Black Women's Disclosure Reasons, Anticipated Response, and Strategies When Discussing PrEP Uptake with Partners

Although Black women represent 13% of the population of women, nearly 50% of HIV acquisitions among women occur in Black women. Pre-exposure prophylaxis (PrEP) is a highly effective and widely available biomedical HIV prevention option. Despite the medication's efficacy and availability, most women who could benefit are not using it. Although PrEP can be used autonomously and discretely, many women who wish to use it may feel obligated to disclose PrEP use to male sex partners and may experience partner resistance to their utilization of PrEP, undermining PrEP's potential for autonomous use and its efficacy. This study examines the process of disclosing the intention to use PrEP to sexual partners among women in a high-prevalence community. We analyzed interviews from (N = 23) adult, sexually active Black cisgender women. We conducted reflexive thematic analysis, followed by co-occurrence analysis, to identify (a) reasons for disclosure, (b) anticipated partner responses to disclosures, and (c) the strategies women anticipate using to disclose. Results demonstrate that many women would disclose PrEP use to their partners. Respondents commonly cited relationship- and partner-motivated reasons and anticipated using direct strategies to disclose. Others described entrapment and incremental strategies for disclosure. Although some participants anticipated supportive responses to their disclosure, others reported uncertainty about their partner's response as well as anticipated negative emotional reactions and/or conflict/accusation. Results demonstrate that programs to cultivate women's skills for negotiation of safer sex via PrEP are needed to support women's uptake of this important innovation.