Investigating the influence of provider communication and language reframing on HIV pre-exposure prophylaxis (PrEP) engagement with Black African and Caribbean women: a systematic review

Patient-provider engagement with HIV pre-exposure prophylaxis (PrEP) continues to exhibit significant disparities, particularly among Black African and Caribbean (BAC) women. In the United Kingdom, cisgender women accounted for one-third of HIV diagnoses in 2022, with 64.1% of these cases occurring among BAC women, underscoring a critical gap in equitable access to PrEP information and services. This systematic review explored health service provider-level communication barriers and facilitators influencing PrEP uptake and engagement with BAC women. A comprehensive search across four databases yielded 31 eligible studies examining provider communication about PrEP with BAC women. Thematic analysis identified two key areas: the role of provider communication in PrEP engagement and the importance of reframing language. Barriers included limited provider-initiated conversations, insufficient medical knowledge about PrEP for women, and medical mistrust driven by racial bias and stigma. Facilitators included culturally sensitive, nonjudgmental communication approaches and the strategic reframing of the language surrounding PrEP as a tool for empowerment rather than solely risk reduction. These findings highlight the need for improved provider communication strategies and support the adoption of more inclusive and affirming dialogue to foster equitable PrEP engagement among BAC women, who remain disproportionately excluded from current PrEP narratives.