Date of Award

Summer 2019

Document Type

Open Access Dissertation


Health Promotion, Education and Behavior

First Advisor

Lucy Annang Ingram


There are approximately 1.1 million people living with HIV in United States, with nearly 40,000 new diagnoses annually. Significant regional and racial disparities are associated with HIV diagnoses — with the South experiencing the greatest burden of HIV and African American women accounting for 60% of new diagnoses among women. Pre-exposure prophylaxis (PrEP) has been designated as an effective tool to prevent HIV transmission among individuals who may be at risk of HIV infection. Earlier PrEP research has focused mainly on at-risk groups such as men who have sex with men (MSM). Previous PrEP research involving African American women included mixed-race and mixed-gender populations, took place in larger, urban cities, and were mainly single-method studies. Given the disproportionate burden of HIV in the South and among African American women, further HIV prevention research is needed in this region and with this at-risk population. Therefore, a sequential, mixed-methods study was conducted to 1) examine the sexual behaviors that put African American women, living in the Southeast, at risk of HIV infection and eligible for PrEP and 2) to explore African American women’s current knowledge, perceptions, and willingness of PrEP use for HIV prevention. Data were collected from May 2018 – April 2019 from African American women, 18 years of age or older, who were HIV-negative, and resided in the Southeastern United States. Quantitative data were collected from 413 women, through a confidential, self-administered sexual behavior survey. Four focus groups were conducted, with 27 women, to discuss sexual risk behaviors and PrEP for HIV prevention. Quantitative results demonstrate African American women are engaging in sexual risk behaviors that make them eligible for PrEP use, with nearly half of eligible women reporting an interest in potential PrEP use. Predictors of PrEP interest among women included younger age (18-35 years), perceived risk of HIV, receiving or giving money for sex, past experience of sexual assault, and comfort with condom negotiation. Qualitative data analyses revealed major themes around 1) sexual risk behaviors linked to HIV and 2) potential PrEP use for HIV prevention. First, several themes emerged highlighting HIV risk behaviors and multi-level factors that influence risk behaviors. These included: 1) lack of condom use; 2) HIV status, disclosure, and testing; 3) sexual partner sharing; 4) cultural and southern influences; 5) perceived societal worth; and 6) health care system and provider experiences impacting health care seeking. Second, several themes emerged which highlighted African American women’s thoughts and likelihood of potential PrEP use. These included: 1) knowledge and awareness of PrEP; 2) perceptions of PrEP; 3) willingness to use PrEP; 4) concerns about PrEP; and 5) recommendations to increase PrEP uptake. Study findings are encouraging of PrEP implementation efforts targeting African American women in the South. It is important that future efforts to increase PrEP uptake be relatable to African American women and provide comprehensive information of PrEP use.


© 2019, Jamie Troutman