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Willingness to Use Pre-Exposure Prophylaxis Among Black/African American Adolescent Girls and Young Adult Women in the U.S.
Wallace-Selman, Olivia
Wallace-Selman, Olivia
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Reynolds, Simone A., Thompson, Azure, Joseph, Michael A.
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2025-06
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Abstract
Background:
HIV (human immunodeficiency virus) attacks the immune system by targeting CD4+ T cells. It
spreads through direct contact with body fluids such as semen, vaginal and rectal fluids, blood,
and breast milk. In 2022, there were an estimated 1.2 million people living with HIV in the U.S.
and 31,800 new infections. Although women account for only 15% of new cases, Black/African
American women are disproportionately affected. Their infection rate (15.1 per 100,000) is nearly
8 times higher than that of White women. Despite the availability of pre-exposure prophylaxis
(PrEP), uptake remains low, particularly among adolescents and young adults. In 2018, only 18.1%
of individuals with indications for PrEP received a prescription, with the lowest rates among those
aged 13–24 years.
Methods:
This cross-sectional study examined Black women aged 13–24 years, with primary analyses
focused on those aged 18–24 (n = 279). The aims were: (1) to assess the relationship between selfperceived and actual HIV risk, and (2) to identify factors associated with willingness to use PrEP.
Data was collected from May to November 2024 via surveys measuring demographics, sexual
behaviors, self-perceived risk, PrEP awareness, and facilitators/barriers to PrEP use. Inclusion
criteria were identifying as Black, assigned female at birth, HIV-negative, and sexually active. Chi
square tests were used to compare the demographic distributions between the study groups.
Cohen’s Kappa Statistic, McNemar Test and a Binomial Test, were used to assess the level of
agreement between self-perceived HIV risk and actual HIV risk (aim 1). Modified Poisson
regression with robust error variance was used to estimate prevalence ratios (aPRs) for the
associations with facilitators (aim 2a) and barriers (aim 2b) for willingness to use PrEP (aim 2).
Results:
For Aim 1, no demographic differences were found between those with high versus low selfperceived HIV risk. However, a major finding was that 60.9% of participants had not heard of
PrEP, and this lack of awareness was associated with low self-perceived risk. Notably, 78.6% of
participants categorized as high risk (based on sexual behavior) were PrEP-aware. Yet, most
participants incorrectly self-identified as low risk, indicating a significant misalignment between
perceived and actual risk.
For Aim 2, willingness to use PrEP did not differ by demographic factors but was significantly
associated with self-perceived risk. Participants who perceived themselves at high risk were more
likely to express willingness to use PrEP (9.65% vs. 1.82%, p = 0.004). Key facilitators included
a desire to remain HIV-negative (aPR = 2.70; 95% CI 1.54, 4.72) and knowing others on PrEP
(aPR = 1.44; 95% CI 1.10, 1.89). Barriers included concerns about access (aPR = 1.82; 95% CI
1.29, 2.58) and stigma (aPR = 0.60; 95% CI 0.43, 0.83).
Conclusion:
Findings highlight a critical disconnect between actual and perceived HIV risk among young Black
women, which may impede PrEP uptake. Increased awareness and accurate risk perception are
essential to improving PrEP utilization. These results underscore the need for targeted, culturally
responsive interventions that enhance HIV prevention efforts in this vulnerable population.
Citation
Wallace-Sellman, O. Willingness to Use Pre-Exposure Prophylaxis Among Black/African American Adolescent Girls and Young Adult Women in the U.S. [Doctoral Dissertation, SUNY Downstate Health Sciences University] SUNY Open Access Repository. https://soar.suny.edu/handle/20.500.12648/17061