HIV/STI Prevention Strategies During COVID-19 Among PrEP-Eligible Cisgender Women in New York State: A Qualitative Analysis

PrEP-eligible cisgender women underutilize PrEP, and little is known about how PrEP fits within broader HIV/STI prevention ecologies shaped by personal preferences and relationship contexts. These ecologies inform prevention strategies that shift with relationship dynamics and vary by race/ethnicity, age, and setting; the COVID-19 pandemic further influenced these contexts. Data were drawn from the Women's Study in Sexual Health and Empowerment (WISE), a mixed-methods study of PrEP-eligible cisgender women in New York City and Rochester, NY. One-time semi-structured interviews were conducted with 48 women from the WISE cohort. Women described tailoring prevention to relationship context, often initiating relationships with condoms and later relying more on trust and periodic HIV/STI testing. Strategies included situational condom use, combination prevention with PrEP and HIV/STI testing, and PrEP initiation or discontinuance as perceived risk changed. Women also reported challenges negotiating condom use, including partner resistance, and some described abstinence as a deliberate strategy. Comparative analyses identified patterns by race/ethnicity, age, and site. Pandemic-related disruptions reduced opportunities for new partnerships, altered relationship dynamics, and shifted some prevention conversations toward SARS-CoV-2 exposure risk. Findings highlight the need for women-centered, culturally and contextually tailored prevention services that strengthen PrEP access and routinized HIV/STI testing while accounting for relationship dynamics.