The human immunodeficiency virus (HIV) is an infection that attacks the immune system. At the advanced stage, the disease is called acquired immunodeficiency syndrome (AIDS). The disease disproportionately affects Black women, who in the United States experience rates of HIV infection that are two to eight times higher than those of their White and Hispanic counterparts [1]. According to Troutman et al. [1], women make up 19% of new HIV diagnoses in the United States, with African American women comprising 60% of these cases. Research has identified Black women as a key demographic for interventions aimed at reducing risky behaviors, increasing self-efficacy for healthy practices, expanding prevention knowledge, and overcoming barriers to safe sexual activity [1]. Despite advancements in treatment and prevention, this population remains at heightened risk, largely due to systemic inequities and social determinants of health [1,2], The current study seeks to address these disparities by exploring the perceptions and knowledge of HIV/AIDS among Black women.

By shedding light on the unique challenges faced by this community, this research aims to inform the development of targeted interventions and policies that support HIV prevention and care. Understanding the experiences and voices of Black women is crucial in framing an evidence-based response to the epidemic while advancing social work and public health strategies. The findings will provide critical insights into the broader social factors influencing HIV-related vulnerabilities and help identify actionable steps to enhance public welfare through education, empowerment, and advocacy.

This study employs an exploratory methodology to capture the perceptions and knowledge of HIV/AIDS among a diverse sample of Black women, with data collected through electronic surveys. The analysis delves into various dimensions of HIV/AIDS awareness, including general knowledge, transmission risks, and sources of information, offering a detailed examination of how sociocultural factors influence health outcomes. The findings are anticipated to contribute to the ongoing efforts to reduce disparities and improve the quality of life for Black women at risk for or living with HIV/AIDS.       

Literature review: Defining HIV/AIDS

The AIDS disease first appeared in the U.S. in 1981, when five young gay men in Los Angeles came down with a rare opportunistic infection. Many more cases were soon reported in other cities [3]. By the end of 1982, it was evident that AIDS was an infectious disease, passed from person-to-person through body fluids such as blood, semen, rectal and vaginal fluids, and breast milk [3]. The time from infection to death, if left untreated, was estimated to range from 9 to 11 years, depending on the subtype of HIV. In 2018, Black women were dying from AIDS at a rate nearly 14 times that of non-Hispanic White women, putting into sharp focus the ongoing HIV/AIDS crisis among Black women [3,4].

Health disparities are defined as differences in disease burden, health outcomes, or access to care among distinct segments of the population (World Health Organization, 2018). When these disparities are considered unfair or result from injustices in health status or resource distribution, they are termed health inequities. These inequities are driven by the social conditions in which people are born, grow, live, work, and age. For Black Women of African Descent (BWAD), addressing these inequities requires robust evidence and implementing equity-driven policies and practices that tackle the root causes of these disparities [5].                                

The social determinants, intertwined with structural and systemic factors like racism and stigma, as well as inequality in access to health services, that contribute to reducing opportunities for the best possible health outcomes in populations with high rates of vulnerability to HIV [5]. HIV vulnerability among women of color and the intersection of these identities is rooted in social, economic, and political inequities. Structural factors, like financial insecurity, have an indirect but significant impact on HIV risk by reducing access to HIV testing, prevention, and care. Black women face multiple and intersecting barriers when accessing appropriate and responsive health information and care, compared to white women. Besides social and structural barriers, the cascade of HIV prevention, diagnosis, and treatment can be completed with the use of healthcare systems, policies, and guidelines. The COVID-19 pandemic has further exacerbated existing health inequalities faced by racial and ethnic minorities, including Black women in HICs [5].

Black women have been at the forefront of the AIDS war, playing key roles in the fight against AIDS through HIV prevention, advocacy, and activism throughout the United States. Haslip and other activists organized, demonstrated, and lobbied the CDC to redefine AIDS to include infections that were primarily experienced by women such as cervical cancer and recurring yeast infections, as well as anyone living with HIV who had a CD4 count under 200 cells [6]. These changes to the CDC's definition allowed women living with HIV/AIDS to qualify for HIV/AIDS disability resources [7].

