‘Educating, demystifying, destigmatising’: Black women’s perspectives on effective PrEP messaging in the USA

Abstract

Black cisgender women in the USA are disproportionately affected by HIV but remain underrepresented in HIV-related pre-exposure prophylaxis (PrEP) messaging. Despite PrEP’s efficacy in preventing HIV, uptake among Black cisgender in the USA women remains low. This qualitative study explored how PrEP messaging can better resonate with Black women’s interests and needs by focusing on their experiences and preferences. We conducted semi-structured interviews with 30 Black cisgender women in the Midwest region of the USA between October and December 2022, capturing a diverse sample (US-born, African-born, and first-generation women of African descent). Thematic analysis developed four key themes: (1) the need for culturally tailored PrEP messaging strategies; (2) the importance of an empowering, inclusive tone and language; (3) challenging the perception that current PrEP advertising is primarily aimed at men who have sex with men and transgender women; and (4) the vital role of trusted voices, particularly Black women and community leaders, in promoting PrEP. Participants stressed that hearing about PrEP from individuals who share their racial, cultural, and gender identities would increase their comfort and engagement. Public health initiatives should prioritise culturally specific messaging that reflects Black women’s lived experiences in the USA to reduce HIV disparities and promote equitable PrEP access.

Introduction

Black cisgender women in the USA remain disproportionately impacted by new HIV diagnoses. Yet only 8% of women who would benefit from pre-exposure prophylaxis for HIV prevention (PrEP) have received prescriptions, highlighting a persistent gap in access and awareness (Mann et al. 2024). The low uptake of PrEP among Black cisgender women can be attributed to multiple factors, including structural barriers, stigma, and a lack of culturally relevant messaging (Arnold et al. 2023; Bond et al. 2022; Conley et al. 2022; Irie, Calabrese, et al. 2024; Irie, Mahone, et al. 2024)

One notable barrier to PrEP use is the perception that PrEP is not intended for heterosexual cisgender women but rather for men who have sex with men or transgender women, as these groups are perceived to be the primary focus of PrEP marketing campaigns (Cernasev et al. 2021; Chandler et al. 2020; Clement et al. 2024; Hill et al. 2024). Research has shown that Black women often report a lack of visibility in HIV prevention advertisements, reinforcing the belief that PrEP is not a relevant option for them (Alexander et al. 2024). This perception is further compounded by mistrust of medical institutions stemming from historical medical racism, which can discourage Black cisgender women from engaging with PrEP (Boudreaux, Valdebenito, and Pichon 2025; Irie, Mahone, et al. 2024; Willie et al. 2021), making it critical for health communication strategies to be culturally responsive and inclusive.

Although there have been efforts to diversify PrEP campaigns, the visibility of Black cisgender women in advertisements remains inconsistent. A recent study examined US-based PrEP media campaigns and found that Black cisgender women were represented in 49% of media items (Rosen et al. 2023). Participants’ reflections in Rosen’s study findings suggest that marketing strategies for PrEP must go beyond simply inserting Black women into advertisements; they must also actively counter the exclusionary messages that have shaped how Black women view the medication. Additional evidence suggests that even when women are included in campaigns, the framing of messages often does not adequately address the unique social and cultural contexts that shape health behaviours among Black women (Cernasev et al. 2021). Marketing visibility may not translate into meaningful engagement if campaigns fail to resonate with Black women’s lived experiences. Understanding these gaps is essential for designing more effective programmes and interventions that can increase PrEP uptake within this population.

Addressing the barriers to PrEP uptake among Black women requires a multifaceted approach that leverages diverse communication channels and trusted sources of information. Digital platforms, social media, healthcare providers, and peer networks have all been identified as potential avenues for disseminating PrEP messages (Kudrati, Hayashi, and Taggart 2021; Lambert et al. 2018). Culturally tailored messaging that speaks to the specific concerns and experiences of Black women can play a pivotal role in overcoming misconceptions and increasing awareness. Strategies for reducing health disparities among underserved populations emphasise visual materials, community partnerships, and message framing that promotes empowerment and self-efficacy (Ashenafi et al. 2024; Hall, Shah, and Bowie 2024).

This study explored the messaging strategies that Black cisgender women find most effective for promoting PrEP use. By centring the voices and experiences of Black women, this research seeks to inform health communication strategies and provide actionable recommendations for public health campaigns – ultimately engaging Black women more effectively in PrEP uptake and helping to reduce HIV-related disparities.

