Why Black Women Face Higher HIV Risk, Lower PrEP Access

Black women continue to carry the highest burden of new HIV diagnoses among women in the US, even as national conversations about prevention often overlook the specific barriers they face.¹

Zandraetta Tims-Cook, MD, medical director and primary physician at Faebris Infectious Disease Medical Practice in the Atlanta metro area, sees these gaps firsthand in a region with one of the highest HIV case rates in the country. In an interview with The American Journal of Managed Care^® (AJMC^®), Tims-Cook discussed the systemic barriers, including medical mistrust, stigma, and limited access to prevention information, that keep many Black women from testing, prevention, and sustained care.

She also addressed how clinicians can build trust through open dialogue, why a range of prevention and treatment options matters, and where long-acting injectable medications fit into closing persistent gaps in infectious disease and health equity outcomes.

This transcript was lightly edited for clarity.

AJMC: What are some of the unique barriers that Black women face when it comes to HIV prevention, testing, treatment, and staying connected to care?

Tims-Cook: Practicing in the Atlanta metro area, which ranks 3rd highest for HIV cases in the US, I see firsthand that one of the most significant barriers Black women face is limited conversation on HIV-prevention options and a limited focus on the reasons for HIV prevention.¹ This challenge is shaped, in part, by longstanding gaps in HIV education, outreach, and access to prevention information for this population.

According to the CDC, women represent 19% of all new HIV diagnoses in the US, yet women only account for 9% of pre-exposure prophylaxis (PrEP) users, while 91% are men.² For Black women, these disparities are even more acute. In 2023, despite comprising only 13% of the female population, Black women accounted for 50% of new HIV diagnoses among women, with a diagnosis rate 11 times higher than that of White women.²

Black women must navigate deep-rooted systemic barriers. Medical mistrust, rooted in historical and ongoing inequities, may create hesitancy for some women in their engagement with health care settings and HIV prevention. Furthermore, pervasive societal stigma and self-stigma around HIV can remind women of the possibility of HIV status; this may cause many women to delay or drop out of care.

These barriers are exactly why consumer health campaigns like "Do It For Future You" are so important—they can help shift narratives around accessing health care to help envision a future where connections to HIV care (whether in prevention or treatment) are made and celebrated.

AJMC: How can clinicians create more effective conversations about sexual health and HIV prevention with Black women, particularly when stigma, mistrust, or misconceptions may make those conversations difficult?

Tims-Cook: Clinicians must shift from an outdated model of assessing HIV “risk” to actively normalizing sexual health as a core component of overall health and wellness. It’s essential that we reframe the conversation around a patient’s personal reasons for HIV prevention—rather than labeling a patient with high-risk behaviors, we can help them take their health and their future into their own hands. We cannot expect patients will necessarily bring up these topics proactively, so as providers, we should be prepared to take the lead and approach these conversations with empathy, open dialogue, and transparency.

This means reframing HIV testing not as a tool for diagnosis alone, but as a gateway to routine prevention and long-term health. When sexual health discussions are integrated seamlessly into annual health checkups, we can help remove the embarrassment and judgment, allowing Black women to feel respected and heard.

AJMC: For women who may be hesitant to discuss HIV prevention or treatment with a health care provider, what can clinicians do to make those conversations more approachable and judgment-free?

Tims-Cook: An important step clinicians can take is to initiate the conversation so the burden doesn't fall on the patient. Many women feel embarrassed or hesitant because society hasn't conditioned us to speak openly about sexual health or because they fear being judged. Clinicians can ease this anxiety by validating their feelings and explicitly stating that sexual health is a routine, essential part of overall care.

Clinicians can open the door with warm, nonjudgmental language, such as: “As part of comprehensive care for all my patients, I like to discuss sexual health and options for HIV prevention like PrEP. Is that something we can explore today?” Creating a safe, welcoming environment where options are presented clearly and transparently reassures patients that their provider is an ally dedicated to supporting their health goals.