Identifying risk factors and barriers

Black and African American women are disproportionately at risk of HIV infection due to structural and societal factors rather than solely individual behaviors. Browne and colleagues found that only 21% of African American women consistently used condoms with their partners over the past year, highlighting a significant risk for HIV exposure [8]. This inconsistent use of condoms is at times attributed to the contextual and structural issues regarding a lack of access to health care and education, especially within neighborhoods of low income where women perceive their environment as risky for HIV/STIs [9]. The most significant barrier to healthcare services is a lack of financial means, particularly health insurance. Residents face difficulties obtaining services both within and outside their communities because they cannot afford a car, access a ride, or pay for public transit [9]. Despite these limitations, there is a clear need and desire for health programming, especially sexual health education, within these communities.

HIV prevalence rates have also been linked to drug use among Black and African American women. Studies show that drug use is related to increased sexual activity, multiple partners, and unprotected intercourse [10]. Black and African American women who use drugs are at risk because of engagement in high-risk behaviors and live in social contexts that increase their vulnerability. Drug use is a major factor in the spread of HIV/AIDS, with injection drug use, unprotected sex with drug users, and unsafe sex to support drug habits contributing to over a third of AIDS cases in the U.S. [10]. Between 1985 and 1999, African Americans were more than twice as likely as whites to contract HIV and progress to AIDS due to injection drug use [10]. To understand these disparities, it is essential to consider the larger social context. Focusing solely on individual risk behaviors overlooks societal conditions that facilitate these risks. For example, a woman who exchanges sex for drugs is influenced by the availability of drugs, social norms, poverty, and systemic issues like racism, sexism, and classism. Epidemiology traditionally emphasizes the agent, host, and environment, but understanding social factors' impact on drug use and HIV/AIDS is less developed. Research often focuses on the most visible drug users, such as those in public treatment programs or correctional settings, leading to an overrepresentation in epidemiologic data [10]. This highlights the need for a comprehensive approach that includes neighborhood effects and community characteristics to understand and address the broader sociocultural context of HIV/AIDS and drug use.

Structural barriers such as stigma, misconceptions, and fear associated with HIV/AIDS, have greatly influenced society's attitudes and actions. Such biases can impair the delivery of effective and compassionate care to those living with HIV/AIDS, leading to discrimination and a lack of trust between patients and healthcare professionals [11]. For HIV/AIDS patients, this can result in delayed diagnosis, insufficient treatment, and poorer health outcomes. It is important to emphasize, however, that these biases are not strictly personal failings but also reflect broader social attitudes and institutional imbalances. These sets of bias can be changed only through personal actions and social change. Thus, interventions might focus specifically on the development of enhanced power, self-efficacy, community involvement, critical consciousness, and access to resources as a means to reduce HIV transmission and promote well-being.

In terms of awareness, studies show that Black women in college have higher HIV awareness rates compared to their white peers. However, despite this awareness, Black college women often underestimate their risk of HIV infection [12]. This disconnect between knowledge and perceived risk can make them more vulnerable to HIV through high-risk behaviors. Interventions that not only convey information but also improve perception and awareness may be significant. As Chandler et al. [12] note, there is a lack of research specifically targeting HIV prevention for young Black college women that focuses on risk perception and awareness through mass media campaigns. These interventions have the potential to reach wide audiences with targeted and culturally relevant messaging.

Effective strategies and interventions

Race, ethnicity, and culture are some of the variables to consider when planning for the success of interventions. Race has historically been used to classify humans based on phenotype and skin color. Ethnicity involves identification with a group sharing a collective identity, often based on cultural heritage or nationality [13]. In a multi-cultural society, ethnic groups have a hierarchical power structure, wherein one ethnic group is normally at the top of the power structure. Culture refers to the shared beliefs, values, and attitudes within a group, shaping how individuals interpret experience [13]. For example, among Black and African American women at risk for HIV, strong religious and spiritual beliefs can be a barrier to risk reduction. Effective interventions must incorporate the protective aspects of religiosity and spirituality while motivating behavioral change [10].

