Pre-Exposure prophylaxis knowledge, use and adherence among a US national sample of women.

Pre-exposure prophylaxis (PrEP) is a proven strategy for HIV prevention, yet uptake among women vulnerable to HIV remains low. This study draws on survey data and urine-based adherence testing from the American Women Assessing Risk Epidemiologically (AWARE) study to assess PrEP knowledge, use, and adherence in a behaviorally vulnerable sample. Despite high awareness of PrEP, actual use and willingness to consider PrEP were minimal. Objective adherence testing showed that most women who self-reported current PrEP use adhered to the daily regimen. Findings suggest that socioeconomic status, insurance coverage, relationship dynamics, and health literacy influence PrEP engagement. The small number of PrEP users underscores persistent barriers, including misinformation and medication affordability. Addressing these factors is critical to converting awareness into sustained use. Future prevention efforts should prioritize improving PrEP health literacy and expanding access to affordable medication. These findings highlight the need for targeted interventions that address the intersecting structural and informational barriers to PrEP uptake among women in the U.S.