PrEP Is for Black Women, Too!
Pre-Exposure Prophylaxis (PrEP) for the Prevention of Human Immunodeficiency Virus (HIV)
Learning module activity
Published ____ 2026
A Module Course Designed for Health Care Providers Who Provide Health Care Services to Black Women
Intended Audience
This module activity is intended for use by prescribing clinicians; however, health care professionals involved in patient education may also benefit from the information and tools provided. This toolkit is intended as a guide for PrEP-naïve individuals. For complete guidance for patients newly starting, or previously taking, HIV PrEP, please refer to the PrEP clinical guidelines.
Language
Throughout this module activity, the term “women” specifically refers to Black cisgender women. This intentional focus is not meant to exclude transgender women, nonbinary individuals or others who may benefit from HIV prevention efforts but rather to highlight the urgent need to address the unique experiences, health disparities and structural inequities faced by Black cisgender women. Despite being disproportionately affected by HIV, this group is often overlooked in research, policy and clinical guidance. Centering Black cisgender women allows us to directly confront these gaps and provide tailored, affirming and impactful care strategies.
Disclosures
The development of this module activity is supported by grant funding issued by the Michigan Department of Health and Human Services (MDHHS).
No one involved in the development of this toolkit has a relevant financial relationship to disclose with an ineligible company. Brand names of medications are used within this toolkit solely for educational purposes.
Although this activity is designed to offer comprehensive guidance on delivering PrEP services to Black women, users are encouraged to consult full prescribing information and relevant clinical guidelines for additional context and detailed recommendations.
Introduction
Introduction
HIV PrEP is a powerful tool — but its power is only realized when it reaches the people who need it most. For Black women, that access remains far too limited. Despite clear evidence of PrEP’s effectiveness, and national guidelines recommending it for all sexually active individuals, many Black women are still left out of the conversation — and left vulnerable to HIV acquisition.
Black women are disproportionately impacted by HIV. In 2023, despite making up only 13% of the United States (US) population, Black women accounted for half of all new HIV diagnoses among heterosexual cisgender women nationwide. In Michigan alone, the HIV incidence rate among Black women was more than nine times higher than that of white women. This is not just a statistic. This is a call to action.
Barriers — such as stigma, lack of awareness, medical mistrust and systemic inequities — continue to limit PrEP access. But one of the most powerful tools to overcome those barriers is YOU.
As a health care provider, YOU can play a valuable role in changing the trajectory of HIV for Black women.
By integrating PrEP into your everyday practice, you are not just following evidence-based guidelines, but also showing your patients that they are seen, heard and valued.
This module activity, created in partnership with the Mahogany Blue campaign, was designed to support you in this effort. It's here to help you feel confident and equipped to talk about PrEP, prescribe it and ultimately help protect the health and futures of Black women in your care. This activity aims to empower clinicians to be proactive allies in closing the prevention gap for Black women and to promote equity, autonomy and PrEP access.
Mahogany Blue
The Mahogany Blue campaign presents an opportunity to promote PrEP utilization among Black women by decreasing stigma, medical mistrust, the lack of awareness about PrEP and insurance challenges. The campaign is dedicated to empowering women by recognizing the unique barriers Black women encounter in accessing HIV prevention tools like PrEP. Through heightened awareness, advocacy for research inclusive of stratified data for Black women and community engagement, MDHHS aims to implement meaningful change and ensure equitable health care access for all.
Mahogany Blue
The Mahogany Blue campaign is an adaptation of the Centers for Disease Control and Prevention’s (CDC) She's Well campaign, which is now a component of the CDC’s overall Let’s Stop HIV Together campaign. Mahogany is a nod to not only the various shades of Black women, but also the resiliency of Black women. “Blue” references PrEP medication that has traditionally been recognized as a blue pill. The campaign features Black women of various hues, shapes and ages in informational materials customized for Wayne County. While the original PrEP pill was blue in color, PrEP now comes in many colors and forms. Patients and providers can work together to determine the best form of PrEP for their needs.
The Burden of HIV Among Black Women
Black women continue to be disproportionately impacted by HIV, representing 50% of new HIV diagnoses among US women, despite comprising less than 13% of the female population. Their infection rate remains the highest among all racial and ethnic groups of women. This data highlight the critical role clinicians play in addressing social determinants of health, reducing stigma and ensuring equitable access to prevention, testing and treatment services.
To effectively support Black women in HIV prevention, it is critical that clinicians understand the structural and social drivers that heighten their vulnerability. Please take the time to click on each of the three topic icons below to learn more about these important concepts:
Medical Mistrust
Intersectionality
Structural Racism
Clinicians have a unique opportunity and critical responsibility to tailor HIV prevention in a way that validates these realities, fosters trust and centers the lived experiences of Black women.
The Burden of HIV Among Black Women in the US and the State of Michigan
PrEP is the use of antiretroviral medications to prevent HIV acquisition among persons who could be exposed to HIV via sexual intercourse and/or the use of intravenous drugs. PrEP can reduce HIV acquisition through sex by 99% and from injection drug use by 74%. Despite a clear need, Black women continue to be underserved by HIV prevention strategies such as PrEP.
In 2024, women accounted for only 9% of PrEP users, an especially low proportion when compared with the 91% of users who were men. Data on PrEP uptake among Black women is even more limited, obscuring the true extent of this gap. This disparity reflects a critical missed opportunity to deliver effective HIV prevention to women, particularly Black women, who remain disproportionately affected by HIV in the U.S.
Understanding PrEP for HIV Prevention
Recommendation for Use
The U.S. Preventive Services Task Force provides a grade A recommendation encouraging clinicians to prescribe PrEP to individuals who are at increased vulnerability to HIV acquisition. Several options for PrEP are available for use in Black women.
Available PrEP Options for Use in Women
Important Note: Tenofovir alafenamide (TAF/FTC) [Brand name: Descovy] is a PrEP medication that is not currently FDA approved for use in cisgender women due to previously lacking efficacy data. However, studies are ongoing.According to the International Antiviral Society–USA (IAS–USA) Panel, a 2025 analysis showed an 89% reduction in HIV acquisition risk among cisgender women who had biomarker evidence of taking an average of at least two doses of tenofovir alafenamide/emtricitabine (TAF/FTC) per week. The PURPOSE 1 clinical trial demonstrated a strong link between TAF/FTC adherence and HIV protection. As a result, the IAS now recommends TAF/FTC for HIV prevention from vaginal exposure in individuals for whom tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) is either contraindicated or not preferred. Due to non-FDA approval, the use of TAF/FTC for HIV prevention in cisgender women is not covered in this toolkit. For more details, consult the IAS–USA guidelines and the full prescribing information for TAF/FTC.
PrEP is a powerful tool in the primary care toolkit — especially for supporting the health and well-being of Black women.
Despite facing unique social and structural challenges that increase their risk for HIV, Black women are too often left out of patient-provider discussions about PrEP. This gap in care contributes to ongoing disparities.
As health care providers, it is essential to view PrEP as a routine part of preventive care and not as a specialized or stigmatized intervention. All licensed health care providers are authorized to prescribe PrEP, yet many patients are unnecessarily referred to specialists, creating avoidable barriers to access.
By incorporating PrEP into everyday checkups, like blood pressure screenings or Pap smears, we can help normalize its use, reduce stigma and empower patients with more choices to protect their sexual health.
Tenofovir Disoproxil Fumarate and Emtricitabine (TDF/FTC) Brand name: Truvada
Dosage and dosing schedule
Type of medication
Duration of action
Side effects
Efficacy
Use in People Who Inject Drugs (PWID)
Use During Pregnancy and by Women of Childbearing Potential
Other considerations
Cost
Click here for more prescribing information:
Clinical Considerations
Initiating PrEP begins with conducting a thorough sexual health history in a manner that is nonjudgmental, affirming and free from assumptions about behavior, identity or risk.
Many Black women are overlooked for PrEP simply because clinicians fail to ask or offer. Normalize PrEP as part of routine preventive care by proactively offering it to all women who may benefit, regardless of whether they explicitly request it. Doing so shifts the burden away from the patient and ensures that HIV prevention is equitably accessible.
The figures on the next page present questions intended to help assess behaviors and factors associated with increased HIV vulnerability. This information is typically gathered during sexual and social history-taking. While these conversations can feel uncomfortable for both providers and patients, open and nonjudgmental dialogue is essential to reducing stigma around sexual health.
These tools are designed to support you in identifying whether discussing and prescribing PrEP may be appropriate for your patient.
It’s important to recognize that some patients may not feel comfortable disclosing certain information. Therefore, if a patient expresses interest in PrEP — even if they answer “no” to the following questions — they should still be offered and prescribed PrEP if they desire it.