While all these existing interventions are important in preventing new infections with HIV and caring for those who are infected, they fall far short of what is required if UNAIDS 95-95-95 goals are to be met and if HIV/AIDS is to be ended as a threat to health in the HICs by 2030 [5]. Traditional HIV prevention strategies often use a one-size-fits-all approach, neglecting the diverse factors influencing an individual's risk. The racial and ethnic inequities faced by Black women and other women of color highlight systemic fragmentation in HIV prevention programming and policies. Over the past four decades, unchanged HIV intervention approaches in HICs underlines the urgent need for tailored, innovative, and equitable strategies to effectively end the HIV epidemic and address inequalities in HIV-related health outcomes [5]. Understanding the race and ethnic inequities and the determinants of effective HIV programs targeting at-risk populations like Black women is critical to combating the HIV epidemic and reducing HIV outcome inequalities.

Evidence suggests that structural interventions, such as comprehensive sex education, should be widely implemented in the United States to address HIV [14]. Sex education is an important HIV prevention tool, and appropriate sexual health information is a basic human right. Appropriate awareness of gender and sexual diversity should form part of comprehensive sex education programs, as should health promotion, the prevention of illness, and access to devices for safer sex. Demonstrating proper use of male and female condoms, developing female empowerment and personalized risk reduction plans, and referring to local health departments for regular testing. HIV testing is an essential tool for engaging young African American women in the HIV care continuum.

HIV risk-reduction programs for women can lower sexual risk behaviors while simultaneously increasing knowledge about HIV/AIDS as well as confidence [10]. The Health Intervention Project (HIP) in Atlanta was designed to reduce the HIV risk among Black women. It began with a one-year formative research phase involving ethnographic mapping and in-depth interviews to understand their drug use experiences [10]. Key themes included the influence of male partners, roles as mothers, African American identity, and the importance of spirituality and extended family support. Women expressed frustrations with social roles dominated by drug use and discussed challenges such as setting priorities and addressing unrealistic expectations. They emphasized the need for community-based, women-only intervention locations with privacy and individualized sessions [10]. The HIP interventions were to be respectful, warm, and responsive. Reflective listening and motivational techniques were to be used in the face of ambivalence about change. The motivation intervention within the HIP aimed to help African American women in Atlanta set achievable priorities, potentially linked to reducing HIV risk [10]. It consisted of four sessions, including pre-and post-test HIV counseling. Women worked with interventionists to develop action plans and reviewed their progress and setbacks in subsequent sessions. The intervention was grounded in the principle that people will change behaviors for which they feel motivated to change and can resolve their crises with facilitative support. The intervention incorporated the Stages of Change Model by assessing readiness, intervening based on an individual's stage of readiness, goal setting in a more realistic manner, and overcoming personal barriers to behavioral change, such as racism and unrealistic expectations [10]. The approach aimed to empower women through problem-solving skills and positive reinforcement, fostering commitment to behavioral changes like reducing drug use and adopting safer sexual practices. The HIV Negotiation Intervention in the Health Intervention Project targeted the improvement of technical and communication skills among African American women in Atlanta, primarily in an effort to reduce HIV risk [10]. It consisted of four sessions where women developed action plans reviewed with the interventionist. Assertive communication skills were taught through role-playing, emphasizing directness without aggression, aiming to negotiate safer sexual practices effectively. Discussions included anatomy education, relationship dynamics (such as abusive relationships and power dynamics), and identifying triggers for risky behaviors. The intervention aimed to empower women to assert their boundaries while recognizing realistic goals for risk reduction and broader life challenges. Additionally, interventions should focus on macro-level factors. While religiosity and spirituality are indeed important cultural dimensions, the broader context of the daily lives of people should also not be deemed lowly. If women believe they have opportunities for upward social mobility, they may use their religious and spiritual beliefs as a source of strength to change behavior rather than as a coping mechanism that does not lead to change.