AJMC: Where do you see long-acting injectable options fitting into efforts to address disparities in HIV prevention and treatment, particularly for patients who face challenges with taking a medication every day?

Tims-Cook: Long-acting injectable (LAI) options, such as cabotegravir plus rilpivirine (Cabenuva; ViiV Healthcare) for HIV treatment and cabotegravir (Apretude; ViiV Healthcare) for HIV prevention, assist in our efforts to close the gaps that currently exist. For many women who are balancing busy routines, caregiving, work, and more, remembering to take a daily oral pill can be challenging.

Injectables administered in clinical settings like my own can offer a highly effective alternative. They can help eliminate the privacy concerns associated with keeping pill bottles at home or work, potentially relieving patients of the worry that someone might discover their medication. Additionally, for some, removing the daily pill can alleviate the emotional weight and self-stigma attached to taking medication every single day. Clinically, these regular visits also provide invaluable touchpoints for us to help establish trust, perform routine STI screenings (in line with CDC guidelines for testing), and address evolving health needs in real time.

AJMC: How important is it for patients to have a range of HIV prevention and treatment options, and how can clinicians make sure those choices are presented in a way that reflects each patient's individual circumstances and preferences?

Tims-Cook: Having options when it comes to HIV medicines is vital because effective health care is never one-size-fits-all. I’m grateful for recent innovation in treatment options, and I strongly advocate for the concept of “prevention for every person.” When patients realize they have options, whether it’s a daily pill or a long-acting injection, it can help tailor their health care around their lifestyle.

In my practice, I outline the full range of available options, thoroughly detailing the benefits, dosing schedules, injection sites, potential side effects, and administration methods of each. By asking open-ended questions about a patient's daily routine, privacy needs, and comfort levels, we can choose a regimen option together that fits seamlessly into their own life.

AJMC: What role can patient education play in improving uptake of PrEP and helping people living with HIV achieve and maintain viral suppression?

Tims-Cook: Patient education is the bridge that transforms apprehension and fear into proactive, sustained health management. When patients are educated about how PrEP and HIV treatments work, we demystify the sometimes-complicated science and dismantle myths and stigma. Knowledge can restore a sense of control and personal agency.

Education equips patients with the tools and language they need to advocate for themselves, ask targeted questions about different options, and navigate conversations with partners, family, or friends. For people living with HIV, understanding the concept of viral suppression and Undetectable = Untransmittable reinforces the real-world impact of consistent adherence and encourages long-term retention in care.

AJMC: Looking beyond medication itself, what changes are needed across the health care system and in communities to close persistent gaps in HIV prevention and treatment among populations that have historically been underserved?

Tims-Cook: Closing persistent gaps requires much more than simply prescribing medications; it demands driving education, elevating public awareness, and actively dismantling long-standing stigma. For communities disproportionately impacted by HIV, systemic inequities and pervasive stigma often make it difficult for individuals to see a thriving future version of themselves. An HIV diagnosis, or even the fear of one, can make that vision feel distant or completely unreachable.

This is why targeted awareness campaigns are so critical for shifting the narrative. A powerful example of this is ViiV Healthcare’s campaign "Do It For Future You," anchored by the website ForFutureU.com. Built on a series of interconnected, relatable stories, the campaign carries one clear, empowering message: the choices you make today shape your tomorrow.

Author Disclosures: Dr. Tims-Cook is compensated by ViiV Healthcare.

References

1. Gaines J. New HIV case rate in metro Atlanta third highest in nation. Morehouse School of Medicine. April 2024. Accessed September 1, 2026. https://www.msm.edu/RSSFeedArticles/2024/April/Atlanta-HIV-Rate.php

2. AIDSVu releases 2024 PrEP use data showing growing use across the U.S. AIDSVu. June 26, 2025. Accessed September 1, 2026. https://aidsvu.org/news-updates/aidsvu-releases-2024-prep-use-data-showing-growing-use-across-the-u-s/