HIV Prevention and Education Needed for Young, Female Populations in the U.S.
December 1, 2025 7 minutes read
By Melinda Young
Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is no longer an epidemic in the United States, but some parts of the country and some populations still have high rates of the disease among young women. Family planning and family medicine providers need to be aware of risk to young Black women and adolescents and provide thorough HIV prevention counseling, new research suggests.1
HIV incidence in the South accounts for about half of all new HIV cases in the United States, according to 2022 data. In Alabama, one in four cases of HIV are among people between the ages of 13 and 24 years, with Black individuals accounting for more than 60% of incident HIV cases.1 The solution to lowering those numbers is to raise awareness of HIV prevention among that young population. Physicians can talk with their patients about HIV and the highly effective biomedical prevention strategy of HIV pre-exposure prophylaxis (PrEP).
“If we look at HIV incidents since the 1990s, there’s a trend for the state of Alabama, and many similar states that are rural in the Southeast, of having absolute numbers of infections that are not so high — but they have not changed over the decades,” says Lynn T. Matthews, MD, MPH, professor in the division of infectious diseases at Yale University School of Medicine in New Haven, CT. Matthews’ research for this study was conducted while she was on the faculty at the University of Alabama at Birmingham.
The lack of change is notable because a great deal has changed in preventing and treating HIV during the past three decades. For example, testing for HIV is easier, and there is an excellent prevention strategy called PrEP. When data show that incidence rates have not changed in certain geographic areas or in certain populations, it suggests that some people at risk of HIV infection are falling through the cracks. “The populations disproportionately affected are people of color and young people, as well,” Matthews says. “Look at who in this country is getting PrEP or HIV prevention interventions, and it tends to be white men — rather than these other populations who are disproportionately impacted.”
One obstacle is knowledge. Many people are unaware that PrEP exists, or they may think it is a drug only for sexual minority populations instead of anyone who could be exposed to HIV, she notes. “It’s associated with other identities and behaviors that are stigmatized,” she says. “For providers, they also see the same commercials and think about practices for certain populations that are ‘high risk.’” But PrEP is for many people who may not have classic risk factors, Matthews says.
The cost of PrEP is another barrier to care. “In states where a lot of people don’t have health insurance and who may not be eligible for Medicaid, they might not have PrEP covered,” she says. “Even if the medication is covered, PrEP still comes with clinic visits and STI testing that may or may not be covered.”
The third important barrier is stigma. “There is so much stigma that people don’t talk about it very much,” Matthews says. “People may travel very far to get their HIV care just so they can be in a different community, and they may not be open about it.” Stigma contributes to people within a community learning about their own potential risk because they are unaware of who else might be vulnerable to HIV or living with HIV.
Obstacles to HIV preventive care have created a situation where young Black women are being infected with HIV when it could be prevented if barriers were addressed. “We’re not implementing all the tools we have to dramatically reduce HIV,” Matthews says. Changes in clinician practice and in government priorities could help end some of the inequities.
For instance, a lower-effort intervention would be to train providers to think about HIV and to test for HIV and to have conversations with patients about PrEP, Matthews suggests. “There are community-based organizations (CBOs) that are focused on HIV and are doing a great job of working with people already living with HIV,” she says. “HIV infection specialists are skilled and adept with PrEP, but they’re not seeing the general population that is touched by HIV in some way, whether through a partner, etc.”
Part of the solution is for experts to educate clinicians who see young women for general healthcare and reproductive care needs about HIV risk and prevention strategies for their patient populations. “A lot of women see OB/GYNs and see pediatricians and family medicine doctors and those providers,” Matthews explains. “Training those providers to think about offering HIV testing and having conversations about PrEP would be a good opportunity to reach more people with this HIV prevention strategy.”
Training these physicians to enhance their skills in assessing sexual health in adolescents and young women is one strategy, since these are the clinicians who do most of the primary care in rural America, she adds. OB/GYNs already test women for HIV during their first and third trimesters of pregnancy. They also could have conversations about PrEP so women who may be at risk of HIV could use that during pregnancy, Matthews says.
