Rural and urban differences in HIV pre-exposure prophylaxis (PrEP) awareness and acceptability among Black cisgender women living in the U.S. South

Black cisgender women in the U.S. South experience a significant disparity in HIV infection rates. Pre-exposure Prophylaxis (PrEP) is an effective medication that can reduce HIV risk but is underutilized among Black women. We assessed the association between setting and PrEP awareness and acceptability in Black cisgender women in the U.S. South. A cross-sectional online survey was administered from March to June 2022 to HIV-negative Black cisgender women living in the Southern United States. Participants reported demographic information, PrEP awareness, likelihood of PrEP use, HIV knowledge, risk perception, and healthcare access. Logistic regression models assessed correlates of PrEP awareness and acceptability. Of 491 participants (Mean age = 40.42 [SD = 17.5], 20.0% rural, 80.0% urban/suburban), 44.9% of rural and 38.2% of urban/suburban participants were PrEP aware. 44.9% of rural versus 36.1% of urban/suburban participants were likely to use PrEP. Rural Black women reported higher PrEP acceptability (adjusted odds ratio [aOR] = 1.96, 95% CI 1.20, 3.18, <i>p</i> = 0.01). Having health insurance (aOR = 2.43, 95% CI 1.28, 4.65, <i>p</i> = 0.01) and younger age (aOR = 0.98, 95% CI 0.96, 0.99, <i>p</i> < 0.001) were associated with PrEP acceptability. To improve PrEP awareness, acceptability, and uptake, intervention programs should be tailored to individuals' geographical circumstances and needs.