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Women and Pre-Exposure Prophylaxis for HIV Prevention
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Women and Pre-Exposure Prophylaxis for HIV Prevention

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Infectious Diseases, Chronic Diseases, and Disease Prevention".

Deadline for manuscript submissions: 30 June 2026 | Viewed by 6471

Special Issue Editor

Dr. Whitney C. Irie

E-Mail Website
Guest Editor
1. School of Social Work, Boston College, Chestnut Hill, MA 02467, USA
2. The Fenway Institute, Fenway Health, Boston, MA 02215, USA
Interests: community-driven solutions; critical health equity; black women's sexual and reproductive health; implementation science for black lives; structural evaluation and transformation; social and environmental justice

Special Issue Information

Dear Colleagues,

Despite the availability of pre-exposure prophylaxis (PrEP) as a highly effective biomedical intervention for preventing HIV, women globally continue to experience significant barriers to access and uptake. In 2023, women and girls accounted for approximately 44% of these new infections, indicating the ongoing, disproportionate impact of HIV on women, particularly in regions like sub-Saharan Africa. Research shows that gender power dynamics, intersectionality, and socio-structural factors, such as stigma, poverty, and lack of healthcare access, compound the challenges women face in accessing and effectively using PrEP.

This Special Issue seeks submissions that examine the multi-level determinants of PrEP use among women and girls. We invite submissions that explore how gendered power dynamics, intersectionality, racialized experiences, coloniality, culture, and social norms influence HIV prevention efforts. Moreover, we welcome studies focusing on adolescent girls and young women, as they are particularly vulnerable to HIV infection, often due to biological, social, and structural vulnerabilities that intersect during this critical life stage. Contributions addressing US and non-US contexts are encouraged, as the issue aims to highlight diverse experiences and solutions across different regions and populations.

We are particularly interested in manuscripts that explore innovative interventions and programs designed to increase PrEP uptake among women, implementation science studies, and studies employing diverse methodological approaches, and analyses that unpack the influence of policies, healthcare systems, and community dynamics on women's health outcomes.

We hope this Special Issue will further our collective understanding of women's HIV prevention needs and provide insights for developing equitable, sustainable, and community-centered solutions. We look forward to your valuable contributions, as they will help shape the future of PrEP for women globally.

Dr. Whitney C. Irie
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • HIV prevention
  • women and PrEP
  • intersectionality
  • gender power dynamics
  • adolescent girls and young women
  • healthcare access
  • stigma and discrimination
  • structural inequalities

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Published Papers (6 papers)