“PrEP is very safe and effective during pregnancy and breastfeeding, so they could use that while they are pregnant,” she adds. “And then, moving the needle up, to reach women who are thinking about becoming pregnant would be great because they could think about HIV prevention at the same time.”
Working with community advisory boards that included peers from the populations targeted in the study, researchers developed an intervention with training materials and tools.1 They helped family medicine providers learn about taking patients’ sexual history, increased their own knowledge about PrEP, and increased prescriptions, Matthews says.
“The next steps after these pilot studies is to prepare a larger trial using the implementation strategies we used in these clinics and see if we can improve PrEP use in adolescents and young women,” she adds. Here are five steps in the training strategy:
1. Create locally informed sexual history videos. “We found videos of sexual health discussions that some of our peers had developed or that were available online,” Matthews says. “Some were from the West Coast or Northeast. None of them had anyone who seemed Southern, and they were out of date.”
Their community advisory board asked researchers to create their own videos, using local patient actors from their community. “So, we made them with support from the family medicine department at the University of Alabama Birmingham,” she says. “There were six different people who were in three pairs, and each pair did a take of a video where the interaction was less ideal and then a video with a more optimized interaction.”
The people portraying providers were their colleagues and doctors. The people portraying patients were patient actors who came from a pool of patient actors that the medical center has available for different activities.
2. Conduct an HIV epidemiology review. The community advisory board recommended investigators review local HIV epidemiology to refine messages on the importance of HIV prevention. These messages could be included in training of PrEP champions, who were given more in-depth information so they could train others and promote HIV prevention among colleagues.1
3. Make quick-reference badge and pocket cards on PrEP. Another suggestion was for researchers to create pocket and badge cards that support PrEP prescribing and sexual history discussions. “Pocket cards are little and foldable — the size of an envelope that bills come in, long and skinny and folded into three panels,” Matthews says.
“Those had tips on taking sexual history with some key phrases for starting the conversations,” she explains. “And the badges had little tables with different products and how to prescribe, dosing, baseline laboratory test, and follow-up test.” Pocket and badge cards stressed the importance of confidentiality for adolescent clients.1
4. Offer didactic, case-based content. Provider participants suggested educational content be case-based and include interactive questions, examples, quizzing, and comparisons.1 They also suggested having slides with take-home messages on each slide. Audio recordings from teens could be embedded within the presentations. Participants felt that each case study helped them engage with the content in a more meaningful way and enabled them to compare the case study experience with experiences of their own patients.1
5. Make web-based content. Interestingly, youth thought some paper education and sexual health screening forms would be better than an entirely electronic and web-based process, Matthews notes.
The community advisory board thought posters created for adolescents would prepare youth for conversations with providers about their sexual history and help youth understand that the doctor’s office was a safe space with privacy and security, she says. “We also developed a sexual history screening tool for them, and there are different ways providers can do this,” she adds. “Adolescents wanted something on paper; they didn’t like it on an iPad.”
Concerned about electronic privacy, adolescents and young adults said their providers could use the paper tool to inform the discussion, and they did not want the tool to be automatically sent to the health system’s electronic health record, Matthews explains. “We had thought we could have QR coding on their phones for the tool, and they said, ‘No, who is going to see that, and we don’t trust that,’” she adds. “So, the questionnaire about sexual activity is on paper.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Pratt MC, Isehunwa OO, Hill SV, et al. Adapting an intervention to improve adolescent sexual health assessment and pre-exposure prophylaxis prescription by family medicine physicians in Alabama. AIDS Patient Care STDS. 2025;39(9):371-379.
2. Byron J. HIPAA, the Cures Act and information blocking compliance. AIHC. May 12, 2021. https://aihc-assn.org/hipaa-the-cures-act-and-information-blocking-compliance/
Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is no longer an epidemic in the United States, but some parts of the country and some populations still have high rates of the disease among young women.
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