Method

Procedure

Participants for this study were recruited through multiple strategies, including social media advertisements, flyers at sexual health clinics, and direct referrals from the Community Wellness Project’s¹ network. Snowball sampling was also used to encourage participants to refer other eligible women from their social circles. Recruitment efforts prioritised building trust by involving local opinion leaders and engaging with the community to address potential barriers to participation. Local opinion leaders were identified through partnerships with the Community Wellness Project and included trusted figures such as community health workers, educators, and advocates who worked directly with Black women. These leaders, most of whom were Black women, shared recruitment materials within their networks. Women who expressed interest were screened for eligibility based on self-reported criteria, including HIV-negative status, self-identification as a cisgender Black woman, English proficiency, and residence in St. Louis City or County.

For this study we employed a qualitative research design to explore Black women’s experiences, perceptions, and preferences related to sexual health, particularly PrEP. The study aimed to understand how identity, culture, and social context shape health behaviours and access to care among Black women in St. Louis, Missouri. Eligibility criteria included identifying as a cisgender Black woman, being aged 18 years or older, residing in St. Louis City or County, having self-reported HIV-negative status, and having English language proficiency. Purposive sampling was used to ensure representation across diverse subgroups, including US and Caribbean Born Black women, African immigrants, and first-generation women of African and Caribbean descent. Recruitment and data collection were conducted in partnership with the Community Wellness Project, a community-based organisation providing health services to Black residents in the region.

The Boston College Institutional Review Board approved all study procedures (IRB Protocol Number: 23.033.01). All participants provided verbal informed consent. Prior to their interview, participants received an electronic copy of the informed consent form via email as part of their appointment confirmation. At the start of each interview, the interviewer shared their screen to display the consent form, read it aloud, and invited participants to ask questions or raise concerns. Verbal consent was then obtained and documented before proceeding with the interview. At the end of the study, and within 7–10 business days, participants received a $50 electronic gift card for their participation.

Data collection involved semi-structured interviews designed to explore participants’ perspectives on PrEP for HIV prevention, including PrEP medication attitudes, delivery, and messaging. The interview guide² covered topics including PrEP awareness and knowledge, perceptions of existing PrEP campaigns, cultural values that shape health behaviours, and preferences for message framing and delivery channels. Interviews were conducted via Zoom by the principal investigator and a trained community interviewer, both Black women, between October and December 2022. Each session lasted 45–60 min and began with a short socio-demographic survey. All interviews were audio-recorded and securely stored on an encrypted, access-restricted server. Identifiable information was removed during transcription, and pseudonyms were assigned to protect participant confidentiality throughout data analysis and dissemination.

Analysis

Interview recordings were transcribed verbatim, de-identified, and imported into Dedoose (2025) for analysis. A three-member team of Black qualitative researchers conducted the thematic analysis, guided by Braun and Clarke’s six-phase framework (Braun and Clarke 2006). Each team member independently performed initial open coding, identifying meaningful patterns across transcripts. The team then iteratively developed and refined a shared codebook through discussion and consensus, with axial coding used to cluster codes into broader thematic categories. Analytical rigour was enhanced through peer debriefing and consensus resolution of discrepancies. Saturation was assessed using a pragmatic approach, with the team determining that no new themes were emerging after approximately 25 interviews. The final five interviews confirmed thematic redundancy, supporting the adequacy of the sample size. Thematic findings were thus grounded in repeated, consistent participant insights and refined through multiple coding cycles, ensuring both credibility and analytical depth.

Reflexivity

Reflexivity refers to researchers’ self-reflection on how their social identities, personal backgrounds, and epistemological orientations may have influenced the design, data collection, analysis, and interpretation of findings (Creswell and Creswell 2017).

The research team for this study consisted of three Black women with advanced training and professional backgrounds in public health, psychology, and community-based participatory research. The first author is a US-born, Black, cisgender, heterosexual woman with a doctorate in social work and over a decade’s experience in HIV prevention research and health communication. The interview team included the first author and a trained community-based researcher affiliated with the Community Wellness Project (BA), also a Black, cisgender woman, both of whom are embedded in and deeply familiar with the St. Louis Black community.