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Research

19 pages, 815 KB  
Article
Developing a Female Sex Worker-Led Program to Improve the Uptake of Oral Pre-Exposure Prophylaxis in South Africa: An Intervention Mapping Study
by Nosipho Faith Makhakhe and Gift Khumalo
Int. J. Environ. Res. Public Health 2025, 22(12), 1862; https://doi.org/10.3390/ijerph22121862 - 14 Dec 2025
Viewed by 237
Abstract
In 2016, the South African government approved free oral PrEP distribution among high-risk groups like female sex workers (FSWs) to reduce new HIV infections. Despite the availability, unique barriers exist that challenge PrEP persistence, including limited knowledge, side effects, stigma, and mobility that [...] Read more.
In 2016, the South African government approved free oral PrEP distribution among high-risk groups like female sex workers (FSWs) to reduce new HIV infections. Despite the availability, unique barriers exist that challenge PrEP persistence, including limited knowledge, side effects, stigma, and mobility that hinder adherence. As such, engaging FSWs in the design of an FSW-led intervention program is crucial to promote PrEP uptake, adherence, and retention. Processes of an intervention mapping approach were applied to design and develop the program in KwaZulu-Natal, South Africa. A needs analysis was completed through existing literature and through engagements with FSWs, FSW peer educators, and a healthcare provider. The working group, comprising eight FSW peer educators and a researcher, co-created the intervention following a six-step mapping process. A total of six meetings took place, during which intervention determinants, change objectives, theory-based methods, and the intervention program were discussed and formulated, as well as implementing partners and the evaluation plan identified. The program focuses on the development of agency, self-efficacy, and hope among FSWs and aims to destigmatize PrEP through positive messaging, equipping FSWs with the ability to differentiate PrEP from ARVs given to people living with HIV. Through role-playing, participants will practice discussing PrEP with their intimate partners and friends, receive suggestions on managing pill supply and side effects, and be equipped to become PrEP ambassadors. The introduction of PrEP as a pill for high-risk groups can be stigmatizing. Therefore, it is crucial to involve marginalized groups in the design and implementation of their interventions to foster acceptance and develop a sense of ownership, ensuring the programs’ sustainability. Full article
(This article belongs to the Special Issue Women and Pre-Exposure Prophylaxis for HIV Prevention)
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17 pages, 326 KB  
Article
I Don’t Really Know Much About PrEP: Examining Black HBCU Women’s Pre-Exposure Prophylaxis Knowledge and Awareness
by Marissa N. Robinson, Brittany M. Williams, Gloria Aidoo-Frimpong, Reginald A. Blockett, Calvin R. Lowery, Michelle Sandoval-Rosario and Rasheeta Chandler
Int. J. Environ. Res. Public Health 2025, 22(12), 1813; https://doi.org/10.3390/ijerph22121813 - 3 Dec 2025
Viewed by 524
Abstract
Despite HIV/AIDS disproportionately impacting Black women in the United States, HIV knowledge, awareness, and uptake of prevention efforts like pre-exposure prophylaxis (PrEP) have been limited for this community. Since campus leaders can maintain the attention of Black college women for a sustained period, [...] Read more.
Despite HIV/AIDS disproportionately impacting Black women in the United States, HIV knowledge, awareness, and uptake of prevention efforts like pre-exposure prophylaxis (PrEP) have been limited for this community. Since campus leaders can maintain the attention of Black college women for a sustained period, they are an ideal demographic for PrEP interventions. Accordingly, the purpose of this study was to assess the awareness and knowledge of PrEP among Black Historically Black Colleges and University (HBCU) women, informing future possibilities and strategies for PrEP interventions and uptake. The lead author employed a descriptive, qualitative approach to collect data from five focus groups of Black HBCU women. Within this, the authors examined Black HBCU women’s PrEP knowledge and awareness in their own words and on their own terms. The results revealed that Black HBCU women have notable gaps in knowledge and limited awareness about PrEP and sexual health, with some assuming PrEP is only for men who have sex with men (MSM). Others believed it was used to manage an existing HIV diagnosis. Given that these participants perceived PrEP as primarily for MSMs, there is a clear gap in public health practice. Therefore, it is essential to focus future HIV prevention efforts on college-aged Black women by exploring their perspectives and considering how institutions like student activities, Greek Life, and campus health services can contribute to PrEP education for HIV prevention. Full article
(This article belongs to the Special Issue Women and Pre-Exposure Prophylaxis for HIV Prevention)
15 pages, 581 KB  
Article
A Qualitative Consolidated Framework for Implementation Research Evaluation of Innovative PrEP Delivery During COVID-19 Among Adolescent Girls and Young Women in North West Province, South Africa
