Beyond Individual Risk: A Qualitative Exploration of Intersectional HIV Vulnerabilities Among Black Cisgender Women in Baltimore.

Black cisgender women in the USA experience compounded challenges in protecting themselves from HIV. While prevention efforts often focus on individual-level behaviors, structural and contextual factors critically shape HIV vulnerability and access to care. We conducted qualitative in-depth interviews between October 2021 and April 2023 with 26 Black cisgender women aged 18 to 44 who reported inconsistent condom use and vaginal or anal sex with a male partner in the past 6 months. We used a combined inductive and deductive approach to analyze the data and presented illustrative themes across Black women. Participants described intersecting social, relational, and structural conditions that uniquely shaped HIV vulnerability, highlighting how traditional prevention strategies may not fully address their lived realities. Poverty, limited economic opportunities, and housing instability contributed to engagement in sex work and substance use, increasing perceived risk. Unequal gender power, coercive sexual dynamics, and challenges in condom negotiation constrained women's protective behaviors. Stigma, healthcare discrimination, and misinformation hindered access to prevention services. These findings reveal how HIV prevention practices, including testing and perceived monogamy, are negotiated within broader structural marginalization, underscoring the importance of addressing intersecting sociostructural determinants. Findings underscore the need for HIV prevention approaches that extend beyond individual behavior and address structural inequities-including economic precarity, gendered power imbalances, and healthcare discrimination-that shape Black women's lived realities and HIV risk.