Identifying access barriers to PrEP among cisgender Black/African American women in the United States: A systematic review of the literature

BACKGROUND/OBJECTIVES: Cisgender Black women in the U.S. face disproportionately high HIV rates due to systemic inequities rooted in institutional racism, not individual behaviors. These disparities are particularly severe in the southern U.S., driven by limited access to healthcare, economic instability, and unsafe social environments. Despite its proven effectiveness, PrEP remains significantly underutilized in this population. METHODS: This systematic review followed PRISMA guidelines to identify and select relevant studies and used the CASP checklist to appraise the quality of the selected qualitative studies. The review focuses on individual and systemic barriers to PrEP access for cisgender Black women, aiming to guide equitable health interventions and improve HIV prevention efforts. RESULTS: Key barriers include limited PrEP awareness, medical mistrust, and stigma. Financial, structural, and social determinants also hinder access. Facilitators, such as PrEP education, social normalization, trust building, and affordability, were identified as critical to improving uptake. CONCLUSIONS: The findings emphasize the need for culturally tailored strategies that build trust, provide education, and empower cisgender Black women to overcome barriers to PrEP access.

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Income
  • Stigma/discrimination
• Population(s)
  • Women
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
  • Prevention
• Engagement and Care Cascade
  • Linkage/engagement in care
• Prevention
  • Biomedical interventions