African American women's perceptions of HIV prevention communication with their reproductive health providers

Despite a decline in HIV incidence among African American women, they still bear the most significant disease burden among U.S. women.  Numerous studies offer plausible explanations for the disparity, such as the impact of poverty, limited healthcare access, low literacy, and living in areas with high HIV rates.  Additionally, many studies provide insight regarding prevention strategies.  However, this study shares the unique perspective of urban, underserved African American women aged 20 to 44 years, regarding their perceptions about HIV prevention communication with their reproductive health providers (RHPs).  In this study, 20 African American women with unknown HIV status participated in face-to-face interviews designed to explore their perceptions about HIV prevention communication with their RHPs.  Audio-taped interviews were transcribed verbatim and coded using NVivo10 software.  Guided by constructs of the Health Belief Model, inductive and deductive coding yielded four key themes: (1) lack of expectation to receive information; (2) failure of RHPs to initiate and offer information; (3) lack of desire to receive information due to fear and stigma associated with HIV and confirming partner infidelity; and (4) recommendations regarding their preferred methods to receive HIV prevention communication.  Findings indicated that RHPs missed prime opportunities to initiate and offer HIV prevention information during visits for contraception and pregnancy or STI testing with women at greatest risk.  These findings will be useful to inform best practices in designing, implementing and evaluating patient education protocols to facilitate RHPs seizing the opportunities to address HIV prevention in this highly vulnerable population.