"It's Not Just Based on Behavior": A Qualitative Study of Stakeholder Perspectives on Women's HIV Vulnerability in the United States.

Despite advances in HIV prevention, cisgender women account for nearly one in five new HIV diagnoses in the United States. To inform prevention strategies for women who could benefit most, our study explored key stakeholder perspectives on factors shaping women's vulnerability to HIV acquisition. Semi-structured interviews were conducted with 40 stakeholders involved in HIV prevention across the United States. Interviews were audio recorded, professionally transcribed, and analyzed using directed content analysis guided by the Ecological Model of Health Behavior. Stakeholders described factors shaping women's HIV vulnerability across intrapersonal, interpersonal, organizational, community, and policy levels, including low perceived HIV risk, intimate partner violence, limited access to community resources, and policy environments that may discourage HIV testing and pre-exposure prophylaxis uptake. Stakeholders highlighted strategies to address these factors, including trauma-informed care and peer-led, community-based approaches. These findings underscore the importance of multilevel, women-centered approaches to strengthen women's engagement in HIV prevention.