"I was Thinking of Taking PrEP by the Way": A Qualitative Exploration of HIV/STI Prevention Strategies Utilized by Young Black Women in the U.S. South.

Young Black women in the Southern U.S. are disproportionately impacted by HIV and sexually transmitted infections (STIs). While pre-exposure prophylaxis (PrEP) is an evidence-based HIV prevention strategy, uptake is low among this population. As efforts to increase PrEP use among young Black women continue, it is important to understand how this population defines sexual health, the sexual health services utilized, their PrEP knowledge, and the HIV/STI prevention strategies they employ. Women aged 18-34 were recruited to participate in semi-structured interviews (n = 75) conducted between January and October 2021, and a secondary thematic analysis was conducted with NVivo. When participants were asked to define sexual health distinct from reproductive health, the primary definition given was protection from HIV/STIs. Participants accessed sexual health services (e.g., Pap smears, HIV/STI testing) in diverse settings including private physician offices, community-based organizations, public health clinics, and reproductive health clinics. Very few participants had discussed PrEP with a provider. Knowledge of PrEP varied widely, with some participants expressing PrEP misinformation. Most participants had seen an advertisement for PrEP but few saw themselves represented in those advertisements. Participants utilized several HIV/STI prevention strategies, including condoms, HIV/STI testing, and monogamy. Our findings highlight potential opportunities for future HIV prevention efforts including interventions that address HIV and other STIs, providing PrEP in sexual health settings that Black women access, comprehensive discussions between providers and young Black women about the full spectrum of prevention products, and continued efforts to improve PrEP knowledge and center young Black women in PrEP campaigns.