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Abstract: Black Women’s Disclosure Motivations, Strategies, and Anticipated Response when Discussing PrEP Uptake with Partners - TOP CONFERENCE PAPER
Background: Pre-exposure prophylaxis (PrEP) is an oral, daily medication used to prevent HIV acquisition; it is covered by most insurances, including Medicare. Despite the medication’s efficacy, most women who are eligible and could benefit are not using it. Women are 20% of new HIV acquisitions, but only 9% of PrEP users (AIDSvu.org, 2025). Inequities in PrEP use are magnified in high prevalence communities. Thus, there is a dire need for interventions to increase women’s PrEP use, particularly in jurisdictions with high HIV prevalence (i.e., Ending the Epidemic Priority Jurisdictions). Previous research has shown that while PrEP can be used discretely and autonomously, many women voice an obligation to disclose its use to their male partners (Goparaju, et al., 2015). Thus, there are relational barriers to women’s PrEP use. However, little is known about this phenomenon - why (i.e., motivations) and how (i.e., strategies) women disclose PrEP use to intimate partners, and to what effects (i.e., anticipated responses).
Disclosure scholarship outlines primary motivations that influence disclosure decisions (Greene et al., 2006) including self-focused, other-focused, relationship-focused, and situational-environmental motivations. When sharing stigmatizing information with others, individuals select among various strategies such as being direct, sharing small details building to a larger disclosure (incremental), or revealing information when feeling compelled to explain (entrapment), among others (Afifi & Steuber, 2009). How information is shared (disclosure strategy) impacts recipient response and influences evaluations of interactions (i.e., effective, competent, successful; Chernichky-Karcher et al., 2021).
Method: As part of a larger project to design a women’s PrEP intervention, we interviewed women about HIV risk, protective behaviors, and communication with partners about PrEP. We interviewed Black women (BW) in Washington, DC. In collaboration with The Women’s Collective in Washington, D.C., a community-based organization focused on supporting BW’s HIV prevention and treatment, we recruited BW (N = 30) to complete 60-minute semi-structured, in-depth interviews. Adult (18+ years) cisgender BW were eligible for participation if they were sexually active, spoke English, and reported at least one HIV risk factor (i.e., recent STI, sex work, inconsistent condom use, IDU, high-risk sex partner; CDC, 2014). Interviews occurred at the Women’s Collective Headquarters and were video recorded and transcribed.
We asked respondents whether they would disclose PrEP use to partners and to describe the strategies they would use, probing for their expectations about how their partners’ would respond. We conducted a thematic analysis (Braun & Clarke, 2021) and are currently conducting a thematic co-occurrence analysis (Scharp, 2021) to understand patterns of co-occurrence between themes related to motivations, communication strategies, and anticipated responses.
Results: Respondents reported motivations that aligned with previous research (Greene et al., 2006).The most commonly cited strategies to initiate discussions included directness, entrapment, and topic avoidance. Some participants expressed uncertainty about their partner’s response. Partners’ anticipated responses included lack of support, relational turbulence, and collaboration.
Conclusion: Thematic results, along with the forthcoming co-occurrence analysis results, will inform the development of strategies to support women’s pursuit of PrEP for HIV prevention.
Disclosure scholarship outlines primary motivations that influence disclosure decisions (Greene et al., 2006) including self-focused, other-focused, relationship-focused, and situational-environmental motivations. When sharing stigmatizing information with others, individuals select among various strategies such as being direct, sharing small details building to a larger disclosure (incremental), or revealing information when feeling compelled to explain (entrapment), among others (Afifi & Steuber, 2009). How information is shared (disclosure strategy) impacts recipient response and influences evaluations of interactions (i.e., effective, competent, successful; Chernichky-Karcher et al., 2021).
Method: As part of a larger project to design a women’s PrEP intervention, we interviewed women about HIV risk, protective behaviors, and communication with partners about PrEP. We interviewed Black women (BW) in Washington, DC. In collaboration with The Women’s Collective in Washington, D.C., a community-based organization focused on supporting BW’s HIV prevention and treatment, we recruited BW (N = 30) to complete 60-minute semi-structured, in-depth interviews. Adult (18+ years) cisgender BW were eligible for participation if they were sexually active, spoke English, and reported at least one HIV risk factor (i.e., recent STI, sex work, inconsistent condom use, IDU, high-risk sex partner; CDC, 2014). Interviews occurred at the Women’s Collective Headquarters and were video recorded and transcribed.
We asked respondents whether they would disclose PrEP use to partners and to describe the strategies they would use, probing for their expectations about how their partners’ would respond. We conducted a thematic analysis (Braun & Clarke, 2021) and are currently conducting a thematic co-occurrence analysis (Scharp, 2021) to understand patterns of co-occurrence between themes related to motivations, communication strategies, and anticipated responses.
Results: Respondents reported motivations that aligned with previous research (Greene et al., 2006).The most commonly cited strategies to initiate discussions included directness, entrapment, and topic avoidance. Some participants expressed uncertainty about their partner’s response. Partners’ anticipated responses included lack of support, relational turbulence, and collaboration.
Conclusion: Thematic results, along with the forthcoming co-occurrence analysis results, will inform the development of strategies to support women’s pursuit of PrEP for HIV prevention.