Facilitators and Barriers to Pre-Exposure Prophylaxis (PrEP) Use Among Black Young and Older Adult Women in Baltimore: A Qualitative Study.

BACKGROUND

The majority of incident HIV infections among women in the US occur among Black cisgender women with significant heterogeneity by age. This study aimed to explore the differences in PrEP barriers and facilitators among Black young and older adult women in Baltimore, Maryland.

METHODS

We purposively recruited young adult 18 to 29 (n = 12) and older adult women ages 30 to 44 (n = 14) from Baltimore, Maryland, who have never used PrEP to participate in a semi-structured interview. We utilized a combination of deductive and inductive coding to analyze the data. Coded segments were analyzed by age group and were presented using the socioecological model.

FINDINGS: At the individual level, low PrEP awareness and knowledge, lack of perceived PrEP candidacy, and concerns about PrEP side effects and efficacy were barriers to PrEP interest. At the relationship level, monogamy and anticipated partner reaction to PrEP use (only for young adult Black women) were barriers to PrEP interest. At the community level, HIV stigma impeded PrEP interest, whereas sexual norms in college among young adult Black women contributed to PrEP interest. Finally, on a structural level, medical mistrust and PrEP costs were barriers to PrEP interest.

CONCLUSIONS

Taken together, these data suggest the need for increasingly tailored approaches to better serve young and older adult Black women. Engaging Black women in specific venues such as health centers on college campuses may be optimal to reach young adult Black women, whereas healthcare settings may be optimal to reach older adult Black women.