All interviews were conducted by Black women, and all data were coded and analysed by a team of Black women researchers (WI, MT, and BA) shaped a culturally responsive approach to data collection and interpretation. The team entered the study with prior knowledge of systemic barriers to PrEP access among Black women, as well as a collective commitment to improving health equity through inclusive and affirming health communication.

While the research team held a foundational belief in the value of PrEP as a preventive tool and the importance of improving its accessibility, we worked hard to ‘bracket’ our assumptions during the interviews and analysis process. We prioritised participants’ voices and maintained reflexive discussions throughout the coding and interpretation stages to critically assess how our positionalities might shape theme development. This reflexive stance was integral to ensuring that findings authentically represented participants’ perspectives, rather than the research team’s preconceived notions.

Findings

Participants

The final sample included 30 Black women, ranging in age from 18 to 63 years, with an average age of 31.2 years (SD = 10.7). Most participants were born in the USA (n = 22, 73.3%), while 8 participants (26.7%) were born in Ghana (n = 4), Nigeria (n = 3), and Kenya (n = 1). Regarding parental immigration status, 19 participants (63.3%) had both parents born in the USA, while 11 participants (36.7%) had one or both parents born outside the USA. Among those with immigrant parents, 10 participants (90.9%) had both parents born outside the USA, and 1 participant (9.1%) had only their mother born outside the USA. The countries of origin for immigrant parents included Ghana, Nigeri and Kenya, with additional Caribbean representation through mothers from Haiti (n = 1) and Trinidad and Tobago (n = 1), representing both African and Caribbean diasporic communities within the sample.

Participants resided either in St. Louis County (n = 16, 53.3%) or the City of St. Louis (n = 14, 46.7%), providing geographical diversity within the St. Louis metropolitan region. The sample was well-educated, with 13 participants (43.3%) holding bachelor’s degrees and 8 participants (26.7%) holding master’s degrees. Regarding sexual orientation, the majority identified as heterosexual (n = 26, 86.7%), with smaller numbers identifying as gay/lesbian (n = 2, 6.7%) or bisexual (n = 2, 6.7%). Most participants were single (n = 17, 56.7%), and 21 participants (70%) reported being sexually active with a male partner within the past 12 months. Overall, the sample reflects diverse backgrounds, generational statuses, educational attainment, and relationship patterns among Black women in the St. Louis region (Table 1).

Table 1.

Participant demographics (N = 30).

Characteristic	n (%)
Age
M (SD)	31.2 (10.7)
Range	18–63
Place of birth
USA	22 (73.3)
Outside USA	8 (26.7)
Ghana	4(13.3)
Nigeria	3(10)
Kenya	1(3.3)
Parental immigration status
Both parents born in USA	19 (63.3)
One or both parents born outside USA	11 (36.7)
Both parents born outside USA	10 (90.9)
Mother only born outside USA	1 (9.1)
Mothers born outside USA (n = 11)
Country
Ghana	4(36.4)
Haiti	1(9.1)
Kenya	2(18.2)
Nigeria	3(27.3)
Trinidad and Tobago	1(9.1)
Fathers born outside USA (n = 10)
Country
Ghana	5(50)
Kenya	2(20)
Nigeria	3(30)
Sexual orientation
Heterosexual	26 (86.7)
Gay/lesbian	2 (6.7)
Bisexual	2 (6.7)
Relationship status
Single	17 (56.7)
Dating	4 (13.3)
In a relationship	5 (16.7)
Married	3 (10)
Engaged	1 (3.3)
Sexually active with male partner	21 (70)
Yes	21 (70)
No	9 (30)
Education level
Less than high school	1 (3.3)
High school/GED	3 (10)
Some college	3 (10)
Bachelor’s degree	13 (43.3)
Master’s degree	8 (26.7)
Doctorate/Professional	2 (6.7)
Employment status
Employed full-time	12 (40)
Employed part-time	4 (13.3)
Student	11 (36.7)
Unemployed	2 (6.7)
Retired	1 (3.3)
Annual income
Less than $10,000	6 (20)
$10,000-$19,999	2 (6.7)
$20,000-$29,999	5 (16.7)
$30,000-$39,999	6 (20)
$40,000-$49,999	1 (3.3)
$50,000-$59,999	6 (20)
$60,000-$69,999	2 (6.7)
$100,000-$149,999	2 (6.7)
Residence
St. Louis County	16(53.3)
City of St. Louis	14 (46.7)

Notes:

All participants identified as Black or African American women;

Percentages for parental immigration categories are based only on the 11 participants who had at least one parent born outside the USA

Our analysis yielded four themes that reflect how Black cisgender women perceive and respond to PrEP messaging: (1) Centring Black women in outreach strategies, (2) Emphasising empowerment and inclusive messaging, (3) Addressing misrepresentation and marketing gaps, and (4) Elevating trusted messengers and community voices. These themes underscore the need for culturally resonant communication strategies tailored to Black women’s lived experiences. In the following quotes presented, we provided a pseudonym, as well as the participants’ reported country of birth, and age at the time of the interview.

