HIV prevention efforts have traditionally focused on urban areas, yet about one-fourth of new HIV diagnoses in the U.S. are in non-urban areas. This study explored rural and urban differences in perceived HIV risk; perceived HIV stigma; and pre-exposure prophylaxis (PrEP) awareness, attitudes, beliefs, communication behaviors, and use to inform the development of communication messages to promote informed decision-making among available HIV prevention options, including PrEP. We conducted interviews, preceded by a brief survey, with 255 adults in 5 rural and 6 urban locations throughout the U.S. with high HIV burden. Participants from rural areas more frequently described their risk of getting HIV as low compared with those from urban areas, although partly due to differences in gender/sexual identity and sexual risk. Participants from rural areas more frequently reported perceived stigma around getting tested for HIV, taking PrEP to prevent HIV, or having HIV and less frequently reported having heard of PrEP and having a healthcare provider talk with them about PrEP compared with those from urban areas. No participants from rural areas reported using PrEP, although 48% of those with HIV-negative or unknown status were at substantial risk based on reported risk factors. Our findings highlight notable differences in perceived HIV risk; perceived HIV stigma; and PrEP awareness, attitudes, beliefs, communication behaviors, and use between individuals residing in rural and urban areas, suggesting that HIV prevention messaging needs to be tailored for rural audiences to support receptivity.

To succeed in ending the HIV epidemic in the United States, the Centers for Disease Control and Prevention (CDC) focuses on delivering combinations of scientifically proven, cost-effective, and scalable interventions to priority populations. Systemic factors continue to contribute to persistent health disparities and disproportionately higher rates of HIV diagnosis in some communities. The National HIV/AIDS Strategy has designated cis-gender Black women (CgBW) as a priority population to address the racial and ethnic inequities in HIV. This report presents the portfolio of projects, programs, and initiatives funded by the CDC's Division of HIV Prevention (DHP) to address disparities in HIV and improve health and QOL among CgBW. These funded activities include the development, planning, and implementation of HIV prevention programs, mass media campaigns, and behavioral interventions focused on CgBW. This report also summarizes DHP's community engagement, capacity building, and partnership efforts, and highlights research and surveillance activities focusing on CgBW. Finally, this report outlines future directions for CDC's efforts to improve access to HIV testing, treatment, and prevention for CgBW in the United States.

There are no evidence-based recommendations for communicating about pre-exposure prophylaxis (PrEP) as part of a broader HIV-prevention messaging approach. To inform future message development related to PrEP uptake, we interviewed 235 individuals across ten locations in the U.S. to explore their understanding and perceptions of draft HIV prevention messages and assess their overall preferences for a broad or PrEP-focused messaging approach. Participants responded favorably to and related to both draft messages. Participants who were not aware of PrEP were more likely to say the broad HIV-prevention message was personally relevant than those aware of PrEP. There were no significant differences in perceived personal relevance for the PrEP-focused message. Qualitative findings suggest that HIV prevention messages should use specific well-defined terms, include links to additional information, and use choice-enhancing language that emphasizes personal agency and frames the call to action as an informed decision among an array of effective prevention options.