In a nationwide sample of Black women in the U.S., we assessed preferences for HIV preexposure prophylaxis (PrEP) products, including long-acting injectable (LAI) PrEP and once-daily oral PrEP. Among 315 respondents, 32.1% were aware of PrEP and 40.6% were interested in using it; interest increased to 62.2% if PrEP were provided for free. Oral PrEP was the preferred option (51.1%), followed by LAI PrEP (25.7%), vaginal gel (16.5%), and vaginal ring (6.7%). When examining oral and LAI PrEP alone, most (62.7%) preferred oral PrEP. LAI PrEP was more likely to be preferred among respondents with concerns about healthcare costs or PrEP-related stigma, and among those who reported inconsistent condom use and multiple sexual partners. Although most Black women preferred oral PrEP, LAI PrEP may be appealing to a subset with social and structural barriers to PrEP use, such as cost and stigma, and those at increased risk of HIV infection.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
The data that support the findings of this study are available from the corresponding author, Whitney Irie, upon reasonable request.
Consent for Publication
Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2015–2019, vol. 26, HIV Surveillance Supplemental Report 2021. CDC; 2021. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Accessed 8 July 2021.
Bradley ELP, Williams AM, Green S, Lima AC. Disparities in Incidence of human immunodeficiency virus infection among Black and White women—United States, 2010–2016. Morb Mortal Wkly Rep. 2019;68(18):416–8.
Huang Y-LA, Zhu W, Smith DK, Harris N, Hoover KW. HIV preexposure prophylaxis, by race and ethnicity—United States, 2014–2016. Morb Mortal Wkly Rep. 2018;67:1147–50. https://www.iqvia.com/locations/united-states/commercial-operations/. Accessed 8 July 2021.
Centers for Disease Control and Prevention (CDC). HIV and women: HIV diagnoses. HIV Surveillance Report. CDC; 2021. https://www.cdc.gov/hiv/group/gender/women/diagnoses.html. Accessed 8 July 2021.
Auerbach JD, Kinsky S, Brown G, Charles V. Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV. AIDS Patient Care STDS. 2015;29(2):102–10. https://doi.org/10.1089/apc.2014.0142.
Flash CA, Stone VE, Mitty JA, Mimiaga MJ, Hall KT, Krakower D, et al. Perspectives on HIV prevention among urban Black women: a potential role for HIV pre-exposure prophylaxis. AIDS Patient Care STDS. 2014;28(12):635–42. https://doi.org/10.1089/apc.2014.0003.
Goparaju L, Praschan NC, Jeanpiere LW, Experton LS, Young MA, Kassaye S. Stigma, partners, providers and costs: potential barriers to PrEP uptake among US women. J AIDS Clin Res. 2017;8(9):730.
Ojikutu BO, Bogart LM, Higgins-Biddle M, Dale SK, Allen W, Dominique T, et al. Facilitators and barriers to pre-exposure prophylaxis (PrEP) use among Black individuals in the United States: results from the National Survey on HIV in the Black Community (NSHBC). AIDS Behav. 2018;22(11):3576–87.
Bogart LM, Ransome Y, Allen W, Higgins-Biddle M, Ojikutu BO. HIV-related medical mistrust, HIV testing, and HIV risk in the National Survey on HIV in the Black Community. Behav Med. 2019;45(2):134–42.
Hirschhorn LR, Brown RN, Friedman EE, Greene GJ, Bender A, Christeller C, et al. Black cisgender women’s PrEP knowledge, attitudes, preferences, and experience in Chicago. J Acquir Immune Defic Syndr. 2020;84(5):497–507.
Koren DE, Nichols JS, Simoncini GM. HIV Pre-exposure prophylaxis and women: survey of the knowledge, attitudes, and beliefs in an urban obstetrics/gynecology clinic. AIDS Patient Care STDS. 2018;32(12):490–4.
Calabrese SK, Dovidio JF, Tekeste M, Taggart T, Galvao RW, Safon CB, et al. HIV pre-exposure prophylaxis stigma as a multidimensional barrier to uptake among women who attend planned parenthood. J Acquir Immune Defic Syndr. 2018;79(1):46–53. http://insights.ovid.com/crossref?an=00126334-201809010-00007. Accessed 12 Apr 2019.