Centring Black women in outreach strategies

Participants emphasised that effective outreach about PrEP must occur in familiar, trusted environments, such as community events, churches, salons, and social media platforms, where Black women already engage. They highlighted the need for representation and culturally relevant visuals that signal PrEP is ‘for them’.

Suggestions for effective outreach included using media platforms such as popular television shows, social media, and dating apps, as well as incorporating messaging into trusted community spaces. One participant articulated this approach very clearly:

The best way for Black women is you have to put it in our circle. Like, you know, you have to put it in things that we see. You have to put it in our TV. You have to put it in our you know, the girls that we listen to… the shows, the places that we go to. You have to put it in our dating life. People only go within their proximity, you know. (Carol, Age 28, African-born)

Outreach should be community-embedded, leveraging local organisations, cultural celebrations, and everyday venues like grocery stores and dating apps. Messages should use Black women’s imagery and language to foster recognition and relevance. Participants explained how incorporating images of Black women into promotional materials, whether through illustrations, photographs, or video content, would signal that PrEP is intended for them. One participant explained:

For this particular study, the graphic was of Black women characters drawn, figures. And that was what attracted me, so if I see that, I recognise that that is something that might be geared towards me. So, using Black women in the marketing, I think, will be very critical… whether it’s cartoon-style drawings or real models, or if it’s on TV or I notice a lot of streaming platforms have commercials. YouTube has commercials, so if you’re using those platforms, to have Black women as the folks who are starring in it. (Lisa, Age 32, US-born)

Emphasising empowerment and inclusive messaging

Participants stressed that messaging should be empowering rather than fear-based. They believed that PrEP messaging should emphasise strength, control, and self-determination, given the historical and ongoing marginalisation of Black women in society. One participant articulated this sentiment, saying:

I feel like the tones that are best to reach Black women is always going to be empowerment. I think it’s always going to be building yourself up, like, ‘This is this is another jewel for your crown. This is some information that you can have that can be a tool for you.’ Um, so I think that’s always going to be the best thing – just empowerment – because you’re dealing with a group of people. Black women have been so marginalised, and even with Black women being the most educated women in the country, we still have to struggle so hard for every little inch… so this is something that can be empowering for you. This is something that can give you a sense of control in a world that’s constantly feeling like it’s trying to take it from you.’ (Mary, Age 45, US-born)

Moving away from risk and towards prevention

Participants expressed that framing PrEP as a tool that Black women can use to protect themselves and their communities would resonate more strongly than fear-based approaches. Participants emphasised that PrEP messaging should move away from risk-based framings and instead promote PrEP as a proactive form of self-care—comparable to birth control or other everyday wellness measures.

So, I would put something in there like, ‘Oh, PrEP is a preventative measure… to combat the risk of… contracting HIV.’ I would say something more like that. Like, make sure you put the word ‘preventive’ in there, because if you just say, ‘the risk of HIV,’ then it’s like, ‘Oh. No. Turn the channel.’ (Diane, Age 22, US-born)

They also noted that situating PrEP within broader conversations about safer sex, protection, and wellness could help reduce stigma and make the messaging more relatable and empowering. One participant shared:

Like whilst you are taking PrEP, you should, you need to have safe sex, you know. Because once you are takin’ PrEP and havin’, like, unprotected [sex]… yeah, I think you can also message us around safe sex. That would also bring some good results. (Carol, Age 28, African-born)

While participants valued messaging that framed PrEP as a preventative measure, there were mixed responses to the phrase ‘healthy living’ in PrEP communications. Some participants thought that promoting PrEP as part of overall wellness could be beneficial and might resonate with individuals who prioritise their health

Not just going in with PrEP, but, we should ask their own perception of, women’s wellness thing. Wrap it up in a package, not just PrEP. So, like, how do you take care of yourself? You know, are you involved with anybody? And, if so, do you have any education around disease prevention and do you know about the solution? (Megan, Age 28, African-born)

However, other participants felt that the phrase ‘healthy living’ was more closely associated with diet and exercise and would not immediately bring to mind HIV prevention or PrEP.

