Awareness, Acceptability, and Preferences for Pre-exposure Prophylaxis Modalities Among Black Women: A Critical Review and Brief Report of a Pilot Study.

Abstract

Black women experience a disproportionate burden of human immunodeficiency virus in the United States, yet use of pre-exposure prophylaxis remains low. This article critically reviews published research on barriers to and facilitators of pre-exposure prophylaxis acceptability among Black women and presents findings from a qualitative pilot study examining awareness and preferences for available and emerging prevention modalities. A critical review of 50 peer-reviewed studies published between 2012 and 2025 identified persistent challenges as well as facilitators. The pilot study included focus groups and interviews with 20 pre-exposure prophylaxis-naïve Black women in two high-incidence Texas counties. Participants demonstrated limited awareness of injectable prevention options, varied preferences across modalities, and strong interest in expanded delivery settings such as pharmacies, mobile services, and at-home options. Findings indicate that low uptake reflects structural gaps in prevention systems rather than lack of interest, underscoring the need for diversified modalities and accessible delivery models.