Prevention and intervention should aim to stop individuals from engaging in risky behaviors and address those already involved. Many risk-reduction programs are limited due to the fact that they deal with only one risk behavior when multiple risks exist, such as sexually transmitted diseases, HIV/AIDS, and hepatitis B and C. Drug use and HIV/AIDS are common in disadvantaged inner-city areas populated by racial and ethnic minorities. These communities face a cluster of social and health issues, and intervention efforts should seek to assist both people and groups in achieving collective effectiveness. This involves the development of mutual trust, sharing of information networks, informal social control mechanisms, and voluntary groups, all of which help to build social capital. Effective preventative and intervention programs must be culturally sensitive, community-focused, and relevant on an individual level, with active participation from the target group.

Theoretical framework

Empowerment theory serves as a critical framework for understanding and addressing HIV/AIDS among Black women. This theory emphasizes how individuals and communities gain control over their lives and the socio-political environment, fostering enhanced self-efficacy and collective efficacy [7,15]. In this context of HIV/AIDS, empowerment theory directs to the need to address the complex barriers, build agency, and demand change among Black women. Empowerment theory supports that the efforts to address multilevel barriers among Black women and work toward agency and a call for systemic change are multifaceted in the context of HIV/AIDS. According to Wechsberg et al. [15], HIV research based on women's empowerment theory acknowledges that a woman's capacity and readiness to safeguard herself from HIV are shaped by the empowerment she gains through her daily interactions and social experiences. By focusing on enhancing power, self-efficacy, community participation, critical consciousness, and access to resources, interventions can be designed to not only reduce HIV transmission but also improve overall well-being. This theoretical perspective emphasizes the essential role of both individual and collective empowerment in the fight against HIV/AIDS and the promotion of health equity.

HIV studies centered on women's empowerment theory recognize that a woman's ability and commitment to protect herself from HIV is impacted by her feeling of empowerment derived from everyday interactions. The health advantages of fostering empowerment among minority women have only recently garnered attention. Integrating strategies that help women enhance their power within relational and economic contexts has been pivotal to the effectiveness of HIV risk-reduction interventions [15]. For example, a culturally sensitive HIV prevention intervention intended specifically to help women gain relationship power enhanced safer-sex intentions.

Black women in the United States are disproportionately impacted by HIV/AIDS, experiencing higher rates of new infections and poorer health outcomes compared to other racial and gender groups. This study aims to examine perceptions and knowledge related to HIV/AIDS among Black women, contributing to the advancement of understanding in social work and public health. By addressing the gaps in knowledge and understanding of the unique challenges faced by this population, the project seeks to provide insights that can inform the development of targeted interventions and policies to mitigate the impact of HIV/AIDS on Black women.

Additionally, this study has the potential to enhance our understanding of HIV/AIDS by elevating the voices and experiences of Black women within the broader discourse. The findings will have important implications for public welfare, as they will help inform evidence-based approaches to HIV/AIDS prevention, care, and advocacy.

The following research question guided the study: What are the perceptions and knowledge of HIV and AIDS amongst Black and African American women?

The study utilized an exploratory research methodology to describe and analyze perceptions and knowledge related to HIV/AIDS among Black women. The sample included approximately 205 Black and African American women aged 18 and older from across the U.S. Data were collected electronically through a self-administered questionnaire distributed via Google Forms. Recruitment occurred through email listservs and social media platforms to ensure a statistically significant response rate.

The study employed a random probability sampling frame, with the researcher disseminating electronic questionnaires along with a consent form that outlined confidentiality measures to maintain participant anonymity. Participants received a debriefing statement detailing the study's purpose, the researcher's contact information, and a message expressing gratitude for their involvement. No identifying information was collected from participants, and all ethical procedures were approved by the University’s Institutional Review Board (IRB). Data analysis was conducted using the Statistical Package for the Social Sciences (SPSS 29). Both univariate analyses and cross-tabulation analyses were performed to explore the data.

Measures

The self-administered questionnaire consisted of the Sociodemographic Questionnaire, the HIV/AIDS Knowledge Scale, and the Source of Information Questionnaire.