Healthy living, to me, doesn’t go with PrEP, because when you say, ‘healthy living,’ to me, that could be your food choice. Or that could be you need to go to the gym, you need to exercise. It doesn’t make me think of HIV or an STI. It doesn’t. (Aisha, Age 39, US-born)

Using relatable and inclusive language that reflects identity

Participants further stressed the importance of using inclusive language that resonates with Black women’s lived experiences and centres their identities. They valued simple, jargon-free language and messaging that builds solidarity and agency among Black women.

‘I’m a Black woman… you’re a Black woman, we need to protect ourselves.’ And, you know? Just being open and honest and real… and using language that they can relate to. I think that it’ll give people more willingness to, number one, listen, and then be more willing to try. (Nia, Age 43, US-born)

Addressing misrepresentation and marketing gaps

Many participants felt that current PrEP marketing excludes them by focusing on gay, bisexual and other men who have sex with men and transgender individuals. This absence of representation led to the perception that PrEP is not intended for cisgender women.

It’s never like, women, let alone Black women, are never mentioned in HIV ads, anything nowadays. So I just think it’s, like, really shocking to see an HIV medication that is for everyone. (Imani, Age 22, US-born)

The lack of representation in PrEP advertisements created feelings of invisibility and exclusion, reinforcing the idea that HIV prevention efforts often overlook Black cisgender women. Another participant added:

So, I think the main reason I feel that way is because it’s… promoted that way. There are commercials for PrEP, and it’s always displaying folks who are part of the queer community, so I didn’t realise that I mean, I guess it’s medicine, right? So, in my mind, I should have known that it was for everyone, but the way it is promoted seems like it’s more used within the queer community. (Lisa, Age 32, US-born)

Participants’ observations suggest that current PrEP advertisements fail to convey that the medication is a preventive option for anyone who is sexually active, regardless of gender or sexual orientation. One participant described how the advertisements come across:

I guess when looking at the advertisements… it almost makes you think that it’s specifically for people who are gay. That’s what the advertisements personify. They make you think that it’s for gay people. That’s basically how the advertisements come off – not thinking that it’s for all people who may engage in sexual encounters and be exposed to HIV. It doesn’t give you that input. It’s not what I read into the advertisements… it’s not how the advertisements read out to me. (Fatima, Age 63, US-born)

Participants called for intentional inclusion of Black women in campaigns, with clear language that PrEP is for all who may be vulnerable to HIV infection.

I think making that known – that Black women get HIV too. And then I’m thinking of some of the PrEP commercials, and it’s mostly trans people or same-sex couples, and so I think the advertising would have to be, like, a straight Black woman and a straight Black man, showing that they’ve chosen to do [PrEP] too. Because right now, I still think it’s very much not that in people’s minds. (Sarah, Age 28, US-born)

Trusted messengers and community channels

Participants stressed that who delivers the message is as critical as what is said. They preferred hearing about PrEP from Black women, whether clinicians, community workers, or public figures, who share their racial and cultural identity.

Hearing from black women who are using PrEP

One participant described how impactful it would be to hear from African women with personal experience using PrEP. She explained that testimonials from someone who shared her cultural background would make the message more relatable and powerful:

To hear from an African who has taken PrEP would really mean a lot to me. Like, maybe someone, ‘Oh, I’ve been takin’ PrEP for the past 10 years. And my children, and I’m doing well. This is my husband.’ You know, also hearing from somebody who identifies with me, who had experience with PrEP, would really push me and so many other African women. I think that is really important. (Megan, Age 28, African-born)

Participants believed that seeing someone who looks like them advocating for PrEP would increase their comfort and openness to the message. One participant noted:

So one, education, education, education. Two, demystifying, destigmatising. And then three, using key people or resource people who identify like me to lead such conversations. That will make it more comfortable for us to go for it, you know. But if you use a white [person], it will not I think it will not make much impact… But to make more impact, [it] will be more comfortable hearing somebody who identifies as us leading such conversations and sharing experiences. (Carol, Age 28, African-born)

