Black Women Turn to PrEP as HIV Rates Soar

Black women embrace PrEP as a safeguard in high-risk sexual relationships With Bisexual Men

HIV PrEP (pre-exposure prophylaxis) Medication

By Sharnellia Bennett-Smith

Atlanta, GA — Among the many unspoken truths surrounding Black women’s sexual vulnerability is this: a significant number of the Black men they sleep with are also having sex with other men—and not disclosing it. This hidden bisexuality, often masked by hypermasculinity and secrecy, puts Black women at uniquely high risk for HIV transmission. These men move between communities, carrying the burden of their silence and leaving behind disproportionate rates of infection. For the women who trust them, the cost is their health, their bodies, and in many cases, their lives.

It’s not just infidelity—it’s epidemiological betrayal. In communities where stigma around homosexuality and masculinity runs deep, disclosure rarely happens. As a result, Black women are left unprotected in sexual relationships where risk is invisible, unspoken, and deadly. According to the Centers for Disease Control and Prevention, Black women are significantly more likely to contract HIV than any other group of women in the United States. In Georgia alone, the rate of HIV among Black women is more than eleven times that of white women, with metro Atlanta sitting at the center of this crisis.

In this context, the 4B lifestyle—an ideology that encourages women to reject relationships with men altogether—takes on more than just symbolic meaning. It becomes a medical survival strategy. Why should Black women take a daily pill with side effects, subject themselves to emotional manipulation, and live in chronic fear of exposure, just to maintain romantic relationships with men who often cannot or will not be honest about their sexuality?

When taken consistently, PrEP reduces the risk of HIV infection through sex by approximately 99 percent. However, despite this high efficacy rate, usage among women—particularly in the United States—remains disproportionately low. According to recent data, women account for 18 percent of new HIV diagnoses nationwide, but only about 8 percent of current PrEP users are women. Many health experts attribute this gap to lack of awareness, limited access to prescribing providers, and persistent social stigma.

In many cases, women who could benefit from PrEP do not know it exists. Among those who are aware, few receive the recommendation or support to begin treatment. Healthcare inequities and systemic biases continue to play a role in limiting Black women’s ability to access preventative care. Misconceptions about who is “at risk” for HIV also contribute to the silence around PrEP use among heterosexual women. In contexts where women cannot reliably negotiate condom use, especially within long-term or emotionally complex relationships, PrEP offers a discreet and self-managed layer of protection.

The situation is particularly urgent in cities like Atlanta, where HIV rates among Black women are staggering. Black women in Georgia are over eleven times more likely to contract HIV than white women. Metro Atlanta bears the brunt of these numbers, with Black women accounting for more than half of new HIV infections among women. Nationally, Black people represented 42 percent of new HIV diagnoses in 2021 but only 14 percent of PrEP users. In the South, where the epidemic is especially concentrated, Black people made up 52 percent of new HIV cases but just 21 percent of those using PrEP. In Atlanta, a study showed that while over 60 percent of young Black women said they would take PrEP if it were accessible, structural barriers—such as cost, stigma, and poor access to healthcare—kept them from doing so.

These numbers point to a deeper cultural conflict. Even in the face of high HIV risk, many women continue to engage in sex with men who they know are unsafe or whose status is unknown. The reasons are layered: emotional attachment, dependency, societal pressure, and the normalization of dysfunction in relationships. Movements like 4B, which originated in South Korea and advocate that women reject romantic and sexual relationships with men as an act of protest and self-preservation, provide an alternative that some are beginning to consider. While it may not be a widely adopted path, 4B introduces a critical conversation: what if women simply refused to die for intimacy?

Still, many women turn to PrEP not as a last resort, but as a means to maintain relationships with men who do not prioritize their health. But this raises a difficult truth—PrEP was not intended for recreational use or to be taken as a substitute for boundaries or behavioral change. It was created as a medical emergency tool for those at high risk of exposure, particularly in settings of sexual violence, transactional sex, or known HIV-positive partners. It was never meant to be a daily sacrifice women must take on just to survive having sex with men.

If a woman needs to be on PrEP indefinitely just to be with men, the issue isn’t the HIV risk—it’s the men. It means sex with bisexual men, has become a medical hazard, and instead of confronting that, society asks women to carry the burden in silence.

Globally, PrEP uptake tells a different story. In sub-Saharan Africa, where women make up a majority of new HIV infections, they also account for over 65 percent of new PrEP starts. This reflects more targeted public health efforts and an acute awareness of women’s vulnerability in regions with high prevalence.

Recent medical advancements may shift the landscape further. Injectable PrEP options, such as lenacapavir, have shown 100 percent effectiveness in preventing HIV during clinical trials. These long-acting alternatives may improve adherence and accessibility for women who struggle with daily pill regimens or live in areas with limited medical infrastructure.

Recent medical advancements may shift the landscape further. Injectable PrEP options, such as lenacapavir, have shown 100 percent effectiveness in preventing HIV during clinical trials. These long-acting alternatives may improve adherence and accessibility for women who struggle with daily pill regimens or live in areas with limited medical infrastructure. Still, PrEP use does not come without side effects—fatigue, gastrointestinal distress, and long-term concerns like kidney function and bone density loss are realities that all women should be informed about. The case for a 4B lifestyle among Black women becomes clearer in this context.

Why should women be expected to take a daily pill that impacts their health, just to survive sex  with bisexual men? For many, abstinence is not just a moral or spiritual stance but a political and medical necessity. While PrEP should absolutely be available in cases of sexual violence, coercion, or other high-risk contexts, its use as a recreational safety net in sexual relationships with men, raises serious questions. Rather than adjusting to male behavior, women must ask why that behavior remains the standard, and whether refusing it altogether is the more radical and health-protective choice.