Sociodemographic questionnaire: The sociodemographic questionnaire captured the participant's sociodemographics such as race, gender, age, relationship status, religious affiliation, military status, socioeconomic status, location, etc. (Table 1).

HIV/AIDS knowledge scale: The HIV/AIDS Knowledge Scale was developed to serve as an instrument in determining respondent’s level of knowledge about the HIV disease. This scale has been used with preservice education students, teachers in the field, and related professionals including school counselors [16]. The HIV/AIDS Knowledge Scale consists of two parts, the first part is the General Knowledge regarding the HIV disease process (e.g., cause, symptoms, diagnosis, effects, and treatment), and the second part, is the Likelihood of Transmission of HIV. In this study, the General Knowledge was modified to a 16-item scale consisting of true, false, or not sure responses. Sample scale items included: "AIDS is an infectious disease caused by a bacterium," "Latex condoms are not as effective as "lambskin" or natural membrane condoms in preventing the spread of HIV," "There is no cure for AIDS at present," and "HIV is carried in the blood," (Table 2). The Likelihood of Transmission of HIV scale consisted of a 4-point Likert scale (1 = Very Likely 2 = Somewhat Likely 3 = Somewhat Unlikely 4 = Very Unlikely). The scale was modified to 15 items that assessed participants' knowledge regarding possible modes of HIV transmission (Table 3). Participant’s responses were aggregated into two categories: “likely” and unlikely.”

Source of information questionnaire: The Source of Information Questionnaire consisted of 5 items capturing participants’ sources of information relating to HIV/AIDS. Sample items consisted of the following: “I first learned about HIV/AIDS from the news/social media,” “I first learned about HIV/AIDS from an educational source (high school/higher education class, guest lecture, continuing education opportunity, etc.),” and “I regularly update my knowledge about HIV/AIDS by attending a course, lecture series, or presentation where HIV/AIDS is the main topic” (Table 4).    

Sociodemographic questionnaire

The sample consisted of 205 respondents who identified as female. The participants' ages ranged from 18 to 69. Among the respondents, 83% self-identified as Black or African American, with smaller representation for Middle Eastern (9%), Asian or Pacific Islander (3%), Hispanic or Latino or Chicano (2%), American Indian or Alaska Native (2%), and White (0.5%). Eighty-one percent of respondents indicated no military experience. Meanwhile, 7% identified as veterans or retirees, 5% identified as active duty, 2% in the reserves and 2% in the National Guard. Regarding sociodemographic status, 21% identified as lower class (less than $34,999), 48% as working class ($35,000 to $74,999), 29% as middle class ($75,000 to $149,999), and 3% as wealthy class (over $150,000). The predominant sexual orientation is heterosexual (80%), followed by lesbian (6%), bisexual (7%), and other orientations such as gay (3%), pansexual (1%), and asexual (0.5%). A significant portion of the respondents identified as Christian (61%), with smaller groups identifying as Catholic (8%), no religion (13%), and other religions such as Buddhism, Islam, and Judaism. A small percentage (10%) of participants reported having a disability, while 90% indicated they did not. Regarding educational attainment, 25% of respondents hold a Bachelor's degree, 18% have a Master's degree, 17% possess a high school diploma or GED, 15% have completed some college credit, but no degree, and 9% hold an Associate degree. In terms of relationship status, most respondents are married (46%), with others being single (24%), dating (17%), or divorced (8%). Over half of the participants (55%) have children, while 45% do not (Refer to Table 1 for an overview).