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Assessing Sexually Active Patients10
Assessing Patients Who Inject Drugs10
Other factors to consider that may warrant the benefit of PrEP:
- Engaging in transactional sex.
- Recent use of post-exposure prophylaxis (PEP).
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Baseline Assessments Prior To Prescribing PrEP10
Before starting PrEP, perform essential baseline assessments to ensure safe, appropriate and person-centered care:
- Confirm HIV-negative status.
- Use a 4th generation HIV antigen/antibody test.
- Starting PrEP in someone with undiagnosed HIV can lead to drug resistance.
- Assess for signs of acute HIV: fever, fatigue, myalgia, skin rash, headache, pharyngitis, cervical adenopathy, arthralgias, night sweats, diarrhea.
- Screen for sexually transmitted infections (STIs).
- Include tests for syphilis, gonorrhea and chlamydia.
- Assess renal function.
- Check estimated creatinine clearance (eCrCl); must be ≥60 mL/min for tenofovir disoproxil fumarate (TDF)-based PrEP.
- Screen for hepatitis B and C.
- Tests needed: hepatitis B surface antigen, core antibody, surface antibody.
- Note: Tenofovir has activity against hepatitis B; co-infections may require coordinated care.
- Tests needed: hepatitis C antibody with reflex RNA.
- Perform pregnancy testing (if applicable).
- Reminder: PrEP is safe during pregnancy and breastfeeding and may be particularly important during these times.
These baseline labs and assessments help build a strong clinical foundation for effective and safe PrEP prescribing.
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Navigating PrEP Options11
When discussing PrEP with Black women, health care providers should take a holistic and person-centered approach that considers the benefits, risks and limitations of each available option.
Daily oral PrEP offers effective HIV prevention, especially when adherence is consistent, while long-acting injectable PrEP may better suit patients with challenges related to daily pill-taking or privacy concerns.
It is essential to evaluate potential side effects, drug interactions and access barriers such as insurance coverage, clinic access or medical mistrust. Additionally, understanding how each option aligns with a patient’s lifestyle, reproductive goals and health care preferences ensures the chosen method supports both autonomy and overall well-being.
Providers should create a safe space for open dialogue and shared decision-making, recognizing the historical and ongoing structural factors that may influence Black women's health care experiences.
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Risk-Based vs. Reason-Based Language12,13
Risk-based language often centers judgment and reinforces harmful stereotypes, particularly those rooted in racial and gender bias.
In contrast, reason-based language acknowledges that individuals engage in behaviors for a variety of valid, personal and contextual reasons — such as pleasure, connection, autonomy or survival. This approach invites open dialogue, empowers patients to share their experiences without fear of blame or shame, and centers their values and goals.
Shifting from risk-based to reason-based language when collecting sexual health histories from Black women is critical to fostering trust, reducing stigma and promoting equitable care.
Below, please find examples adapted from ViiV Healthcare's Risk to Reasons initiative demonstrating how you may consider adjusting your use of language related to HIV/STIs.
Scan the QR code for more information on ViiV Healthcare's Risk to Reasons initiative.
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Culturally Responsive Communication Strategies
Culturally responsive communication is essential for building trust and improving PrEP uptake among Black women. Clinicians should approach every interaction with a trauma-informed lens, recognizing that past experiences with discrimination, stigma or neglect may influence how patients engage with care.
Centering autonomy means affirming that Black women are the best experts on their own bodies and lives, and creating space for informed, collaborative decision-making.
Avoid making assumptions about a patient’s sexual orientation, relationship status or possibility of HIV acquisition — these factors are not always visible or volunteered. Instead, normalize prevention by saying, “I offer PrEP to all my patients because everyone deserves access to prevention tools,” rather than making judgments about who appears to need it.
Use open-ended questions and practice active listening to create a safe, respectful dialogue. To deepen trust and accountability, partner with Black-led community organizations that can help bridge cultural and systemic gaps in care.
For example, the Black Women’s Health Imperative’s initiative On Our Own Terms (OOOT) is a network of informed organizations and experts who focus on the prevention and care of HIV for Black cisgender and transgender women.
Scan the QR code for more information on the Black Women’s Health Imperative OOOT initiative.
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Addressing Barriers To PrEP Access
Despite its proven effectiveness in preventing HIV, access to PrEP remains limited for many individuals who could benefit from it. A range of structural, systemic and personal barriers — including stigma, cost, lack of provider awareness and limited health care access — can hinder PrEP uptake and adherence. Identifying these challenges is essential to developing focused strategies that improve equitable access. The table below outlines common barriers to PrEP and corresponding approaches to help address them.
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PrEP With a Purpose
Black women deserve access to the full spectrum of HIV prevention tools, including PrEP. Health care providers are pivotal in making that access a reality.
As stewards of health and equity, you have the power to transform clinical spaces into affirming, inclusive environments where Black women feel seen, heard and protected.
This toolkit is more than a resource — it’s a call to action. By normalizing PrEP conversations, using reason-based and empowering language and addressing systemic barriers head-on, you help close the HIV prevention gap and affirm the dignity and autonomy of every Black woman in your care.
Your commitment to integrating PrEP into routine preventive care is not just a clinical best practice — it is an act of equity, advocacy and justice.
PrEP is for Black women, too, and together, we can ensure it becomes a trusted, accessible and empowering option for every woman who desires it.
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References
- Centers for Disease Control and Prevention. HIV Diagnoses, Deaths, and Prevalence: 2025 Update. HIV Data. Published April 29, 2025. https://www.cdc.gov/hiv-data/nhss/hiv-diagnoses-deaths-and-prevalence-2025.html
- AIDSVu. (2025, June 26). AIDSVu Releases 2024 PrEP Use Data Showing Growing Use Across the U.S. - AIDSVu. AIDSVu. https://aidsvu.org/news-updates/aidsvu-releases-2024-prep-use-data-showing-growing-use-across-the-u-s/
- Michigan Department of Health and Human Services. (2024). PrEP and black women. https://www.michigan.gov/mdhhs/keep-mi-healthy/chronicdiseases/hivsti/prep/prep-and-black-women
- Michigan Department of Health and Human Services. (2025). HIV Prevalence Report. https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/HIVSTI/Data-and-Statistics/2025/HIV-Prevalence-Report-Slides-2024.pdf
- Centers for Disease Control and Prevention (2022, July 6). HIV and Black/African American People in the U.S. https://stacks.cdc.gov/view/cdc/120030/cdc_120030_DS1.pdf
- United States Preventive Services Task Force. (2023). Preexposure Prophylaxis to Prevent Acquisition of HIV: US Preventive Services Task Force Recommendation Statement. The Journal of the American Medical Association, 330(8), 736–745. https://doi.org/10.1001/jama.2023.14461
- Landovitz, R. J., Molina, J.-M., Buchbinder, S. P., & International Antiviral Society-USA (IAS-USA) Panel. (2025). Preexposure prophylaxis for HIV: Updated recommendations from the 2024 international antiviral society-usa panel. JAMA. https://doi.org/10.1001/jama.2025.11410
- Gandhi, R. T., Landovitz, R. J., Sax, P. E., Smith, D. M., Springer, S. A., Günthard, H. F., Thompson, M. A., Bedimo, R. J., Benson, C. A., Buchbinder, S. P., Crabtree-Ramirez, B. E., Rio, C. del, Eaton, E. F., Eron, J. J., Hoy, J. F., Lehmann, C., Molina, J.-M., Jacobsen, D. M., & Saag, M. S. (2024). Antiretroviral drugs for treatment and prevention of HIV in adults: 2024 recommendations of the international antiviral society–USA panel. Journal of the American Medical Association, 333(7). https://doi.org/10.1001/jama.2024.24543
- Department of Health and Human Services. (2025, June 12). Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States. https://clinicalinfo.hiv.gov/en/guidelines/perinatal/safety-toxicity-arv-agents-nrtis-tenofovir-disoproxil-fumarate-viread
- United States Public Health Service, Centers for Disease Control and Prevention (U.S.), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (U.S.). Division of HIV/AIDS Prevention, & Preexposure Prophylaxis Work Group. (2021, December). Preexposure prophylaxis for the prevention of HIV infection in the United States -- 2021 update: A clinical practice guideline. CDC Stacks. https://stacks.cdc.gov/view/cdc/112360
- New York State Department of Health AIDS Institute. (2025, February 7). Interim guideline on the use of twice-yearly lenacapavir for HIV prevention . https://www.hivguidelines.org/guideline/hiv-prep-len/?mytab=tab_5&mycollection=pep-prep#table-1
- ViiV Healthcare. (2021b). Risk to reasons. ViiV Healthcare. https://viivhealthcare.com/en-us/supporting-the-hiv-community/positive-action/risk-to-reasons/
- Johnson, R., Duroseau, B., Randolph, S., & Chandler, R. (2024). Reasons over risks: NPs and HIV prevention for Black women. The Journal for Nurse Practitioners, 20(3), 104931–104931. https://doi.org/10.1016/j.nurpra.2024.104931
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Appendices
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Summary of Tenofovir Disoproxil Fumarate/Emtricitabine (TDF/FTC) as PrEP for Cisgender Women1,2
Indication: FDA-approved for PrEP in HIV-negative individuals, including cisgender Black women, who may be vulnerable to HIV acquisition through sex or injection drug use.