Strategically leveraging public figures

Participants also pointed to the importance of leveraging public figures to spread awareness about PrEP. Celebrities, politicians, and influencers, particularly Black women, were viewed as credible messengers who could increase the visibility and appeal of PrEP. They suggested that prominent figures such as Michelle Obama or Kamala Harris could help make conversations about PrEP more mainstream. Additionally, participants felt that relatable popular culture influencers could promote PrEP in a casual, approachable tone. One younger participant imagined:

So, if Michelle Obama was talking about [PrEP], if Kamala Harris… somebody that was in power or, you know, maybe one of these little rap girls [was talking about it]. (Aisha, Age 19, US-born)

Power of word of mouth via trusted avenues and institutions

Beyond well-known figures, participants highlighted the power of community-based word-of-mouth communication. They believed that the most effective way to spread information about PrEP is through trusted community networks where personal stories and recommendations carry weight.

People really value someone else’s thoughts and opinions and their experiences. So, if someone’s able to speak to it, [that] would be, I think, more helpful than if it’s just, like, an ad on Instagram, if that makes sense. (Lisa, Age 32, US-born)

Participants identified specific trusted institutions in their communities where PrEP information could be disseminated. They believed that religious institutions, educational spaces, and family networks could be effective for promoting PrEP, given their credibility and central role in community life. One participant suggested:

Go to the institutions that they trust the most… Religious institutions, educational institutions, um, also leveraging family connections. Whoever in the family is the doc family doctor, the family nurse, or the family whatever, leveraging those connections as well. Any cultural institutions, you know, just those central locations of social life and communication. (Regina, Age 27, US-born)

Medical providers were also identified as key messengers in promoting PrEP. Participants believed that consistent communication from healthcare professionals, particularly obstetricians and gynaecologists (OB/GYNs) and primary care providers (PCPs), would help normalise PrEP discussions and encourage uptake. One participant stated:

Your medical providers, which is OB/GYN and PCPs, would need to every time you come in there, have this conversation. Just put it out there like, ‘Hey, you know, last time you were in here I talked about PrEP. I’m going to ask you again.’ (Amara, Age 33, US-born)

While the first and fourth theme discussed above emphasise trust, the first theme focuses on the settings in which PrEP messages are shared, such as churches, salons, and social media, whereas the fourth emphasises who delivers the message, including Black women clinicians, peers, or public figures. Together, these findings point to the importance of culturally congruent communication channels and messengers.

Discussion

This study examined how Black cisgender women perceive and respond to PrEP messaging, identifying four interrelated themes that point to both gaps and opportunities in HIV prevention communication. Our findings emphasise the urgent need for culturally resonant, identity-affirming, and community-driven messaging that positions PrEP as a viable and empowering option for Black women.

First, our findings emphasised that effective outreach must centre Black women, not just demographically, but also geographically and culturally. We found that messaging is more likely to be accepted when it is embedded in trusted, everyday spaces such as churches, salons, and community events. Trusted institutions, including churches, family networks, and community organisations, were also named as essential vehicles for effective dissemination. The literature supports this approach, noting that peer-led interventions and community partnerships are particularly effective in fostering trust and promoting health behaviours in marginalised populations (Ashenafi et al. 2024; Hall, Shah, and Bowie 2024) By embedding PrEP messaging in existing community structures, health communication efforts can reach Black women in ways that feel culturally authentic and trustworthy.

Second, our findings demonstrated that content and tone is a critical determinant of effective PrEP messaging for Black women. Participants underscored that empowerment, not risk, is the most effective tone for PrEP promotion. Messaging should frame PrEP use as an act of agency and self-care, similar to birth control or other preventive health measures. Participants called for plain, relatable language and narratives that normalise PrEP use as part of a broader wellness journey. These preferences echo calls in the literature to move away from deficit-based communication strategies towards affirming, strengths-based public health narratives This approach aligns with recommendations in the literature that advocate for positive, judgement-free messaging (Kerr et al. 2021, 2015). Shifting the narrative around PrEP from one of risk and vulnerability to one of empowerment and self-care has the potential to transform perceptions and increase uptake among Black women.

