Understanding PrEP Contemplation Among Black Women: Insights from a Qualitative Analysis

BackgroundThe lack of engagement and use of pre-exposure prophylaxis (PrEP) among Black women in the Southern United States is an enduring health disparity. Guided by an integrated theoretical framework and the PrEP Cascade, this qualitative inquiry aimed to explore Black women's motivation and decision-making regarding PrEP engagement and identify strategies to enhance PrEP messaging and uptake for those with indication(s) for PrEP use.Materials and MethodsTwelve semi-structured Zoom interviews were conducted between February 2020 and March 2022. Participants were sampled from a larger pool in an online survey study about factors associated with PrEP uptake among Black women. Interviews explored whether women started PrEP (or not) within 3 months after learning about PrEP in the survey and explored their reasoning. Data analysis included quantitative descriptive statistics and directed content analysis.ResultsNone of the 12 women had started PrEP at the time of the interview. Two were in discussions with their provider about PrEP (stage 3: PrEParation), and one intended to initiate PrEP within the next 3 months (i.e., thinking about it). Two main themes emerged as their reasons for not starting PrEP: current relationship status and PrEP information (awareness, knowledge, and literacy). Participants expressed a lack of trust in PrEP due to insufficient information while anticipated challenges in obtaining PrEP included cost and the patient-provider relationship (engagement and communication).ConclusionThe findings highlight missed opportunities to improve PrEP use among Black women within the PrEP contemplation phase, emphasizing the need for improved PrEP messaging and tailored PrEP programs and/or interventions for this group.