Before Prescribing
- Confirm HIV-negative status via HIV antigen/antibody test.
- Assess for signs/symptoms of acute HIV infection.
- Identify factors that could lead to HIV acquisition.
- Condomless vaginal or anal sex with partners of unknown or positive HIV status.
- History of STIs.
- Transactional sex and/or commercial sex work.
- Use of PEP more than once.
- Injection drug use.
- Weight ≥35 kg.
- Renal function: check serum creatinine and calculate eCrCl (must be ≥60 mL/min).
- Check hepatitis B and C status.
- Abruptly stopping TDF/FTC in people with chronic hepatitis B virus can lead to a resurgence of acute hepatitis B virus activity.
- Assess for any known contraindications.
- Pregnancy test.
- STI screening (gonorrhea and chlamydia at all exposed sites; syphilis serology).
Dosing One tablet by mouth daily, with or without food. Takes about three weeks of daily dosing to reach maximum protective levels in cervicovaginal tissues.
Special Considerations for Women Hormonal Contraceptives:
- No impact on hormonal contraception.
- Encourage dual protection with condoms to prevent STIs and pregnancy.
Pregnancy and Breastfeeding:
- Can start and continue during pregnancy and breastfeeding for those who continue to be vulnerable to HIV acquisition, given its strong safety profile during pregnancy.
Counseling Tips
- Encourage adherence.
- Discuss potential side effects.
- Encourage open discussion about sexual health, partner dynamics, sex positivity and STI prevention.
- Address myths or stigma about PrEP use.
Refer to full prescribing guide for more information.
When NOT to Start TDF/FTC for PrEP
- Suspected or confirmed acute HIV infection.
- eCrCl <60 mL/min (consider PrEP alternative).
- Unable or unwilling to adhere to daily dosing or follow-up.
- Weight below 35 kg.
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CDC Screening Recommendations for Cisgender Women Taking Oral Tenofovir Disoproxil Fumarate and Emtricitabine (TDF/FTC) for PrEP1,2
May consider more frequent testing, if indicated.
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Summary of Cabotegravir (CAB-LA) as PrEP for Cisgender Women1,3
Indication: FDA-approved for PrEP in HIV-negative individuals, including cisgender Black women, who may be vulnerable to HIV acquisition through sex.
Before Prescribing
- Confirm HIV-negative status via HIV antigen/antibody test and HIV RNA test.
- Assess for signs/symptoms of acute HIV infection.
- Identify factors that could lead to HIV acquisition.
- Condomless vaginal or anal sex with partners of unknown or positive HIV status.
- History of STIs.
- Transactional sex and/or commercial sex work.
- Use of PEP more than once.
- Injection drug use.
- Weight ≥35 kg.
- Screen for potential contraindications.
- Drug-drug interactions associated with anticonvulsants, methadone and antimycobaterials.
- History of hypersensitivity reaction to cabotegravir.
- Pregnancy test.
- STI screening (gonorrhea and chlamydia at all exposed sites; syphilis serology).
Dosing Schedule
Oral lead-in (optional to assess tolerability): 30 mg oral cabotegravir daily for four weeks.
Inject 3 mL via gluteal muscle every two months in office on a set target date (± one week) thereafter.
Inject 600 mg/ 3 mL via ventrogluteal or dorsogluteal muscle.
Inject 3 mL via gluteal muscle one month later.
Special Considerations for Women
- Shown to be highly effective in cisgender women during clinical trial.
- No impact on hormonal contraception.
- Can be used during pregnancy and breastfeeding if benefits outweigh risks; data limited, but no major safety concerns identified in clinical trial.
Counseling Tips
- Discuss injection schedule and emphasis importance of adherence.
- Potential injection site reactions.
- Long-acting medication may remain in body for >12 months after stopping.
- Integrase resistance risk if patient becomes HIV-positive while on CAB-LA.
When NOT to Start CAB-LA for PrEP
- Suspected or confirmed acute HIV infection.
- Previous hypersensitivity reaction to cabotegravir.
- Coadministration with drugs where significant decreases in cabotegravir plasma concentrations may occur.
- Presence of gluteal implants that prohibit the ability to access injection site.
- Unable or unwilling to adhere to follow-up appointment schedule.
- Weight below 35 kg.
- Active hepatitis B without plan for monitoring/treatment.
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CDC Screening Recommendations for Cisgender Women Receiving Long-Acting Cabotegravir for PrEP1,3
May consider more frequent testing, if indicated.
*Recommendations of the International Antiviral Society–USA Panel suggest that routine follow-up testing for breakthrough infections while on cabotegravir PrEP should include a point-of-care rapid HIV antibody test AND a laboratory-based antigen/antibody test, but not HIV RNA testing. HIV RNA testing is not recommended for routine monitoring of PrEP effectiveness due to its low positive predictive value and the potential for false-positive results, which can lead to harmful consequences. The 2021 CDC PrEP guidelines continue to reflect HIV-1 RNA assay screening at each injectable cabotegravir PrEP visit.4
Refer to full prescribing guide for more information.
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Overview of Lenacapavir for PrEP for Cisgender Women4,5,6
Indication: FDA-approved for PrEP in HIV-negative individuals, including cisgender Black women, who may be vulnerable to HIV acquisition through sex.
Before Prescribing
- Confirm HIV-negative status via HIV antigen/antibody test and HIV RNA test.
- Assess for signs/symptoms of acute HIV infection.
- Weight ≥35 kg.
- Check for potential drug interactions with CYP3A inducers that patient may have newly started (may require lenacapavir dose adjustments).
- Assess for any known contraindications.
- Pregnancy test.
- STI screening (gonorrhea and chlamydia at all exposed sites; syphilis serology).
Dosing Schedule
On day one of initiation of lenacapavir, patient takes two 300 mg tablets of oral lenacapavir in addition to receiving two 463.6 mg/1.5 mL subcutaneous injections.
Continuation injections consist of two 463.6 mg/1.5 mL subcutaneous injections given in office every six months on set target date (± two weeks).
On day two, patient takes two 300 mg tablets of oral lenacapavir at home.
May consider calling patient on day two to assess oral adherence.
Special Considerations for Women
- Shown to be highly effective in cisgender women during clinical trial.
- Pregnancy outcomes similar to those expected for general population in PURPOSE 1 Trial.
- Insufficient data to recommend for use during breastfeeding.
Counseling Tips
- Oral tablets taken on day one may be taken in clinic under direct supervision if desired.
- Injection schedule adherence.
- Potential injection site reactions with nodule development.
- Long-acting medication may remain in body for >12 months after stopping.
When NOT to Start LEN SC for PrEP
- Suspected or confirmed acute HIV infection.
- Unable or unwilling to adhere to follow-up appointment schedule.
- Weight below 35 kg.
- Active hepatitis B without plan for monitoring/treatment.
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IAS-USA Panel Screening Recommendations for Cisgender Women Receiving Long-Acting Lenacapavir for PrEP4,5
May consider more frequent testing, if indicated.
If doses are missed, delayed or taken in conjunction with CYP3A inducers, dosage adjustments may be needed. Refer to the full prescribing information for further details regarding how to manage these types of clinical situations.
Refer to full prescribing guide for more information.
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PrEP Initiation: Standard vs. Same-Day PrEP Start7
PrEP is prescribed after lab results are reviewed, usually within seven days of the initial visit.
PrEP is prescribed at the initial visit but started only after HIV test results return.
Note: Rapid-start PrEP currently applies only to oral PrEP (i.e. TDF/FTC) due to limited data and logistical procedures associated with initiating injectable PrEP.
PrEP is prescribed and begun the same day via prescription or a clinic-provided starter pack.
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Navigating Oral PrEP Medication Access
For more information, visit Michigan’s MIPrEP Payment and Insurance Resource Guide.
Note: Effective Jan. 31, 2025, Gilead’s prescription assistance program, including Advancing Access stopped providing free TDF/FTC.