HIV/AIDS knowledge scale

The findings from the HIV/AIDS Knowledge Scale present responses regarding the participants' knowledge and perceptions of HIV/AIDS, categorized as true, false, or not sure. Forty-five percent of respondents incorrectly identified that AIDS is an infectious disease caused by a bacterium, compared to 47% of respondents stating false. Sixty-eight percent of respondents recognized that AIDS breaks down the body’s immunity by destroying the B cells in the endocrine system, while 23% of respondents selected false. Regarding AIDS damaging the brain, 59% responded correctly, compared to 19% indicating false, and 22% of respondents were unsure. A large majority of participants (77%) indicated a person who has tested negatively on one HIV antibody blood test could still transmit HIV to a sexual partner, while 11% indicated false, and 12% were unsure. Only 28% of participants correctly indicated latex condoms are more effective than lambskin or natural membrane condoms in preventing the spread of HIV, with 84% of participants selecting unsure and 45% stating false. Regarding defining AIDS as Acquired Immune Deficiency Syndrome, 83% of respondents answered correctly, compared to 8% of respondents with incorrect responses. Ninety percent of respondents acknowledged AIDS is caused by a virus, called HIV (Human Immunodeficiency Virus). The majority of respondents (81%) understood that an HIV-positive mother can transmit the virus to her baby. Similarly, the vast majority (93%) of respondents recognized that HIV is carried in the blood, and 74% of respondents acknowledged that HIV is present in male semen. In terms of the impact of AIDS, 97% of respondents understood that AIDS weakens the body’s ability to fight disease, with 83% of respondents correctly identifying the common symptoms of AIDS (i.e. diarrhea, night sweats, weight loss, fever, swollen glands (lymph nodes). Lastly, 15% of respondents believed that AIDS is a man-made disease created in a laboratory, while 63% indicated false, and 23% answered unsure (Table 2).

Table 3 illustrates the findings for the participant's knowledge relating to HIV transmission. Seventy-three percent of participants responded that it is unlikely to transmit HIV when working near someone with AIDS, while 27% indicated it is a likely method to transmit HIV. Eighty-two percent of respondents indicated it is likely that an HIV-infected mother to transmit the virus to the baby during pregnancy/birth, with 18% indicating that it is unlikely. Similarly, 75% of participants recognized that it is likely that an HIV-infected mother to transmit the virus to the baby through nursing, while 25% indicated it is unlikely. In terms of transmitting HIV through kissing, 39% of respondents indicated it is likely, compared to 61% stated unlikely. Thirty-eight percent of participants believed that eating in a restaurant where the cook has AIDS posed a risk of transmission, compared to 72% indicating unlikely. Conversely, 62% of respondents recognized that it is likely to transmit AIDS through a blood transfusion. Only 36% of respondents considered it unlikely to transmit AIDS by sharing plates, forks, or glasses with someone infected, while 54% of respondents selected that it was unlikely to transmit the virus through sharing clothes. Finally, 31% of participants believed it was unlikely to contract AIDS from being coughed or sneezed on (Table 3).

Source of information questionnaire

The findings from the Source of Information Questionnaire reported that 74% of the participants first learned about HIV/AIDS from an educational source (high school/higher education class, guest lecture, continuing education opportunity, etc.). Additionally, 43% of respondents learned about HIV/AIDS through the news or social media, and 37% from a parent, caregiver, family member, or friend. Sixty-nine percent of participants regularly update their knowledge about HIV/AIDS by researching reliable sources, and 59% do so by attending courses, or presentations specifically focused on HIV/AIDS (Table 4).

The sociodemographic overview of the sample provides a snapshot of the participants' diverse backgrounds and lived experiences, with the predominance of Black women constituting 83% of the respondents. This reflects the focus of the study in examining challenges and knowledge gaps within this population, which is disproportionately affected by HIV/AIDS [2]. While the majority of respondents identified as Black or African American, the inclusion of women from various racial and ethnic backgrounds (e.g., Middle Eastern, Asian, Hispanic, American Indian, and White) adds a valuable perspective on how HIV/AIDS is perceived and understood across different communities [2]. The broad age range of participants (18–69 years) also allowed for an examination of how HIV/AIDS knowledge and awareness may vary across generations. Studies indicate that younger women are more vulnerable to HIV infection because of peer pressure and a lack of awareness on how to prevent the disease, while older women may experience barriers to knowing their status due to lack of knowledge, health care access, and social stigma [17].

