Influence of Culture and Historical Dynamics on PrEP Perceptions by Black Women in Chatham County Georgia: A Qualitative Exploration Using the PEN-3 Cultural Model

Term of Award

Fall 2023

Degree Name

Doctor of Public Health in Community Health Behavior and Education (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Department of Health Policy and Community Health

Committee Chair

Stacy Smallwood

Committee Member 1

Bettye Apenteng

Committee Member 2

Nandi Marshall


HIV disproportionately affects Black women, with about 60% of new infections among women in the United States seen in this group. However, Black women have the lowest uptake of pre-exposure prophylaxis (PrEP) because of socioeconomic, structural, and cultural barriers. Existing research on HIV prevention in Black women, particularly PrEP, did not investigate the role of culture on PrEP perceptions and uptake despite evidence that culture is central to health behaviors and intervention adoption. To fill the above gap, this study qualitatively explored the perceptions of 17 Black women in Chatham County, GA, on sex/sexuality, HIV, and PrEP and how the Black culture shapes these perceptions. To ensure detailed theory-based research, research questions and data analysis were guided by components of the PEN-3 model. The results show that positive, existential, and negative aspects of culture influence the perception of sexuality, HIV, and PrEP, including knowledge and awareness. Positive cultural influences included family-oriented culture, a sense of community, respect for prominent community figures, freedom, and self-advocacy. Negative PrEP perceptions were influenced by intersectional stigma, medical distrust, and a superwoman mentality linked with poor health behaviors, poor communication, and religious beliefs. To end the HIV epidemic by 2030, prevention programs should leverage positive cultural findings to address negative perceptions and drive PrEP uptake.

Research Data and Supplementary Material


This document is currently not available here.