Exploring Gaps In Hiv Prevention: Hiv Pre-Exposure Prophylaxis Awareness, Attitudes, Utilization, Coverage, Hiv Testing And Risk Perception Among Sub-Saharan African College Students In The United States

Abstract

This dissertation focuses on increasing HIV awareness and contributing to efforts at reducing new HIV infections among Sub-Saharan African (SSA) college students. It begins with an introductory chapter one and ends in the concluding chapter five. Chapter two presents a systematic review identifying key gaps in HIV Pre-Exposure Prophylaxis (PrEP) knowledge, attitudes, and utilization among Black college students in the United States (U.S). The review synthesizes findings from four studies, revealing that a third of participants demonstrated adequate PrEP knowledge, while PrEP utilization remained under-utilized at three percent. Key barriers to PrEP uptake included fear, low self-perceived HIV risk, infrequent HIV testing, and reliance on inaccurate information sources such as social media. To address these gaps, the chapter emphasizes targeted educational interventions that address both individual and structural barriers to improve PrEP awareness, attitudes, and uptake, ultimately advancing sexual health outcomes in this high-risk population. Chapter three focuses on a concept analysis review of HIV PrEP coverage among Black adults in the U.S. Based on eleven selected studies, the review identifies four distinct definitions of HIV PrEP coverage, highlighting significant racial disparities in PrEP access and utilization. Despite Black individuals being a high-priority population for HIV prevention, they continue to experience disproportionately higher rates of new infections. Through a comprehensive concept analysis, the chapter proposes a unified definition of PrEP coverage that emphasizes equitable access and identifies key attributes, antecedents, and consequences of PrEP use. The findings underscore the need for improved policies, tailored access strategies, and consistent communication to mitigate health inequities and support national HIV prevention goals. Chapter four presents a qualitative phenomenological study exploring HIV PrEP awareness, testing behaviors, and risk perception among SSA college students in the U.S., a subgroup of Black college students that has been understudied. Findings indicate that only 32.8% perceived themselves at HIV risk, 22.7% had ever tested for HIV, and 68.2% were unaware of PrEP. Themes emerging from participant experiences highlight psycho-social factors, socio-cultural influences, facilitators of PrEP awareness and testing engagement. The chapter offers a foundational perspective on improving sexual health outcomes for SSA college students in the U.S