Language choice emerged as another key factor in how PrEP should be with Black women. Participants emphasised that messaging should use plain, simple language that avoids medical jargon and makes the information easy to understand. This aligns with research showing that complex or clinical language in HIV prevention materials can obscure meaning and create barriers to engagement, particularly for populations with a historical mistrust of the medical system or those navigating systemic health inequities. When language reflects the everyday realities and vernacular of target audiences, it enhances clarity, trust, and uptake (Calabrese et al. 2016). Furthermore, empowerment-oriented framing, positioning PrEP as a tool for control, self-care, and wellness, has been found to reduce stigma and increase perceived relevance among Black women and other marginalised groups (Boudewyns et al. 2024; Jaiswal et al. 2021). These findings suggest that messaging grounded in identity affirmation and accessibility, rather than pathology or risk, may be effective in promoting PrEP among Black cisgender women.

Third, our findings highlight a continued disconnect between PrEP marketing and the lived experiences of Black cisgender women. The dominant portrayal of PrEP users as primarily MSM or transgender individuals has unintentionally marginalised Black women from HIV prevention discourse. This lack of representation was not only noted, but felt, prompting confusion about PrEP’s relevance and reinforcing a perception that it is ‘not for them’. These insights extend prior critiques of the narrow scope of PrEP campaigns (Calabrese et al. 2016; Rosen et al. 2023; Underhill et al. 2016). Although recent analyses of US-based PrEP campaigns have noted some efforts to include cisgender women, visibility and accessibility remain significant barriers (Rosen et al. 2023). Participants’ reflections suggest that marketing strategies for PrEP must go beyond simply inserting Black women into advertisements; they must also actively counter the exclusionary messages that have shaped how Black women view the medication.

Finally, participants made clear that trust in the messenger is just as critical as trust in the message. Black women want to hear about PrEP from people who look like them, live like them, and understand their context, whether community health workers, peers, OB/GYNs, or culturally resonant influencers. Participants noted that trusted voices whether from within the community or via familiar media platforms are essential in promoting PrEP to Black women. They emphasised that hearing from individuals who share their racial and cultural identities makes the message more comfortable and impactful. Ensuring that Black women feel genuinely connected to the messengers and the message was seen as key to improving receptivity. This was echoed in a recent PrEP messaging study that found that US-based African immigrants preferred to receive PrEP related messages from ‘familiar faces’ (Aidoo-Frimpong et al. 2025) Research on parasocial interactions, including the one-sided relationships people form with admired media figures (Horton and Wohl 1956), supports this recommendation. These emotional bonds can increase trust and encourage behaviour change (Chung and Cho 2017). Future PrEP messaging for Black women should explore how such connections might help address the barriers identified in this study.

Together, these findings contribute to a growing body of evidence showing that successful HIV prevention among Black cisgender women depends on communication approaches that are not only demographically inclusive but also emotionally resonant and community rooted. They underscore the importance of treating Black women not as an afterthought in PrEP outreach, but as a primary audience whose preferences, insights, and experiences can guide more effective public health strategies.

Strengths and limitations

This study has several strengths, including its community-engaged approach to data collection and its focus on Black women who were US-born, African-born, and first-generation women of African descent – populations of Black women whose heterogeneity is often ignored. The use of individual in-depth interviews conducted by Black women allowed participants to share their perspectives openly and candidly, generating rich data on the barriers and facilitators to effective PrEP messaging for Black women. However, the study also has limitations. The sample size, while sufficient for a qualitative study, was geographically limited to the St. Louis area, which limits generalisability to other regions or contexts. In addition to the geographic specificity of St. Louis, cultural context plays an important role in shaping HIV prevention behaviours. St. Louis is characterised by racial residential segregation and significant health inequities, including disparities in HIV prevalence among Black women. Because of this, the generalisability of findings may be limited to other rather similar contexts.

Conclusion

In conclusion, this study underscores the urgent need for culturally relevant and inclusive health communication strategies tailored to the backgrounds, interests and needs of diverse groups of Black cisgender women in the USA. By addressing barriers to representation, leveraging trusted community voices, and adopting empowering language and imagery, public health initiatives can better support Black women in accessing PrEP. Future research should explore the implementation and effectiveness of these strategies in diverse settings and examine medium- to longer-term outcomes related to PrEP uptake, retention, and adherence. Expanding efforts to promote PrEP among Black women is not only a critical step in reducing HIV disparities but also an essential component of advancing health equity for a population that has long been underserved by public health systems.

Data availability

The data that support the findings of this study may be made available from the corresponding author, WI, upon reasonable request.