by Lerato Lucia Olifant, Edith Phalane, Yegnanew A. Shiferaw, Hlengiwe Mhlophe and Refilwe Nancy Phaswana-Mafuya
Int. J. Environ. Res. Public Health 2025, 22(10), 1602; https://doi.org/10.3390/ijerph22101602 - 21 Oct 2025
Viewed by 768
Abstract
Background: Innovative interventions, such as social media platforms and telemedicine, were implemented during the COVID-19 lockdown period for HIV prevention and treatment services. However, limited studies have reported on the facilitators and barriers of these innovations for HIV pre-exposure prophylaxis (PrEP) service continuity. [...] Read more.
Background: Innovative interventions, such as social media platforms and telemedicine, were implemented during the COVID-19 lockdown period for HIV prevention and treatment services. However, limited studies have reported on the facilitators and barriers of these innovations for HIV pre-exposure prophylaxis (PrEP) service continuity. Therefore, this study aimed to identify the barriers and facilitators of the implemented PrEP innovative interventions during COVID-19 among adolescent girls and young women (AGYW). Methods: A qualitative exploratory design was used to conduct semi-structured interviews with twelve stakeholders in the Dr Kenneth Kaunda District, North West Province of South Africa. Participants included various TB HIV Care programme stakeholders, comprising professional nurses, case managers, peer educators, and counsellors. The Consolidated Framework for Implementation Research (CFIR) 2.0 domains and constructs guided the interview questions and the analysis process. Additionally, all interviews were audio-taped, transcribed verbatim, and analyzed through thematic analysis. The facilitators and barriers of the PrEP innovative interventions were categorized according to the five CFIR domains. Results: The findings showed that despite the COVID-19 disruptions in healthcare services, the implemented innovative PrEP interventions enhanced the HIV prevention services. Facilitators included sufficient mobile data, teamwork, clear communication from managers, resilience, and existing media pages that supported social media-based PrEP service continuity. The implementation barriers included service users’ lack of cell phone devices, incorrect personal information, fear of contracting COVID-19, and limited individual movements. Conclusion: Social media and digital technologies played a crucial role in the continuation of HIV PrEP services among AGYW. These evaluations also illustrated the potential of social media platforms to be leveraged for HIV service delivery during periods of disruption, such as the COVID-19 lockdown period, for HIV service delivery. Furthermore, lessons learned from this study are significant and offer practical considerations for sustaining PrEP during service disruptions. Full article
(This article belongs to the Special Issue Women and Pre-Exposure Prophylaxis for HIV Prevention)
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18 pages, 409 KB  
Article
“I’ll Continue If I Have a Positive Mind”: Identifying the Ways in Which Depression and PTSD Impact PrEP Adherence Among PrEP-Experienced Pregnant and Postpartum Women in Cape Town, South Africa
by Amelia M. Stanton, Madison R. Fertig, Jennifer Nyawira Githaiga, Devisi A. Ashar, Linda Gwangqa, Melinda Onverwacht, Lucia Knight, Landon Myer, Jessica E. Haberer, John Joska, Conall O’Cleirigh and Christina Psaros
Int. J. Environ. Res. Public Health 2025, 22(9), 1350; https://doi.org/10.3390/ijerph22091350 - 28 Aug 2025
Viewed by 1540
Abstract
Pregnant and postpartum people (PPPs) face heightened risk for HIV acquisition, yet depression and trauma-related symptoms can undermine adherence to pre-exposure prophylaxis (PrEP). To inform the development of a brief mental health-focused adherence intervention, we explored the impacts of depression and posttraumatic stress [...] Read more.
Pregnant and postpartum people (PPPs) face heightened risk for HIV acquisition, yet depression and trauma-related symptoms can undermine adherence to pre-exposure prophylaxis (PrEP). To inform the development of a brief mental health-focused adherence intervention, we explored the impacts of depression and posttraumatic stress disorder (PTSD) symptoms on PrEP use among PPPs in Cape Town, South Africa. Twenty-eight PPPs with elevated symptoms of depression and/or PTSD and recent PrEP adherence challenges completed qualitative interviews. Six antenatal providers were also interviewed. Thematic analysis revealed three key findings with subthemes that deepen exploration of each theme: (1) depression and PTSD symptoms contributed to missed PrEP doses or late pickups by increasing doubt about PrEP efficacy, amplifying pill burden, intensifying avoidance and withdrawal (e.g., hypersomnia and disengagement from providers), and disrupting memory through rumination and emotional overload; (2) most PPPs preferred support from professional counselors, while a minority preferred informal support; and (3) intervention design considerations included aligning patient and provider goals, selecting between individual or group formats, and addressing integration barriers such as staffing and space constraints. Providers affirmed the need for embedded mental health support. Intervention strategies that increase PrEP knowledge and motivation while targeting emotional withdrawal, fatigue, and cognitive overload may improve adherence and reduce HIV risk in this population. Full article