Lambert CC, Marrazzo J, Amico RK, Mugavero MJ, Elopre L. PrEParing women to prevent HIV: an integrated theoretical framework to PrEP Black women in the United States. J Assoc Nurses AIDS Care. 2018;29(6):835–48. http://journals.lww.com/00001782-201811000-00005. Accessed 12 Apr 2019.
Smith DK, Toledo L, Smith DJ, Adams MA, Rothenberg R. Attitudes and program preference of African-American urban young adults about pre-exposure prophylaxis (PrEP). AIDS Educ Prev. 2012;24(5):408–21.
Collier KL, Colarossi LG, Sanders K. Raising awareness of pre-exposure prophylaxis (PrEP) among women in New York City: community and provider perspectives. J Health Commun. 2017;22(3):1–7. https://doi.org/10.1080/10810730.2016.1261969.
Chandler R, Hull S, Ross H, Guillaume D, Paul S, Dera N, et al. The pre-exposure prophylaxis (PrEP) consciousness of Black college women and the perceived hesitancy of public health institutions to curtail HIV in Black women. BMC Public Health. 2020;20(1):1–11.
Nydegger LA, Dickson-Gomez J, Ko KT. A longitudinal, qualitative exploration of perceived HIV risk, healthcare experiences, and social support as facilitators and barriers to PrEP adoption among Black women. AIDS Behav. 2021;25(2):582–91. https://doi.org/10.1007/s10461-020-03015-9.
Bond KT, Gunn AJ. Perceived advantages and disadvantages of using pre-exposure prophylaxis (PrEP) among sexually active Black women: an exploratory study. J Black Sex Relatsh. 2016;3(1):1–24. https://muse.jhu.edu/article/647629. Accessed 12 Apr 2019.
Pyra M, Johnson AK, Devlin S, Uvin AZ, Irby S, Stewart E, et al. HIV pre-exposure prophylaxis use and persistence among Black ciswomen: “Women Need to Protect Themselves, Period.” J Racial Ethn Health Disparities. 2021. https://doi.org/10.1007/s40615-021-01020-9.
HIV Prevention Trials Network. HPTN 084 Study demonstrates superiority of CAB LA to oral FTC/TDF for the prevention of HIV. HIV Prevention Trials Network; 2020. https://www.hptn.org/news-and-events/press-releases/hptn-084-study-demonstrates-superiority-of-cab-la-to-oral-ftctdf-for. Accessed 25 June 2021
FDA U.S. Food and Drug Administration. FDA approves first injectable treatment for HIV pre-exposure prevention. FDA News Release. FDA; 2021. https://www.fda.gov/news-events/press-announcements/fda-approves-first-injectable-treatment-hiv-pre-exposure-prevention. Accessed 20 Dec 2021
Centers for Disease Control and Prevention (CDC). Preexposure prophylaxis for the prevention of HIV infection in the United States—2021 update clinical practice guideline. CDC; 2021. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf. Accessed 8 Dec 2021.
Philbin MM, Parish C, Kinnard EN, Reed SE, Kerrigan D, Alcaide ML, et al. Interest in long-acting injectable pre-exposure prophylaxis (LAI PrEP) among women in the Women’s Interagency HIV Study (WIHS): a qualitative study across six cities in the United States. AIDS Behav. 2021;25(3):667–78. https://doi.org/10.1007/s10461-020-03023-9.
Tolley EE, Li S, Zangeneh SZ, Atujuna M, Musara P, Justman J, et al. Acceptability of a long-acting injectable HIV prevention product among US and African women: findings from a phase 2 clinical Trial (HPTN 076). J Int AIDS Soc. 2019;22(10):1–9. https://doi.org/10.1002/jia2.25408.
Calabrese SK, Galvao RW, Dovidio JF, Willie TC, Safon CB, Kaplan C, et al. Contraception as a potential gateway to pre-exposure prophylaxis: US women’s pre-exposure prophylaxis modality preferences align with their birth control practices. AIDS Patient Care STDS. 2020;34(3):132–46.
Coelho LE, Torres TS, Veloso VG, Landovitz RJ, Grinsztejn B. Pre-exposure prophylaxis 2.0: new drugs and technologies in the pipeline. Lancet HIV. 2019;6(11):e788–99.