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Navigating Injectable PrEP Medication Access
With the right planning and support, injectable PrEP can be seamlessly integrated into care. However, without this foundation early challenges may make it harder to sustain its use. Below you’ll find practical tips to help you successfully incorporate injectable PrEP into your clinical practice.
Common implementation challenges:
- Increased clinic volume.
- May result in more clinic visits, specifically with every two month injectable cabotegravir for PrEP.
- Dose tracking.
- Missed or delayed doses can affect efficacy of PrEP medication.
- Shipping and pharmacy coordination.
- Medications often arrive from different pharmacies with varied timelines.
- Assign a team member (e.g., RN or PrEP navigator) to:
- Track dose schedules and manage shipment protocols.
- Monitor shipments and coordinate with the supplying pharmacy to ensure timely delivery.
- Assist in completion and submission of prior authorizations and prescription assistance program applications.
- Plan to:
- Educate and train staff before administering injections.
- Ensure sufficient staff for injection delivery.
- Use a private, climate-controlled space for injections.
- Obtain backup sample doses (if available) from the pharmaceutical company.
- Store tablets and injection kits at room temperature in a designated area.
Addressing Implementation Challenges
- Know each patient’s coverage type:
- Pharmacy benefit → specialty or long-term care pharmacy.
- Medical benefit → infusion suites or in-clinic billing.
- Explore partnerships by payer:
- Medicaid: often long-term care pharmacies.
- Medicare: specialty pharmacy or infusion support.
- Private insurance: varies, check individually.
For more information, visit Michigan’s MIPrEP Payment and Insurance Resource Guide.
Important: Due to a lack of generic options, some health insurers will not cover injectable PrEP options without prior authorization, or at all. Cost may be prohibitive.
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HIV PrEP Resources
Clinical Resources
- Preexposure prophylaxis for the prevention of HIV infection in the United States -- 2021 update: A clinical practice guideline
- Clinical Recommendation for the Use of Injectable Lenacapavir as HIV Preexposure Prophylaxis — United States, 2025
- Antiretroviral Drugs for Treatment and Prevention of HIV in Adults: 2024 Recommendations of the International Antiviral Society–USA Panel
- Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and Other HIV Prevention Strategies: Billing and Coding Guide
- National HIV Curriculum: HIV Preexposure Prophylaxis (PrEP)
- National HIV PrEP Curriculum
Financial Assistance Resources
- Michigan PrEP Payment and Insurance Resource Guide (MDHHS)
- How Can I Pay for PrEP? (HIV.gov)
- Advancing Access Program (Gilead)
- ViiVConnect (ViiV Healthcare)
- Patient Advocate Foundation: 866-512-3861
- GoodRx
Black Women and PrEP Resources
- Mahogany Blue: PrEP and Black Women
- Black AIDS Institute
- The Journal of the American Medical Association (JAMA) - Health Forum: A Call for PrEP Discussions With Black Women—Be a Gardener
- ViiV Healthcare's Risk to Reasons Initiative
- Providing for Women's Well-Being: A Sexual Health Conversation Guide for Clinicians
- Black Women’s Health Imperative: On Our Own Terms (OOOT)
Patient Resources
- My Prevention Green Book
- I Am HIV Possible
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References to Appendices
- United States Public Health Service, Centers for Disease Control and Prevention (U.S.), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (U.S.). Division of HIV/AIDS Prevention, & Preexposure Prophylaxis Work Group. (2021, December). Preexposure prophylaxis for the prevention of HIV infection in the United States -- 2021 update: A clinical practice guideline. CDC Stacks. https://stacks.cdc.gov/view/cdc/112360
- Gilead Sciences, Inc. (2024). Truvada (emtricitabine/tenofovir disoproxil fumarate): Full prescribing information. https://www.gilead.com/-/media/files/pdfs/medicines/hiv/truvada/truvada_pi.pdf
- ViiV Healthcare. (2021a). Apretude (cabotegravir extended-release injectable suspension): Full prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/215499s008lbl.pdf
- Gandhi, R. T., Landovitz, R. J., Sax, P. E., Smith, D. M., Springer, S. A., Günthard, H. F., Thompson, M. A., Bedimo, R. J., Benson, C. A., Buchbinder, S. P., Crabtree-Ramirez, B. E., Rio, C. del, Eaton, E. F., Eron, J. J., Hoy, J. F., Lehmann, C., Molina, J.-M., Jacobsen, D. M., & Saag, M. S. (2024). Antiretroviral drugs for treatment and prevention of HIV in adults: 2024 recommendations of the international antiviral society–USA panel. Journal of the American Medical Association, 333(7). https://doi.org/10.1001/jama.2024.24543
- Gilead Sciences, Inc. (2022b). Yeztugo (lenacapavir): Full prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/220020s000lbl.pdf
- ViiV Healthcare. (2025). YEZTUGO (lenacapavir) Dosing and Administration. https://www.yeztugohcp.com/dosing-administration
- University of Washington. (2025, February 13). Definitions for Same-Day and Standard HIV PrEP. National HIV PrEP Curriculum. https://www.hivprep.uw.edu/custom/hiv-prep-depth-topics/same-day-rapid-start-hiv-prep/2
The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group on the basis of race, national origin, color, sex, disability, religion, age, height, weight, familial status, partisan considerations, or genetic information. Sex-based discrimination includes, but is not limited to, discrimination based on sexual orientation, gender identity, gender expression, sex characteristics, and pregnancy.
37
MDHHS-Pub-2354 (XX-26)
Acknowledgements
This module activity was developed in collaboration with Brianna Kline, MSN, APRN, FNP-BC, AAHIVS, Kyra Sanders, MSW, and Tyffanie Walton, B.S.
Brianna Kline is a family nurse practitioner at the Wayne Health Detroit Public Health STD Clinic and serves as a Clinician Training Specialist with the Michigan site of the Midwest AIDS Education and Training Center (MATEC). She is deeply passionate about advancing HIV prevention for Black women, who face unique challenges and disproportionately high rates of HIV. Combining the power of education with culturally tailored care, Brianna believes these approaches are essential to closing prevention gaps. This toolkit is important to her because it equips health care providers with the knowledge and resources needed to confidently offer PrEP to Black women, improving access and outcomes in communities that need it most. Through her clinical and training work, Brianna aims to inspire providers to deliver compassionate care that uplifts and empowers every patient.
Kyra Sanders is the MDHHS Ending the HIV Epidemic community planner and co-creator of the Mahogany Blue campaign. Kyra is a seasoned public health expert with over 25 years of experience in HIV prevention and education. Her work centers on advancing equity, empowering people — with a special emphasis on Black women and shaping community‑driven health strategies across Michigan. Kyra turns knowledge into power and “good trouble” into lasting change.
Tyffanie Walton is the MDHHS Ending the HIV Epidemic community health educator and co-creator of the Mahogany Blue campaign. She is committed to advancing HIV prevention by centering the voices of Black women, challenging stigma and expanding access to PrEP. For her, this toolkit is more than a resource — it is a declaration that Black women deserve care rooted in dignity, equity and truth. At the same time, Tyffanie views this work as an act of justice for all communities, affirming that prevention is not a privilege but a right every person should be able to confidently claim.
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Use in People Who Inject Drugs (PWID)
Proved to be ~74% effective in preventing HIV among this population.
The Burden of HIV Among Black Women in Michigan
Geographically, the HIV epidemic remains most concentrated in the City of Detroit, which recorded a prevalence rate of 781.6 per 100,000 residents in 2024 — exceeding that of any other jurisdiction in the state by more than fourfold. Wayne, Oakland and Ingham County also exhibit markedly elevated rates, occupying positions among the top four most affected jurisdictions, while Macomb County ranks eleventh in terms of prevalence.
MDHHS HIV Prevalence Report, 2024
Communicate
Showing enthusiasm, giving a smile, and maintaining eye contact with your audience can be your best allies when it comes to telling stories that excite and pique the interest of the public: 'The eyes, chico. They never lie'. This will help you make a connection with your audience. Leave them speechless!
Side effects
Most common: nausea, headache. Less common: renal concerns, bone density loss.
Efficacy
99% prevention via sexual intercourse. 74% prevention via intravenous drug use with consistent daily dosing.
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Intersectionality adds another layer of complexity to these challenges, as Black women face the combined impacts of racial, gender and socioeconomic marginalization. Their experiences are diverse, and prevention efforts that overlook this complexity risk perpetuating the very inequities they seek to eliminate.
Intersectionality
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Approximately 24 hours, daily dosing required.
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When carrying out a presentation, two objectives must be pursued: conveying information and avoiding yawns. To achieve this, it may be a good practice to create an outline and use words that will be etched into the minds of your audience.
