"Really just recognizing that women also have sex.": A qualitative analysis of cisgender women's self-reported barriers to accessing PrEP.

BACKGROUND: Cisgender women (hereafter, referred to as women) account for approximately 19% of new HIV diagnoses in the US, but are underrepresented in PrEP implementation efforts in the US. METHODS: Fourteen semi-structured interviews were conducted with women (M = 32.1 years old, SD = 6.2 years) to understand their PrEP knowledge, clinical and system-level barriers, and supports needed to engage with PrEP. During data collection, the importance of sexual scripts, a social belief that women are heterosexual and 'pure', emerged as a major construct in shaping participants' health-care seeking experiences, regardless of their HIV risk perception or PrEP knowledge. A deductive-inductive thematic approach was used to further analyze this construct. RESULTS: A majority of participants identified as a person of color: seven black women (50%), three multi-racial women (21%), and one Asian woman (7%). A majority of the participants had no experience with PrEP (57%); however, most participants had at least some knowledge of PrEP (72%). Sexual scripts surrounding women's sexuality, clinician priorities, and perceptions of who PrEP is "for" were reported as prominent barriers to PrEP prescription. Participants described clinical interactions that reinforced sexist and heteronormative beliefs and impeded access to necessary sexual health care. Participants emphasized that clinicians who approach sexual health conversations with an openness and non-judgmental demeanor can facilitate access to PrEP and improve overall sexual health. CONCLUSIONS: Findings highlight the need for concerted efforts to challenge sexual scripts in clinical settings and create safe environments where women can openly discuss sexual health.