Beymer MR, Holloway IW, Pulsipher C, Landovitz RJ. Current and future PrEP medications and modalities: on-demand, injectables, and topicals. Curr HIV/AIDS Rep. 2019;16(4):349–58.
International Partnership for Microbicides. IPM’s new drug application for dapivirine vaginal ring to reduce HIV risk in women accepted for filing by US Food and Drug Administration. International Partnership for Microbicides; 2021. https://www.ipmglobal.org/content/ipm’s-new-drug-application-dapivirine-vaginal-ring-reduce-hiv-risk-women-accepted-filing-us. Accessed 4 Mar 2021.
van der Straten A, Agot K, Ahmed K, Weinrib R, Browne EN, Manenzhe K, et al. The tablets, ring, injections as options (TRIO) study: what young African women chose and used for future HIV and pregnancy prevention. J Int AIDS Soc. 2018;21(3):1–9.
Minnis AM, Browne EN, Boeri M, Agot K, van der Straten A, Ahmed K, et al. Young womenʼs stated preferences for biomedical HIV prevention. J Acquir Immune Defic Syndr. 2019;80(4):394–403. http://insights.ovid.com/crossref?an=00126334-201904010-00004. Accessed 8 July 2021.
Browne EN, Montgomery ET, Mansfield C, Boeri M, Mange B, Beksinska M, et al. Efficacy is not everything: eliciting women’s preferences for a vaginal HIV prevention product using a discrete-choice experiment. AIDS Behav. 2019. https://doi.org/10.1007/s10461-019-02715-1.
Nydegger LA, Dickson-Gomez J, Ko TK. Structural and syndemic barriers to PrEP adoption among Black women at high risk for HIV: a qualitative exploration. Cult Health Sex. 2021;23(5):659–73. https://doi.org/10.1080/13691058.2020.1720297.
Sales JM, Steiner RJ, Brown JL, Swartzendruber A, Patel AS, Sheth AN. PrEP eligibility and interest among clinic- and community-recruited young Black women in Atlanta, Georgia, USA. Curr HIV Res. 2018;16(3):250–5.
Beymer MR, Holloway IW, Grov C. Comparing self-reported demographic and sexual behavioral factors among men who have sex with men recruited through Mechanical Turk, Qualtrics, and a HIV/STI clinic-based sample: implications for researchers and providers. Arch Sex Behav. 2018;47(1):133–42.
Ojikutu BO, Bogart LM, Mayer KH, Stopka TJ, Sullivan PS, Ransome Y. Spatial access and willingness to use pre-exposure prophylaxis among Black/African American individuals in the United States: cross-sectional survey. JMIR Public Health Surveill. 2019;5(1):1–8.
Ransome Y, Bogart LM, Nunn AS, Mayer KH, Sadler KR, Ojikutu BO. Faith leaders’ messaging is essential to enhance HIV prevention among Black Americans: results from the 2016 National Survey on HIV in the Black Community (NSHBC). BMC Public Health. 2018;18(1):1–10.
Ransome Y, Bogart LM, Kawachi I, Kaplan A, Mayer KH, Ojikutu B. Area-level HIV risk and socioeconomic factors associated with willingness to use PrEP among Black people in the U.S. South. Ann Epidemiol. 2020;42:33–41. https://doi.org/10.1016/j.annepidem.2019.11.002.
Hernán MA, Robins JM. Causal inference: what if. Boca Raton: Chapman Hill/CRC; 2020.
Flash CA, Stone VE, Mitty JA, Mimiaga MJ, Hall KT, Krakower D, et al. Perspectives on HIV prevention among urban Black women: A potential role for HIV pre-exposure prophylaxis. AIDS Patient Care STDS. 2014;28(12):635–42. http://www.ncbi.nlm.nih.gov/pubmed/25295393%5Cn, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4250961/pdf/apc.2014.0003.pdf. Accessed 12 Apr 2019.
Molina J-M, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373(23):2237–46.
Molina JM, Charreau I, Spire B, Cotte L, Chas J, Capitant C, et al. Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study. Lancet HIV. 2017;4(9):e402–10.