Use During Pregnancy and by Women of Childbearing Potential
FDA-approved and preferred for initiation before pregnancy, during pregnancy and while breastfeeding given the more robust safety and efficacy data available.
We are able to understand images from millions of years ago, even from other cultures.
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Approximately $30 per 30-day supply.
We have thousands and thousands of stories. Two-thirds of our conversations are stories.
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Demonstrate enthusiasm, outline a smile, and maintain eye contact with your audience can be your best allies when telling stories that excite and pique the interest of the public: 'The eyes, chico. They never lie'. This will help you make a connection with your audience. Leave them speechless!
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Convince 67% of the audience. This is because visual language facilitates the rapid acquisition of knowledge in an intuitive way. Could it be said that images are the key to success? Obviously.
The Burden of HIV Among Black Women in the U.S.
Black women continue to be disproportionately impacted by HIV, representing 50% of new HIV diagnoses among US women, despite comprising less than 13% of the female population. This disparity underscores the urgent need for culturally responsive and equity-driven approaches in clinical care. Among Black women nationwide, 91% of new HIV infections are attributed to heterosexual contact. Their infection rate remains the highest among all racial and ethnic groups of women. This data highlight the critical role clinicians play in addressing social determinants of health, reducing stigma and ensuring equitable access to prevention, testing and treatment services.
HIV Diagnoses, Deaths, and Prevalence: 2025 Update
Medical mistrust — often perceived as patient reluctance — must be recognized as a rational response to a legacy of racialized harm in health care, from historical abuses like the Tuskegee Syphilis Study to ongoing disparities in treatment, pain management and maternal care.
Medical Mistrust
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We need to interact with each other. We learn collaboratively.
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Dosage and dosing schedule
A single tablet of 200 mg emtricitabine/300 mg TDF taken once daily.Self-administered by patient.
Type of medication
Oral tablet (taken by mouth).
Other considerations
Lower cost, well-studied.
20XX
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Structural racism is the system-wide embedding of racial inequality in institutions, policies and practices that disadvantage some groups while privileging others. It permeates nearly every aspect of daily life — limiting access to quality health care, affordable housing, stable employment and preventive services like PrEP. These barriers are not accidental but rooted in policies, institutional practices and systems of care that disproportionately harm Black communities.
Structural racism
Surprise
Interactivity and animation can be your best allies when creating tables, infographics, or graphics that help provide context to information and simplify data for translation to your audience.We are visual beings and find it easier to 'read' images than written text.
The Burden of HIV Among Black Women in Michigan
HIV prevalence in Michigan demonstrates profound racial and geographic disparities, with Black/African American communities bearing the highest burden. According to 2024 data, Black women in Michigan have an HIV prevalence rate of 340.3 per 100,000 residents making them 15 times more likely to be living with HIV than white women, who have a rate of just 22.5 per 100,000 residents. Black women also experience higher HIV diagnosis rates, with a diagnosis rate of 8.9 per 100,000 residents making them almost nine times more likely to be diagnosed with HIV than white women, who have a rate of just 0.9 per 100,000 residents. This disparity draws light to the systemic barriers Black women often face in accessing HIV prevention, testing, and treatment services.
MDHHS HIV Prevalence Report, 2024
PrEP Is for Black Women, Too!
Brianna Kline
Created on April 6, 2026
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Transcript
PrEP Is for Black Women, Too!
Pre-Exposure Prophylaxis (PrEP) for the Prevention of Human Immunodeficiency Virus (HIV)
Learning module activity
Published ____ 2026
A Module Course Designed for Health Care Providers Who Provide Health Care Services to Black Women
Intended Audience
This module activity is intended for use by prescribing clinicians; however, health care professionals involved in patient education may also benefit from the information and tools provided. This toolkit is intended as a guide for PrEP-naïve individuals. For complete guidance for patients newly starting, or previously taking, HIV PrEP, please refer to the PrEP clinical guidelines.
Language
Throughout this module activity, the term “women” specifically refers to Black cisgender women. This intentional focus is not meant to exclude transgender women, nonbinary individuals or others who may benefit from HIV prevention efforts but rather to highlight the urgent need to address the unique experiences, health disparities and structural inequities faced by Black cisgender women. Despite being disproportionately affected by HIV, this group is often overlooked in research, policy and clinical guidance. Centering Black cisgender women allows us to directly confront these gaps and provide tailored, affirming and impactful care strategies.
Disclosures
The development of this module activity is supported by grant funding issued by the Michigan Department of Health and Human Services (MDHHS).
No one involved in the development of this toolkit has a relevant financial relationship to disclose with an ineligible company. Brand names of medications are used within this toolkit solely for educational purposes.
Although this activity is designed to offer comprehensive guidance on delivering PrEP services to Black women, users are encouraged to consult full prescribing information and relevant clinical guidelines for additional context and detailed recommendations.
Introduction
Introduction
HIV PrEP is a powerful tool — but its power is only realized when it reaches the people who need it most. For Black women, that access remains far too limited. Despite clear evidence of PrEP’s effectiveness, and national guidelines recommending it for all sexually active individuals, many Black women are still left out of the conversation — and left vulnerable to HIV acquisition.
Black women are disproportionately impacted by HIV. In 2023, despite making up only 13% of the United States (US) population, Black women accounted for half of all new HIV diagnoses among heterosexual cisgender women nationwide. In Michigan alone, the HIV incidence rate among Black women was more than nine times higher than that of white women. This is not just a statistic. This is a call to action.
Barriers — such as stigma, lack of awareness, medical mistrust and systemic inequities — continue to limit PrEP access. But one of the most powerful tools to overcome those barriers is YOU.
As a health care provider, YOU can play a valuable role in changing the trajectory of HIV for Black women.
By integrating PrEP into your everyday practice, you are not just following evidence-based guidelines, but also showing your patients that they are seen, heard and valued.
This module activity, created in partnership with the Mahogany Blue campaign, was designed to support you in this effort. It's here to help you feel confident and equipped to talk about PrEP, prescribe it and ultimately help protect the health and futures of Black women in your care. This activity aims to empower clinicians to be proactive allies in closing the prevention gap for Black women and to promote equity, autonomy and PrEP access.
Mahogany Blue
The Mahogany Blue campaign presents an opportunity to promote PrEP utilization among Black women by decreasing stigma, medical mistrust, the lack of awareness about PrEP and insurance challenges. The campaign is dedicated to empowering women by recognizing the unique barriers Black women encounter in accessing HIV prevention tools like PrEP. Through heightened awareness, advocacy for research inclusive of stratified data for Black women and community engagement, MDHHS aims to implement meaningful change and ensure equitable health care access for all.
Mahogany Blue
The Mahogany Blue campaign is an adaptation of the Centers for Disease Control and Prevention’s (CDC) She's Well campaign, which is now a component of the CDC’s overall Let’s Stop HIV Together campaign. Mahogany is a nod to not only the various shades of Black women, but also the resiliency of Black women. “Blue” references PrEP medication that has traditionally been recognized as a blue pill. The campaign features Black women of various hues, shapes and ages in informational materials customized for Wayne County. While the original PrEP pill was blue in color, PrEP now comes in many colors and forms. Patients and providers can work together to determine the best form of PrEP for their needs.
The Burden of HIV Among Black Women
Black women continue to be disproportionately impacted by HIV, representing 50% of new HIV diagnoses among US women, despite comprising less than 13% of the female population. Their infection rate remains the highest among all racial and ethnic groups of women. This data highlight the critical role clinicians play in addressing social determinants of health, reducing stigma and ensuring equitable access to prevention, testing and treatment services.
To effectively support Black women in HIV prevention, it is critical that clinicians understand the structural and social drivers that heighten their vulnerability. Please take the time to click on each of the three topic icons below to learn more about these important concepts:
Medical Mistrust
Intersectionality
Structural Racism
Clinicians have a unique opportunity and critical responsibility to tailor HIV prevention in a way that validates these realities, fosters trust and centers the lived experiences of Black women.
The Burden of HIV Among Black Women in the US and the State of Michigan
PrEP is the use of antiretroviral medications to prevent HIV acquisition among persons who could be exposed to HIV via sexual intercourse and/or the use of intravenous drugs. PrEP can reduce HIV acquisition through sex by 99% and from injection drug use by 74%. Despite a clear need, Black women continue to be underserved by HIV prevention strategies such as PrEP.
In 2024, women accounted for only 9% of PrEP users, an especially low proportion when compared with the 91% of users who were men. Data on PrEP uptake among Black women is even more limited, obscuring the true extent of this gap. This disparity reflects a critical missed opportunity to deliver effective HIV prevention to women, particularly Black women, who remain disproportionately affected by HIV in the U.S.
