"More Than a Pill": PrEP Perceptions, Campus Sexual Networks, and HIV Prevention Among Young Black Women at an HBCU

Background/Purpose: Black cisgender women account for 57% of new HIV diagnoses among women in the U.S, yet only 3% of those with a clinical indication for Pre-Exposure Prophylaxis (PrEP) have received a prescription. At Historically Black Colleges and Universities (HBCUs), this gap is compounded by campus-specific cultural dynamics, provider communication failures, and a near-absence of targeted outreach. This study examines how campus social networks, clinical encounters, and digital messaging shape PrEP perceptions among young Black women at an HBCU and identifies multilevel strategies to improve prevention reach. Guided by Minority Stress Theory, Intersectionality, and an Ecological Systems framework, the research question was: What social, clinical, and communicative factors shape PrEP perceptions and uptake willingness among young Black women at an HBCU?

Methods: This qualitative descriptive study used five focus groups with 20 Black women aged 18–24 at an HBCU in the U.S. South. Participants were recruited through purposive sampling via word of mouth and electronic flyer distribution. Discussions explored six domains: campus social and dating culture; partner relationship dynamics; routine healthcare experiences; provider communication about sexual health; HIV risk perceptions; and reactions to existing PrEP communications. Participants identified preferred messengers, platforms, and messaging qualities viewed as credible and relevant. All participants were assigned pseudonyms; transcripts were de-identified before analysis. Data were analyzed using Braun and Clarke's (2006; 2022) six-step thematic analysis, proceeding from transcript familiarization through iterative open coding, theme construction, and interpretive review. Member checking and reflexive memo-writing were also conducted. Findings were triangulated with a review of 11 peer-reviewed sources on PrEP barriers, racialized HIV disparities, and HBCU sexual health culture.

Findings: Three thematic domains emerged. In campus relationship dynamics, participants described a complex "sexual web" of overlapping partner networks, yet most held limited PrEP awareness and did not perceive it as relevant to their own risk, primarily associating it with men who have sex with men. Consistent with Minority Stress Theory, stigma functioned not merely as a social barrier but as a chronic stressor shaping whether participants perceived PrEP as viable for someone like themselves, rendering even motivated women reluctant to seek it. In clinical communication, routine healthcare visits emerged as consistent missed opportunities: providers rarely initiated sexual health or PrEP discussions. In digital messaging, existing PrEP communications were described as impersonal, overly promotional, and misaligned with Black college women's realities. Participants identified peer voices, trusted student leaders, and platform-native content on TikTok and Instagram as essential to effective outreach.

Conclusions/Implications: PrEP non-use among young Black women at HBCUs reflects structural exclusion and culturally misaligned systems, not individual disinterest. For practitioners, findings support integrating PrEP literacy and provider communication training into campus-based health social work practice. For researchers, HBCU student organizations, Greek Life, and campus health centers represent underutilized yet trusted channels for developing community-engaged interventions. For policy advocates, findings support expanding Ryan White-funded PrEP navigation services at HBCUs and directing federal HIV prevention funding toward peer-informed digital health strategies that explicitly center cisgender Black women, closing a persistent and preventable gap in the U.S. epidemic response.