black women in nearly 40 years of the HIV epidemic: the Black Women First initiative. A critical step toward advancing racial equity, the initiative addressed the health and social needs of diverse Black women in HIV care and treatment. In this essay, we posit that the disproportionate burden of HIV/AIDS experienced by Black women is rooted in racism, not race. Using critical reflexivity and the Public Health Critical Race praxis, we critically discuss the Black Women First initiative's framing and components, the factors contributing to successes and challenges, opportunities to deepen efforts, and recommendations to focus on dismantling racism in future efforts addressing care and treatment for Black women with HIV. We reflect on how racism was challenged through the involvement of Black women with lived experiences and racial justice organizations, although racism was not a focus of the initiative. Advancing the health of Black women with HIV needs a comprehensive and critical approach that addresses racism by changing intervention funding, service delivery, and the measurement of success. (Am J Public Health. 2025;115(9):1500-1507. https://doi.org/10.2105/AJPH.2025.308138).