Understanding PrEP for HIV Prevention
Recommendation for Use
The U.S. Preventive Services Task Force provides a grade A recommendation encouraging clinicians to prescribe PrEP to individuals who are at increased vulnerability to HIV acquisition. Several options for PrEP are available for use in Black women.
Available PrEP Options for Use in Women
Important Note: Tenofovir alafenamide (TAF/FTC) [Brand name: Descovy] is a PrEP medication that is not currently FDA approved for use in cisgender women due to previously lacking efficacy data. However, studies are ongoing.According to the International Antiviral Society–USA (IAS–USA) Panel, a 2025 analysis showed an 89% reduction in HIV acquisition risk among cisgender women who had biomarker evidence of taking an average of at least two doses of tenofovir alafenamide/emtricitabine (TAF/FTC) per week. The PURPOSE 1 clinical trial demonstrated a strong link between TAF/FTC adherence and HIV protection. As a result, the IAS now recommends TAF/FTC for HIV prevention from vaginal exposure in individuals for whom tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) is either contraindicated or not preferred. Due to non-FDA approval, the use of TAF/FTC for HIV prevention in cisgender women is not covered in this toolkit. For more details, consult the IAS–USA guidelines and the full prescribing information for TAF/FTC.
PrEP is a powerful tool in the primary care toolkit — especially for supporting the health and well-being of Black women.
Despite facing unique social and structural challenges that increase their risk for HIV, Black women are too often left out of patient-provider discussions about PrEP. This gap in care contributes to ongoing disparities.
As health care providers, it is essential to view PrEP as a routine part of preventive care and not as a specialized or stigmatized intervention. All licensed health care providers are authorized to prescribe PrEP, yet many patients are unnecessarily referred to specialists, creating avoidable barriers to access.
By incorporating PrEP into everyday checkups, like blood pressure screenings or Pap smears, we can help normalize its use, reduce stigma and empower patients with more choices to protect their sexual health.
Tenofovir Disoproxil Fumarate and Emtricitabine (TDF/FTC) Brand name: Truvada
Dosage and dosing schedule
Type of medication
Duration of action
Side effects
Efficacy
Use in People Who Inject Drugs (PWID)
Use During Pregnancy and by Women of Childbearing Potential
Other considerations
Cost
Click here for more prescribing information:
Clinical Considerations
Initiating PrEP begins with conducting a thorough sexual health history in a manner that is nonjudgmental, affirming and free from assumptions about behavior, identity or risk.
Many Black women are overlooked for PrEP simply because clinicians fail to ask or offer. Normalize PrEP as part of routine preventive care by proactively offering it to all women who may benefit, regardless of whether they explicitly request it. Doing so shifts the burden away from the patient and ensures that HIV prevention is equitably accessible.
The figures on the next page present questions intended to help assess behaviors and factors associated with increased HIV vulnerability. This information is typically gathered during sexual and social history-taking. While these conversations can feel uncomfortable for both providers and patients, open and nonjudgmental dialogue is essential to reducing stigma around sexual health.
These tools are designed to support you in identifying whether discussing and prescribing PrEP may be appropriate for your patient.
It’s important to recognize that some patients may not feel comfortable disclosing certain information. Therefore, if a patient expresses interest in PrEP — even if they answer “no” to the following questions — they should still be offered and prescribed PrEP if they desire it.
15
Assessing Sexually Active Patients10
Assessing Patients Who Inject Drugs10
Other factors to consider that may warrant the benefit of PrEP:
16
Baseline Assessments Prior To Prescribing PrEP10
Before starting PrEP, perform essential baseline assessments to ensure safe, appropriate and person-centered care:
These baseline labs and assessments help build a strong clinical foundation for effective and safe PrEP prescribing.
17
Navigating PrEP Options11
When discussing PrEP with Black women, health care providers should take a holistic and person-centered approach that considers the benefits, risks and limitations of each available option.
Daily oral PrEP offers effective HIV prevention, especially when adherence is consistent, while long-acting injectable PrEP may better suit patients with challenges related to daily pill-taking or privacy concerns.
It is essential to evaluate potential side effects, drug interactions and access barriers such as insurance coverage, clinic access or medical mistrust. Additionally, understanding how each option aligns with a patient’s lifestyle, reproductive goals and health care preferences ensures the chosen method supports both autonomy and overall well-being.
Providers should create a safe space for open dialogue and shared decision-making, recognizing the historical and ongoing structural factors that may influence Black women's health care experiences.
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19
Risk-Based vs. Reason-Based Language12,13
Risk-based language often centers judgment and reinforces harmful stereotypes, particularly those rooted in racial and gender bias.
In contrast, reason-based language acknowledges that individuals engage in behaviors for a variety of valid, personal and contextual reasons — such as pleasure, connection, autonomy or survival. This approach invites open dialogue, empowers patients to share their experiences without fear of blame or shame, and centers their values and goals.
Shifting from risk-based to reason-based language when collecting sexual health histories from Black women is critical to fostering trust, reducing stigma and promoting equitable care.
Below, please find examples adapted from ViiV Healthcare's Risk to Reasons initiative demonstrating how you may consider adjusting your use of language related to HIV/STIs.
Scan the QR code for more information on ViiV Healthcare's Risk to Reasons initiative.
20
21
Culturally Responsive Communication Strategies
Culturally responsive communication is essential for building trust and improving PrEP uptake among Black women. Clinicians should approach every interaction with a trauma-informed lens, recognizing that past experiences with discrimination, stigma or neglect may influence how patients engage with care.
Centering autonomy means affirming that Black women are the best experts on their own bodies and lives, and creating space for informed, collaborative decision-making.
Avoid making assumptions about a patient’s sexual orientation, relationship status or possibility of HIV acquisition — these factors are not always visible or volunteered. Instead, normalize prevention by saying, “I offer PrEP to all my patients because everyone deserves access to prevention tools,” rather than making judgments about who appears to need it.
Use open-ended questions and practice active listening to create a safe, respectful dialogue. To deepen trust and accountability, partner with Black-led community organizations that can help bridge cultural and systemic gaps in care.
For example, the Black Women’s Health Imperative’s initiative On Our Own Terms (OOOT) is a network of informed organizations and experts who focus on the prevention and care of HIV for Black cisgender and transgender women.
Scan the QR code for more information on the Black Women’s Health Imperative OOOT initiative.
22
Addressing Barriers To PrEP Access
Despite its proven effectiveness in preventing HIV, access to PrEP remains limited for many individuals who could benefit from it. A range of structural, systemic and personal barriers — including stigma, cost, lack of provider awareness and limited health care access — can hinder PrEP uptake and adherence. Identifying these challenges is essential to developing focused strategies that improve equitable access. The table below outlines common barriers to PrEP and corresponding approaches to help address them.
23
PrEP With a Purpose
Black women deserve access to the full spectrum of HIV prevention tools, including PrEP. Health care providers are pivotal in making that access a reality.
As stewards of health and equity, you have the power to transform clinical spaces into affirming, inclusive environments where Black women feel seen, heard and protected.
This toolkit is more than a resource — it’s a call to action. By normalizing PrEP conversations, using reason-based and empowering language and addressing systemic barriers head-on, you help close the HIV prevention gap and affirm the dignity and autonomy of every Black woman in your care.
Your commitment to integrating PrEP into routine preventive care is not just a clinical best practice — it is an act of equity, advocacy and justice.
PrEP is for Black women, too, and together, we can ensure it becomes a trusted, accessible and empowering option for every woman who desires it.
24
References
25
Appendices
26
Summary of Tenofovir Disoproxil Fumarate/Emtricitabine (TDF/FTC) as PrEP for Cisgender Women1,2
Indication: FDA-approved for PrEP in HIV-negative individuals, including cisgender Black women, who may be vulnerable to HIV acquisition through sex or injection drug use.
Before Prescribing
Dosing One tablet by mouth daily, with or without food. Takes about three weeks of daily dosing to reach maximum protective levels in cervicovaginal tissues.
Special Considerations for Women Hormonal Contraceptives:
- No impact on hormonal contraception.
- Encourage dual protection with condoms to prevent STIs and pregnancy.
Pregnancy and Breastfeeding:Counseling Tips
Refer to full prescribing guide for more information.
When NOT to Start TDF/FTC for PrEP
27
CDC Screening Recommendations for Cisgender Women Taking Oral Tenofovir Disoproxil Fumarate and Emtricitabine (TDF/FTC) for PrEP1,2
May consider more frequent testing, if indicated.
28
Summary of Cabotegravir (CAB-LA) as PrEP for Cisgender Women1,3
Indication: FDA-approved for PrEP in HIV-negative individuals, including cisgender Black women, who may be vulnerable to HIV acquisition through sex.
