Pre-Exposure Prophylaxis (PrEP) for HIV: A secular comparison of willingness to use PrEP among black cisgender women in the United States

Although Pre-Exposure Prophylaxis (PrEP) is a powerful tool to prevent HIV acquisition, Black cisgender women (CGW) face disparities in accessing PrEP in the United States. This scoping review aimed to (1) describe PrEP awareness, willingness, and preferred delivery modes, and (2) assess willingness measurement among Black CGW before and after PrEP's widespread availability. We searched PubMed and Google Scholar databases to identify peer-reviewed studies using keywords for pre-exposure prophylaxis and Black women. Although PrEP received FDA approval in 2012, early implementation efforts were disproportionately centered on men who have sex with men, resulting in a lag in awareness among Black CGW. The 2017 cutoff reflects the approximate period when PrEP awareness and accessibility began to more consistently reach this population. Thirty-six studies met the inclusion criteria. Awareness increased over time, from <10% to 40-71% in more recent studies. PrEP willingness ranged from 31% to 77% pre-widespread availability and 10-88% post-widespread availability, highlighting barriers including cost, stigma, and adherence challenges. Long-acting injectables were often preferred over daily pills. Willingness measurement evolved from hypothetical scenarios to more specific intentions and timeframes. Findings underscore an urgent need for culturally tailored interventions to address multilevel barriers to PrEP prescribing, enhance knowledge, and promote uptake among Black CGW.