Background Black and minority ethnic (BME) women in the UK remain disproportionally affected by HIV, comprising 75% of new diagnoses among UK women. Pre-exposure prophylaxis (PrEP) could offer an effective, autonomous, and discreet HIV prevention method for these women. However, PrEP uptake, where available, has been significantly limited. We explored possible reasons for this limited uptake.

Methods Using purposive sampling through community organizations, 32 in-depth semi-structured interviews were conducted with BME women living in London and Glasgow from June-August 2018. Participants (ages 18–60) included women of varied HIV statuses to explore their knowledge of HIV and sexual health, perceptions of sexual risk, and attitudes to PrEP. Interviews were transcribed and an inductive thematic analysis was used to explore how PrEP knowledge and opinions intersected with wider understandings of safer sex

Results Women described extensive peer networks for sexual health advice that shaped their interactions with formal medical care. General HIV literacy was high, though PrEP-specific knowledge was low amongst non-HIV positive women. Participants expressed enthusiasm about PrEP for others but did not situate PrEP within their own safer sex narratives, often because of high levels of HIV stigma that caused women to ignore community risk factors and attribute infection to personal bad decisions. Alternately, some who were more familiar with PrEP believed it to be solely the domain of gay men. Many expressed concern that PrEP would undermine intimacy in their relationships by detracting from the shared responsibility of other HIV prevention practices, like joint testing.

Conclusion Low PrEP awareness and limited notions of candidacy contribute to limited PrEP uptake. For PrEP to be a useful tool for UK BME women, wider discussions of community risk are needed. HIV stigma and gendered responsibility for HIV prevention should be addressed. Existing peer networks should be harnessed to encourage nuanced messaging around these issues.

Disclosure No significant relationships.