Cottrell ML, Yang KH, Prince HMA, Sykes C, White N, Malone S, et al. A translational pharmacology approach to predicting outcomes of preexposure prophylaxis against HIV in men and women using tenofovir disoproxil fumarate with or without emtricitabine. J Infect Dis. 2016;214(1):55–64.
Frew P, Parker K, Horton T, Hixson B, Flowers L, Priddy F, et al. Assessment of a microbicide candidate among a diverse cohort of urban Southern US women and their male sexual partners. J AIDS Clin Res. 2012. https://doi.org/10.4172/2155-6113.S4-004.
Montgomery ET, Noguchi LM, Dai JY, Pan J, Biggio J, Hendrix C, et al. Acceptability of and adherence to an antiretroviral-based vaginal microbicide among pregnant women in the United States. AIDS Behav. 2018;22(2):402–11. https://doi.org/10.1007/s10461-017-1811-9.
Craddock JB, Mangum LC, Aidoo-Frimpong G, Whitfield DL. The associations of HIV pre-exposure prophylaxis interest and sexual risk behaviors among young Black women. AIDS Patient Care STDS. 2021;35(7):263–70.
Glidden DV, Mehrotra ML, Dunn DT, Geng EH. Mosaic effectiveness: Measuring the impact of novel PrEP methods. Lancet HIV. 2019;6(11):e800–6. https://linkinghub.elsevier.com/retrieve/pii/S2352301819302279. Accessed 8 July 2021.
Sales JM, Sheth AN. Associations among perceived HIV risk, behavioral risk and interest in PrEP among Black women in the southern US. AIDS Behav. 2018. https://doi.org/10.1007/s10461-018-2333-9.
Garfinkel DB, Alexander KA, McDonald-Mosley R, Willie TC, Decker MR. Predictors of HIV-related risk perception and PrEP acceptability among young adult female family planning patients. AIDS Care. 2017;29(6):751–8. https://linkinghub.elsevier.com/retrieve/pii/S0031938416312148. Accessed 12 Apr 2019.
Blackstock OJ, Patel VV, Felsen U, Park C, Jain S. Pre-exposure prophylaxis prescribing and retention in care among heterosexual women at a community-based comprehensive sexual health clinic. AIDS Care. 2017;29(7):866–9.
Sewell WC, Patel RR, Blankenship S, Marcus JL, Krakower DS, Chan PA, et al. Associations among HIV risk perception, sexual health efficacy, and intent to use PrEP among women: an application of the risk perception attitude framework. AIDS Educ Prev. 2020;32(5):392–402.
Sewell WC, Powell VE, Mayer KH, Ochoa A, Krakower DS, Marcus JL. Nondaily use of HIV preexposure prophylaxis in a large online survey of primarily men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2020;84(2):182–8.
Johnson AK, Fletcher FE, Ott E, Wishart M, Friedman EE, Terlikowski J, et al. Awareness and intent to use pre-exposure prophylaxis (PrEP) among African American women in a family planning clinic. J Racial Ethn Health Disparities. 2020;7(3):550–4.
Ojikutu BO, Nnaji C, Sithole J, Schneider KL, Higgins-Biddle M, Cranston K, et al. All Black people are not alike: differences in HIV testing patterns, knowledge, and experience of stigma between U.S.-Born and non-U.S.-Born Blacks in Massachusetts. AIDS Patient Care STDS. 2013;27(1):45–54.
Mutchler MG, McDavitt B, Ghani MA, Nogg K, Winder TJA, Soto JK. Getting PrEPared for HIV prevention navigation: young Black gay men talk about HIV prevention in the biomedical era. AIDS Patient Care STDS. 2015;29(9):490–502.
Eaton LA, Kalichman SC, Price D, Finneran S, Allen A, Maksut J. Stigma and conspiracy beliefs related to pre-exposure prophylaxis (PrEP) and interest in using PrEP among Black and White men and transgender women who have sex with men. AIDS Behav. 2017;21(5):1236–46. https://doi.org/10.1007/s10461-017-1690-0.
Brooks RA, Nieto O, Landrian A, Fehrenbacher A, Cabral A. Experiences of pre-exposure prophylaxis (PrEP)-related stigma among Black MSM PrEP users in Los Angeles. J Urban Health. 2020;97(5):679–91. https://doi.org/10.1007/s11524-019-00371-3.
