Barriers and preferences for HIV-PrEP among black heterosexual patients in London: Extending insights from Ogaz et al. (2025)

Dear Editor,

We read with interest the recent article by Ogaz et al. (2025) ¹ exploring acceptability and preference of different HIV-PrEP modalities among gay, bisexual, and other men who have sex with men (GBMSM) and gender-diverse individuals. The authors reported high acceptability of injectable HIV-PrEP, with preference over oral tablets. We welcome this contribution.

Much existing evidence on HIV-PrEP access focuses on GBMSM. However, Black heterosexual people remain disproportionately affected by HIV in England. While Black ethnic groups constitute 4.2% of the population, ² Black heterosexual people accounted for 24% of new diagnoses in 2024 but only 0.6% of HIV-PrEP users. ³ Black African heterosexual women and men represent the largest groups with unmet HIV-PrEP need, ⁴ highlighting a critical gap.

We undertook a local service improvement project, initially exploring barriers to HIV-PrEP among Black heterosexual patients. Using a cross-sectional survey ⁵ underpinned by the Information-Motivation-Behavioural Skills model, we assessed HIV-PrEP knowledge, attitudes, and preferences among Black and Mixed-Black heterosexual patients attending a London GUM/HIV clinic (October 2024–February 2025). The survey was hosted on Microsoft Forms. HIV-PrEP knowledge was measured via 13 questions (score range 0–13), awarding one point per correct answer. Preferences were rated on a five-point Likert scale from “very unlikely” to “very likely.” Recruitment occurred via posters and clinician signposting. Of 1367 eligible patients, 114 participated (8.3% uptake). Respondents were predominantly women (64%), with Black African (41%) and Black Caribbean (38%) the largest ethnic groups.

Our findings revealed HIV-PrEP knowledge was low (median = 2.5; IQR = 6). Women scored significantly higher than men (median = 4 vs 0; p = 0.0058), while differences between Black African and Black Caribbean respondents were not significant (Table 1). Most (68%) were unaware that daily HIV-PrEP reduces HIV risk by >90%. HIV-PrEP preferences favoured long-acting modalities. Six-monthly injections (46%), weekly tablets (44%), and two-monthly injections (35%) were more acceptable than daily tablets (30%). HIV-PrEP preferences did not differ significantly by gender or ethnicity, except for six-monthly injections, which were more likely to be preferred by Black African participants (61%) than Black Caribbean participants (36%) (p = 0.04).

OPEN IN VIEWER

Table 1.

HIV-PrEP knowledge scores stratified by ethnicity and gender.

Categories		Median PrEP knowledge score (range 0-13)	Mann-Whitney U test
Gender	Men	0 (IQR = 4)	U = 1041, p = 0.0058
	Women	4 (IQR = 7)
Ethnicity	Black African	4 (IQR = 7)	U = 1195.5, p = 0.195
	Black Caribbean	2 (IQR = 5)

These findings underscore barriers to HIV-PrEP uptake among Black heterosexual patients. Awareness remains poor, particularly among men, suggesting prevention messaging is not reaching those most at risk. Strong preference for long-acting HIV-PrEP highlights limitations of focusing solely on daily oral PrEP. Expanding delivery options may improve acceptability and uptake.

Limitations include low response rate, single-site recruitment, and lack of data on prior HIV-PrEP use. Additionally, as GUM/HIV clinic attendees, participants were more likely to have awareness of sexual health interventions. Larger studies recruiting from clinic and community settings are recommended.

Our findings complement Ogaz et al. (2025) and reinforce the need for inclusive HIV prevention strategies. While the UK’s HIV-PrEP programme has achieved success among GBMSM, insufficient attention to other groups with greater HIV prevention needs risks entrenching disparities. Tailored interventions for Black heterosexual communities are essential to address inequities. Equitable provision of emerging long-acting HIV-PrEP modalities is central to future HIV prevention planning.