Barriers and facilitators to HIV testing and prevention services among young adults at a historically black college in Tennessee

Black adolescents and young adults (AYA) have high rates of new HIV diagnoses and low pre-exposure prophylaxis (PrEP) uptake, particularly in the U.S. South. Historically Black colleges and universities (HBCUs) are therefore important partners in HIV prevention efforts. The objective was to describe HIV risk behaviors, HIV testing, and PrEP use behaviors, as well as evaluate factors associated with HIV testing and PrEP access, at a southeastern U.S. HBCU to inform future HIV prevention interventions. An electronic cross-sectional REDCap survey was conducted at a midsize HBCU in a southeastern U.S. Ending the HIV Epidemic priority jurisdiction from March-September 2022. Surveys from HBCU students between ages 18–35 who answered if they had previously been tested for HIV or used PrEP were included in the analyses. Questions elicited information regarding demographics (gender identity, age, race/ethnicity, sexual orientation), HIV risk behaviors, PrEP and HIV testing use, barriers, and facilitators, and the HIV Testing Belief Inventory. Categorical data were described using frequency (%) and compared using Chi-squared or Fisher’s exact tests. Continuous data were described using mean (standard deviation) and compared across two categories using Wilcoxon rank-sum tests. Of the 240 responses, 146 surveys were analyzed. Most respondents were female (58.9%), heterosexual (82.9%), Black (84.9%), and sexually active within the last year (93.2%). About half were “high risk” for HIV infection (49.3%). Being “high risk” for HIV was not associated with recent HIV testing ( p = 0.138) or concerns of HIV risk ( p = 0.455). Prior HIV testing was significantly associated with less concern about HIV-associated stigma (mean 1.7 vs. 2.0, p = 0.023) and greater perceived testing benefits (mean 4.4 vs. 4.0, p = 0.002). Less than half of respondents had a recent HIV test (46.6%) and 6.2% of respondents had used PrEP. Respondents most often reported that on-campus testing events (52.4%) would facilitate HIV testing, and most interested persons would rely on the HBCU (40.7%) for more information about PrEP. This sample demonstrated discrepant concern for HIV risk and actual HIV risk, the drivers of which should be evaluated in future work. Frequent identification of the HBCU as a vehicle for HIV testing and PrEP information suggests that HBCUs are acceptable avenues to deliver HIV prevention services to students. Implementation research delivering locally tailored HIV prevention interventions through HBCUs is needed in order to mitigate the HIV epidemic in this priority population.