Before Prescribing
Dosing Schedule
Oral lead-in (optional to assess tolerability): 30 mg oral cabotegravir daily for four weeks.
Inject 3 mL via gluteal muscle every two months in office on a set target date (± one week) thereafter.
Inject 600 mg/ 3 mL via ventrogluteal or dorsogluteal muscle.
Inject 3 mL via gluteal muscle one month later.
Special Considerations for Women
Counseling Tips
When NOT to Start CAB-LA for PrEP
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CDC Screening Recommendations for Cisgender Women Receiving Long-Acting Cabotegravir for PrEP1,3
May consider more frequent testing, if indicated.
*Recommendations of the International Antiviral Society–USA Panel suggest that routine follow-up testing for breakthrough infections while on cabotegravir PrEP should include a point-of-care rapid HIV antibody test AND a laboratory-based antigen/antibody test, but not HIV RNA testing. HIV RNA testing is not recommended for routine monitoring of PrEP effectiveness due to its low positive predictive value and the potential for false-positive results, which can lead to harmful consequences. The 2021 CDC PrEP guidelines continue to reflect HIV-1 RNA assay screening at each injectable cabotegravir PrEP visit.4
Refer to full prescribing guide for more information.
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Overview of Lenacapavir for PrEP for Cisgender Women4,5,6
Indication: FDA-approved for PrEP in HIV-negative individuals, including cisgender Black women, who may be vulnerable to HIV acquisition through sex.
Before Prescribing
Dosing Schedule
On day one of initiation of lenacapavir, patient takes two 300 mg tablets of oral lenacapavir in addition to receiving two 463.6 mg/1.5 mL subcutaneous injections.
Continuation injections consist of two 463.6 mg/1.5 mL subcutaneous injections given in office every six months on set target date (± two weeks).
On day two, patient takes two 300 mg tablets of oral lenacapavir at home.
May consider calling patient on day two to assess oral adherence.
Special Considerations for Women
Counseling Tips
When NOT to Start LEN SC for PrEP
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IAS-USA Panel Screening Recommendations for Cisgender Women Receiving Long-Acting Lenacapavir for PrEP4,5
May consider more frequent testing, if indicated.
If doses are missed, delayed or taken in conjunction with CYP3A inducers, dosage adjustments may be needed. Refer to the full prescribing information for further details regarding how to manage these types of clinical situations.
Refer to full prescribing guide for more information.
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PrEP Initiation: Standard vs. Same-Day PrEP Start7
PrEP is prescribed after lab results are reviewed, usually within seven days of the initial visit.
PrEP is prescribed at the initial visit but started only after HIV test results return.
Note: Rapid-start PrEP currently applies only to oral PrEP (i.e. TDF/FTC) due to limited data and logistical procedures associated with initiating injectable PrEP.
PrEP is prescribed and begun the same day via prescription or a clinic-provided starter pack.
33
Navigating Oral PrEP Medication Access
For more information, visit Michigan’s MIPrEP Payment and Insurance Resource Guide.
Note: Effective Jan. 31, 2025, Gilead’s prescription assistance program, including Advancing Access stopped providing free TDF/FTC.
34
Navigating Injectable PrEP Medication Access
With the right planning and support, injectable PrEP can be seamlessly integrated into care. However, without this foundation early challenges may make it harder to sustain its use. Below you’ll find practical tips to help you successfully incorporate injectable PrEP into your clinical practice.
Common implementation challenges:
Addressing Implementation Challenges
For more information, visit Michigan’s MIPrEP Payment and Insurance Resource Guide.
Important: Due to a lack of generic options, some health insurers will not cover injectable PrEP options without prior authorization, or at all. Cost may be prohibitive.
35
HIV PrEP Resources
Clinical Resources
Financial Assistance Resources
Black Women and PrEP Resources
Patient Resources
36
References to Appendices
The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group on the basis of race, national origin, color, sex, disability, religion, age, height, weight, familial status, partisan considerations, or genetic information. Sex-based discrimination includes, but is not limited to, discrimination based on sexual orientation, gender identity, gender expression, sex characteristics, and pregnancy.
37
MDHHS-Pub-2354 (XX-26)
Acknowledgements
This module activity was developed in collaboration with Brianna Kline, MSN, APRN, FNP-BC, AAHIVS, Kyra Sanders, MSW, and Tyffanie Walton, B.S.
Brianna Kline is a family nurse practitioner at the Wayne Health Detroit Public Health STD Clinic and serves as a Clinician Training Specialist with the Michigan site of the Midwest AIDS Education and Training Center (MATEC). She is deeply passionate about advancing HIV prevention for Black women, who face unique challenges and disproportionately high rates of HIV. Combining the power of education with culturally tailored care, Brianna believes these approaches are essential to closing prevention gaps. This toolkit is important to her because it equips health care providers with the knowledge and resources needed to confidently offer PrEP to Black women, improving access and outcomes in communities that need it most. Through her clinical and training work, Brianna aims to inspire providers to deliver compassionate care that uplifts and empowers every patient.
Kyra Sanders is the MDHHS Ending the HIV Epidemic community planner and co-creator of the Mahogany Blue campaign. Kyra is a seasoned public health expert with over 25 years of experience in HIV prevention and education. Her work centers on advancing equity, empowering people — with a special emphasis on Black women and shaping community‑driven health strategies across Michigan. Kyra turns knowledge into power and “good trouble” into lasting change.
Tyffanie Walton is the MDHHS Ending the HIV Epidemic community health educator and co-creator of the Mahogany Blue campaign. She is committed to advancing HIV prevention by centering the voices of Black women, challenging stigma and expanding access to PrEP. For her, this toolkit is more than a resource — it is a declaration that Black women deserve care rooted in dignity, equity and truth. At the same time, Tyffanie views this work as an act of justice for all communities, affirming that prevention is not a privilege but a right every person should be able to confidently claim.
Index
Audio
Chart + Text
Text + Image
Embedded Content
Table + Text
Highlighted Phrase
Interactive Question
List / Processes
Section
Conclusions
Video
Relevant Data
Close
Text + Icons
Timeline
Use an image
And use this space to describe it. You can upload an image from your computer or use the resources available in Genially, on the left side of the tool. Amaze everyone!Did you know that besides using our resources, you can add any visual elements you want to complement the information? Try it from the Image or Resources menus!
Here you can include a relevant data to highlight
Here you can include a relevant data to highlight
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WOW Effect
'Your content is liked, but it only engages if it's interactive' - Genially
Here you can include a relevant data to highlight
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Here you can put a highlighted title
Bring your content to life and take it to the next level
Describe the problem you are going to solve and, above all,the reason why your idea is interesting
Need more reasons to create dynamic content? Well: 90% of the information we assimilate comes through sight, and we retain 42% more information when the content is in motion. When giving a presentation, two objectives should be pursued: conveying information and avoiding yawns. A good practice for this could be creating an outline and using words that engrave in the minds of your audience.If you want to provide additional information or develop the content in more detail, you can do so through your verbal presentation. We recommend that you train your voice and rehearse: the best improvisation is always the most worked! Showing enthusiasm, drawing a smile, and maintaining eye contact with your audience can be your best allies when telling stories that excite and pique the interest of the public: 'The eyes, kid. They never lie.' This will help you 'match' with your audience. Leave them speechless!
Here you can put a highlighted title, something that captivates your audience
Interactivity and animation can be your best allies when creating tables, infographics, or graphics that help provide context to information and simplify data for translation to your audience.
What you read: Interactivity and animation can turn the most boring content into something fun. At Genially, we use AI (Awesome Interactivity) in all our designs, so you can level up with interactivity and turn your content into something that adds value and engages.Our brain is biologically wired to process visual content. Almost 50% of our brain is involved in processing visual stimuli.
Anima tu contenido y llévalo al siguiente nivel
'Including citations always enhances our presentation.Breaks the monotony'
- Always cite the author
Relevant Data
+85k
+45k
+190
This is how you'll keep your audience's attention
...Even if you explain it orally later
You can present numbers in this way
Show enthusiasm, smile, and maintain eye contact with your audience: 'The eyes, chico. They never lie'.
If you are going to present live, we recommend that you train your voice and rehearse: the best improvisation is always the most worked out!.
You can create a diagram to synthesize the content and use words that will be etched in the minds of your audience.
+24K
+190
This is how you will keep your audience's attention and the data will be engraved in their brains
You can present figures in this way even if you later explain it orally
Use timelines...
20XX
20XX
20XX
20XX
20XX
Surprise
Communicate
Design
Structure
Plan
Contextualize your topic with a subtitle
Contextualize your topic with a subtitle
Contextualize your topic with a subtitle
Contextualize your topic with a subtitle
Contextualize your topic with a subtitle
To tell stories in an orderly, hierarchical, structured, and concise manner.These are the pillars for carrying out a successful presentation.