(This article belongs to the Special Issue Women and Pre-Exposure Prophylaxis for HIV Prevention)
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13 pages, 285 KB  
Article
Examining the Association Between Exposure to the #ShesWell Campaign and Black Women’s Conversations with Healthcare Providers About Pre-Exposure Prophylaxis (PrEP)
by Vanessa Boudewyns, Gabriel Madson, Stefanie K. E. Anderson, Hannah Getachew-Smith, Ryan S. Paquin, Sarah E. Sheff, Nivedita L. Bhushan, Revae S. Downey and Jennifer D. Uhrig
Int. J. Environ. Res. Public Health 2025, 22(8), 1224; https://doi.org/10.3390/ijerph22081224 - 6 Aug 2025
Viewed by 1137
Abstract
Low uptake of pre-exposure prophylaxis (PrEP) for HIV prevention among Black women has been partly attributed to barriers related to patient-provider communication. The goal of this paper was to investigate the association between exposure to the #ShesWell campaign and Black women’s communication about [...] Read more.
Low uptake of pre-exposure prophylaxis (PrEP) for HIV prevention among Black women has been partly attributed to barriers related to patient-provider communication. The goal of this paper was to investigate the association between exposure to the #ShesWell campaign and Black women’s communication about PrEP with a healthcare provider (HCP). We conducted a cross-sectional survey of 403 sexually active, Black women after the initial phase of #ShesWell and used multivariable regression models to analyze whether exposure to #ShesWell was associated with talking to an HCP about PrEP or intention to discuss PrEP with an HCP in the future. Approximately 33% of women surveyed reported exposure to #ShesWell. Campaign exposure was significantly associated with talking to an HCP in the past year about PrEP (OR = 4.96, p = 0.001) and intention to discuss PrEP with an HCP in the next six months (B = 0.29, p = 0.038). Stronger beliefs that doctors should initiate sexual health conversations were positively associated with past PrEP conversations (OR = 2.32, p < 0.001) and future intention (B = 0.11, p = 0.029). Greater comfort discussing prevention (B = 0.35, p < 0.001), self-efficacy discussing PrEP (B = 0.29, p = 0.001), and concern about getting HIV (B = 0.51, p < 0.001) were also associated with intention to discuss PrEP with an HCP. Findings highlight the potential for communication campaigns to motivate patient-provider communication about PrEP, addressing a reported barrier to PrEP uptake among Black women. Full article
(This article belongs to the Special Issue Women and Pre-Exposure Prophylaxis for HIV Prevention)
27 pages, 379 KB  
Article
Examining Perceptions Among Healthcare Providers on Their Awareness of and Experience with Prescribing and/or Referring Pre-Exposure Prophylaxis to Eligible Cisgender Black Female Patients: A Qualitative Inquiry
by Mandy J. Hill, Amber I. Sophus, Sarah Sapp, Jeffrey Campbell, Diane Santa Maria and Jamila K. Stockman
Int. J. Environ. Res. Public Health 2025, 22(3), 450; https://doi.org/10.3390/ijerph22030450 - 18 Mar 2025
Cited by 1 | Viewed by 1520
Abstract
Prescriptions for and use of pre-exposure prophylaxis (PrEP), an available and accessible HIV prevention strategy, remain low among cisgender Black women (CBW). Given PrEP is only available through a prescription from a licensed healthcare provider (HCP), there is a need to identify factors [...] Read more.
Prescriptions for and use of pre-exposure prophylaxis (PrEP), an available and accessible HIV prevention strategy, remain low among cisgender Black women (CBW). Given PrEP is only available through a prescription from a licensed healthcare provider (HCP), there is a need to identify factors associated with HCP’s prescribing and/or referring PrEP to CBW. Qualitative methods (in-depth interviews) were used to examine factors shaping beliefs and behaviors among 12 HCPs that impact their willingness to prescribe or refer PrEP to CBW. Seven primary themes were identified during a thematic data analysis. The themes with the highest frequency of codes (fc) were the provider’s experience discussing sexual health (fc = 284), the provider approach to patient engagement (fc = 240), provider knowledge of PrEP (fc = 158), and the provider approach to determining PrEP eligibility (fc = 141). Findings indicate that prescribing and referral behaviors among HCPs can be influenced by their knowledge of PrEP; perceptions about PrEP for patients; comfort level in engaging/communicating with patients about PrEP; awareness of PrEP resources needed to improve PrEP access among patients; and patient–provider communication relative to sexual health, HIV vulnerability, and PrEP eligibility. Study findings illuminate how usual care practices contribute to gaps in PrEP access among CBW and highlight areas for intervention. Full article
(This article belongs to the Special Issue Women and Pre-Exposure Prophylaxis for HIV Prevention)
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