Understanding Perceptions of HIV Risk, PrEP, and PrEP use among African American Women Attending an HBCU

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Modified Project Summery/Abstract Section Despite advancements in HIV prevention and treatment, Black/African American women remain disproportionally affected by HIV infection. While many biological and behavioral factors shape women’s HIV risk at the individual level, social determinants of health including poverty, living in low-income communities, poor mental health, and lack of knowledge of and access to critical HIV prevention services including preexposure prophylaxis (PrEP) may drive this disproportionate burden. African American women are not only at increased risk but also have inequitable access to PrEP, particularly those living in low-income neighborhoods in the US South. Furthermore, few African American women, including students at HBCUs (many of whom grew up in low-income communities), are aware of PrEP. Although PrEP is highly effective in preventing the spread of HIV, only 10% of women in the US who could benefit from PrEP were prescribed it in 2019 (CDC, 2022). Increasing PrEP access is especially important for young women (under age 35), who experience 41% of all HIV infections among women. As HBCUs serve predominantly young women (64% of HBCU students were female in 2021) and many of their students come from low-income communities, HBCUs are an ideal context to reach an important population underserved by PrEP. To improve PrEP utilization among HBCU women, more research is needed to understand their low use of PrEP. Limited data exist about Black college women’s use of PrEP. Additionally, more African American HIV prevention researchers are needed because they may be more familiar with factors impacting Black communities due to their shared culture and life experiences. Thus, the primary goal of the proposed project is to engage and mentor African American female scholars from an HBCU in research to assess Black college women’s knowledge of and attitudes toward PrEP, perception of HIV risk, HIV testing behaviors, and likelihood of PrEP uptake. In service of this primary aim, the proposed project will also lay the foundation for a program of PrEP delivery research for these scholars, building on an existing community-based PrEP delivery program (IFE4Her). To adapt this program, we will conduct formative research to tailor a peer-based PrEP messaging campaign for HBCU women. These goals will be achieved through 2 Specific Aims: 1) To create and support a cadre of highly skilled African American HIV prevention researchers to address research gaps in the use of prevention strategies including PrEP, in African American communities, focusing on HBCUs. This aim will be achieved through a series of structured trainings and ongoing consultations and mentorship provided by UNC CFAR and associated faculty, longtime partners of the NCCU RCMI. 2)To adapt the IFE4Her peer-based PrEP communication strategy for HBCU women by conducting a mixed-methods (focus groups, key informant interviews, and surveys) tailoring study to understand PrEP knowledge, attitudes, messaging preferences, and delivery needs of African American women attending a HBCU. This study will catapult a body of research for highly promising RCMI investigators to develop HBCU-appropriate interventions to reduce HIV risk among women attending HBCUs.