20XX
Plan
20XX
A step-by-step timeline
Structure
20XX
You can briefly describe what the timeline of your presentation consists of and orally present the milestones achieved so that no one falls asleep.
Design
20XX
Communicate
20XX
Amaze
Describe the problem you are going to solve and, above all, why your idea is interesting
Measure results and experience
Generate experiences with your content
While you shouldn't overuse bulletpoints, icons and schemes can be great allies when telling stories. You will keep your audience's attention and the data will be etched in their brains.
Engage and amaze your audience
Has a WOW effect. Very WOW
+ info
10%
Use this space to briefly describe your chart and its evolution.
50%
Statistics convey professionalism and a greater sense of truthfulness.
70%
A plus: always try to include the source.
Write here a title
Social beings
Narrative beings
Visual beings
Insert a video
Describe the problem you are going to solve and, above all, why your idea is interesting
Measure results and experience
Generate experiences with your content
While you shouldn't overuse bulletpoints, icons and schemes can be great allies when telling stories. You will keep your audience's attention and the data will be etched in their brains.
Engage and amaze your audience
Has a WOW effect. Very WOW
+ info
Write a title here
It is essential to make the relevant checks. Not a single typo should be left!
The tone is usually formal and the vocabulary technical, so keep that in mind when writing.
This is a paragraph ready to contain creativity, experiences, and great stories.
Embedded Content
Map
Music
Social Network
Interactive Question
Interactive Question
Interactive Question
Interactive Question
Conclusion
Did you know that Genially allows you to share your creation directly, without the need for downloads? Ready for your audience to view it on any device and share it anywhere.
A great presentation:
'Your content is liked, but it engages much more when it is interactive'-Genially
Remember to publish!
Write a great headline
Write an awesome subtitle here to provide context
Use this space to add some awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions! Premium tip: If you want to gather insights on how your audience interacts, remember to enable user tracking in the Analytics preferences. Let the communication flow!
Use this space to highlight super-relevant data.
Use in People Who Inject Drugs (PWID)
Proved to be ~74% effective in preventing HIV among this population.
The Burden of HIV Among Black Women in Michigan
Geographically, the HIV epidemic remains most concentrated in the City of Detroit, which recorded a prevalence rate of 781.6 per 100,000 residents in 2024 — exceeding that of any other jurisdiction in the state by more than fourfold. Wayne, Oakland and Ingham County also exhibit markedly elevated rates, occupying positions among the top four most affected jurisdictions, while Macomb County ranks eleventh in terms of prevalence.
MDHHS HIV Prevalence Report, 2024
Communicate
Showing enthusiasm, giving a smile, and maintaining eye contact with your audience can be your best allies when it comes to telling stories that excite and pique the interest of the public: 'The eyes, chico. They never lie'. This will help you make a connection with your audience. Leave them speechless!
Side effects
Most common: nausea, headache. Less common: renal concerns, bone density loss.
Efficacy
99% prevention via sexual intercourse. 74% prevention via intravenous drug use with consistent daily dosing.
Attention! At Genially, we use AI (Awesome Interactivity) in all our designs, so you can level up with interactivity and turn your content into something that adds value and engages.
Intersectionality adds another layer of complexity to these challenges, as Black women face the combined impacts of racial, gender and socioeconomic marginalization. Their experiences are diverse, and prevention efforts that overlook this complexity risk perpetuating the very inequities they seek to eliminate.
Intersectionality
20XX
Design
If you want to provide additional information or develop the content in more detail, you can do so through your oral presentation.We recommend that you practice your voice and rehearse: the best improvisation is always the most worked!
Duration of action
Approximately 24 hours, daily dosing required.
20XX
Structure
When carrying out a presentation, two objectives must be pursued: conveying information and avoiding yawns. To achieve this, it may be a good practice to create an outline and use words that will be etched into the minds of your audience.
Use During Pregnancy and by Women of Childbearing Potential
FDA-approved and preferred for initiation before pregnancy, during pregnancy and while breastfeeding given the more robust safety and efficacy data available.
We are able to understand images from millions of years ago, even from other cultures.
Design
If you want to provide additional information or develop the content in more detail, you can do so through your oral presentation.We recommend that you practice your voice and rehearse: the best improvisation is always the most worked!
Write a great headline
Write an awesome subtitle here to provide context
Use this space to add some awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions! Premium tip: If you want to get insights on how your audience interacts, remember to enable user tracking from the Analytics preferences. Let the communication flow!
Use this space to highlight super-relevant data.
Cost
Approximately $30 per 30-day supply.
We have thousands and thousands of stories. Two-thirds of our conversations are stories.
Plan
What you read: interactivity and animation can make the most boring content fun. At Genially, we use AI (Awesome Interactivity) in all our designs, so you can level up with interactivity and turn your content into something that adds value and engages.
20XX
Communicate
Demonstrate enthusiasm, outline a smile, and maintain eye contact with your audience can be your best allies when telling stories that excite and pique the interest of the public: 'The eyes, chico. They never lie'. This will help you make a connection with your audience. Leave them speechless!
Structure
When carrying out a presentation, two objectives must be pursued: conveying information and avoiding yawns. To achieve this, it may be a good practice to create an outline and use words that engrave in the minds of your audience.
Visual accompaniment...
Convince 67% of the audience. This is because visual language facilitates the rapid acquisition of knowledge in an intuitive way. Could it be said that images are the key to success? Obviously.
The Burden of HIV Among Black Women in the U.S.
Black women continue to be disproportionately impacted by HIV, representing 50% of new HIV diagnoses among US women, despite comprising less than 13% of the female population. This disparity underscores the urgent need for culturally responsive and equity-driven approaches in clinical care. Among Black women nationwide, 91% of new HIV infections are attributed to heterosexual contact. Their infection rate remains the highest among all racial and ethnic groups of women. This data highlight the critical role clinicians play in addressing social determinants of health, reducing stigma and ensuring equitable access to prevention, testing and treatment services.
HIV Diagnoses, Deaths, and Prevalence: 2025 Update
Medical mistrust — often perceived as patient reluctance — must be recognized as a rational response to a legacy of racialized harm in health care, from historical abuses like the Tuskegee Syphilis Study to ongoing disparities in treatment, pain management and maternal care.
Medical Mistrust
Write a great headline
Write an awesome subtitle here to provide context
Use this space to add some awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions! Premium tip: If you want to gather insights on how your audience interacts, remember to enable user tracking in the Analytics preferences. Let the communication flow!
Use this space to highlight super-relevant data.
We need to interact with each other. We learn collaboratively.
Did you know... We retain 42% more information when content is interactive? It is perhaps the most effective resource to capture your audience's attention.
Dosage and dosing schedule
A single tablet of 200 mg emtricitabine/300 mg TDF taken once daily.Self-administered by patient.
Type of medication
Oral tablet (taken by mouth).
Other considerations
Lower cost, well-studied.
20XX
Surprise
Interactivity and animation can be your best allies when creating tables, infographics, or graphics that help provide context to information and simplify data for presentation to your audience.We are visual beings and find it easier to 'read' images than to read written text.
20XX
Plan
What you read: interactivity and animation can make the most boring content fun. At Genially, we use AI (Awesome Interactivity) in all our designs, so you can level up with interactivity and turn your content into something valuable and engaging.
Structural racism is the system-wide embedding of racial inequality in institutions, policies and practices that disadvantage some groups while privileging others. It permeates nearly every aspect of daily life — limiting access to quality health care, affordable housing, stable employment and preventive services like PrEP. These barriers are not accidental but rooted in policies, institutional practices and systems of care that disproportionately harm Black communities.
Structural racism
Surprise
Interactivity and animation can be your best allies when creating tables, infographics, or graphics that help provide context to information and simplify data for translation to your audience.We are visual beings and find it easier to 'read' images than written text.
The Burden of HIV Among Black Women in Michigan
HIV prevalence in Michigan demonstrates profound racial and geographic disparities, with Black/African American communities bearing the highest burden. According to 2024 data, Black women in Michigan have an HIV prevalence rate of 340.3 per 100,000 residents making them 15 times more likely to be living with HIV than white women, who have a rate of just 22.5 per 100,000 residents. Black women also experience higher HIV diagnosis rates, with a diagnosis rate of 8.9 per 100,000 residents making them almost nine times more likely to be diagnosed with HIV than white women, who have a rate of just 0.9 per 100,000 residents. This disparity draws light to the systemic barriers Black women often face in accessing HIV prevention, testing, and treatment services.
MDHHS HIV Prevalence Report, 2024