Aholou TM, Cooks E, Murray A, Sutton MY, Gaul Z, Gaskins S, et al. “Wake Up! HIV is at Your Door”: African American faith leaders in the Rural South and HIV perceptions: a qualitative analysis. J Relig Health. 2016;55(6):1968–79.
Derose KP, Griffin BA, Kanouse DE, Bogart LM, Williams MV, Haas AC, et al. Effects of a pilot church-based intervention to reduce HIV stigma and promote HIV testing among African Americans and Latinos. AIDS Behav. 2016;20(8):1692–705.
Muturi N, An S. HIV/AIDS stigma and religiosity among African American women. J Health Commun. 2010;15(4):388–401. http://www.ncbi.nlm.nih.gov/pubmed/20574877. Accessed 8 July 2021.
Payne-Foster P, Bradley ELP, Aduloju-Ajijola N, Yang X, Gaul Z, Parton J, et al. Testing our FAITHH: HIV stigma and knowledge after a faith-based HIV stigma reduction intervention in the Rural South. AIDS Care. 2018;30(2):232–9. https://doi.org/10.1080/09540121.2017.1371664.
Duthely LM, Sanchez-Covarrubias AP, Brown MR, Thomas TE, Montgomerie EK, Dale S, et al. Pills, PrEP, and Pals: adherence, stigma, resilience, faith and the need to connect among minority women with HIV/AIDS in a US HIV epicenter. Front Public Health. 2021;9(June):1–9.
Randolph SD, Johnson R, Meyers D, Washington D, Saint-Hillaire L. Leveraging social networks of Black women in beauty salons to improve uptake of pre-exposure prophylaxis. Health Educ J. 2021;80(1):95–105.
Wilson TE, Fraser-White M, Williams KM, Pinto A, Agbetor F, Camilien B, et al. Barbershop talk with brothers: Using community-based participatory research to develop and pilot test a program to reduce HIV risk among Black heterosexual men. AIDS Educ Prev. 2014;26(5):383–97. http://libproxy.wustl.edu/login?url=, http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=25299804&site=ehost-live&scope=site. Accessed 8 July 2021.
Baker JL, Brawner B, Cederbaum JA, White S, Davis ZM, Brawner W, et al. Barbershops as venues to assess and intervene in HIV/STI risk among young, heterosexual African American men. Am J Mens Health. 2012;6(5):368–82.
Ross J, Stover J. Use of modern contraception increases when more methods become available: analysis of evidence from 1982–2009. Glob Health Sci Pract. 2013;1(2):203–12.
This publication was made possible by Grant Numbers T32 AI007433 from the National Institute of Allergy and Infectious Diseases, T32 DA15035 from the National Institute on Drug Abuse, R25 MH08362 from the National Institute on Mental Health, and the National Association for Social Workers (NASW) Foundation’s Jane B Aron Dissertation Award to Whitney Irie. Elvin Geng is supported by Grant Number K24 AI134413 from the National Institute of Allergy and Infectious Diseases. This publication’s contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health or the NASW.
Conflict of interest
Dr. Calabrese received partial support from Gilead for conference attendance in 2019 unrelated to this work. Dr. Marcus previously consulted for Kaiser Permanente Northern California on a research grant from Gilead Sciences unrelated to the submitted work. Dr. Mayer has received unrestricted educational grants from Gilead Sciences and served on a scientific advisory board for them unrelated to this work. Dr. Geng has received an educational grant from Viiv Healthcare. All other authors declare no conflicts.
All procedures performed in this study were in accordance with the ethical standards of the Institutional Review Board at Washington University in St. Louis. (IRB201902109) and with the 1964 Helsinki Declaration and its later amendments.
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Irie, W.C., Calabrese, S.K., Patel, R.R. et al. Preferences for HIV Preexposure Prophylaxis Products Among Black Women in the U.S.. AIDS Behav 26, 2212–2223 (2022). https://doi.org/10.1007/s10461-021-03571-8
- Black women
- HIV prevention
- Long-acting injectable (LAI)
- Preexposure prophylaxis (PrEP)