Sociodemographic variables such as socioeconomic status and educational attainment are crucial determinants of health outcomes. A large portion of the sample reported lower class (21%), and 48% reported working class, which is consistent with previous literature that states that individuals from a lower socioeconomic status are less likely to have access to health care, prevention opportunities for HIV/AIDS, and more likely to be at risk of transmission [18,19]. The predominance of heterosexual respondents (80%) reflects trends in the Black female population, where heterosexual transmission remains the primary concern. However, the inclusion of sexual minority women (lesbian, bisexual, and others) underscores the unique challenges they face in HIV prevention and care [20]. This highlights the need for inclusive interventions that cater to the diverse needs of all women at risk. Moreover, religion was a factor that influenced the participants' perceptions since 61% of the participants identified themselves as Christians. Faith-based interventions have indeed been effective in promoting awareness and reducing stigma about HIV among individuals, especially within communities where religious beliefs shape health decision-making [21].

The sociodemographic profile highlights the intersectionality between race, class, and education as the important facilitator of both experiences and knowledge concerning HIV/AIDS. These suggest the importance of targeting appropriate, culturally sensitive interventions on Black women and other vulnerable subpopulations so that they can gain the skills and competencies needed to prevent or self-protect from HIV/AIDS infection.

The results in the HIV/AIDS Knowledge Scale revealed varying levels of knowledge and perceptions of HIV/AIDS among respondents. While the majority of them demonstrated an understanding of most critical aspects of HIV/AIDS, it was clear that some notable gaps in knowledge and misconceptions remained. One of the most concerning findings is that only 45% of respondents correctly identified AIDS as an infectious disease caused by a bacterium, while 47% incorrectly believed it was caused by something else. This indicates a significant misunderstanding of the disease's basic etiology [3]. In contrast, a larger percentage of respondents, 68%, correctly identified that AIDS destroys the body's immune system by attacking B cells in the endocrine system, a fact quite pivotal to the understanding of the disease process. However, 23% of respondents still got this question wrong, indicating further education in how the immune system is affected by HIV/AIDS. Condom use also showed weaknesses in knowledge, as only 28% of those interviewed knew that latex condoms were more effective than lambskin or natural membrane condoms in preventing HIV transmission. The large proportion, 84%, who were not sure indicates a need for much clearer educational campaigns regarding the efficacy of different types of condoms for preventing HIV.

While a significant majority of 90% were able to recognize that AIDS is caused by HIV, there were still some misconceptions. For example, 15% of participants believed that AIDS is a man-made disease created in a laboratory-a myth that has widely been debunked [23,24]. This may be because conspiracy theories persist in some communities and shows the need to debunk misinformation about the disease. On HIV transmission, the results show that though the participants generally have good knowledge of high-risk activities, they still harbor misconceptions. For example, while a majority of respondents (82%) acknowledged the likelihood of HIV transmission from an HIV-positive mother to her baby during pregnancy or birth, 27% believed that working near someone with AIDS posed a risk, and 38% thought eating at a restaurant where the cook has AIDS could lead to transmission. This suggests that some individuals may overestimate the risk of HIV transmission in everyday activities, which underscores the importance of targeted education on how HIV is and is not transmitted [3].

Generally, the results have been encouraging in terms of demonstrating a high level of awareness regarding the basics of HIV transmission and its effects on the human immune system; however, continuous public health education is needed. There is a further need to address myths about HIV/AIDS, promote accurate knowledge in relation to prevention methods such as the use of condoms, and also provide further clarification on everyday risks associated with the disease. By correcting these misconceptions, health interventions can be more effective in reducing HIV transmission and improving health outcomes within the community.

In conclusion, the findings of the study add to the literature in understanding sociodemographic characteristics, knowledge, and perception about HIV/AIDS among Black female respondents. The findings reflect important considerations for targeted public health interventions, particularly for minority populations that have historically been disproportionately impacted by HIV/AIDS. One of the major findings demonstrated a solid understanding of the basic concepts surrounding HIV/AIDS, there are notable gaps in specific areas. For example, 45% of respondents believed that AIDS is caused by a bacterium, and a significant proportion were unsure about the effectiveness of different types of condoms in preventing HIV transmission. These are a few of the misconceptions that stand out in regard to the need for more specific education in the biological causes of AIDS and preventive measures.

In terms of HIV transmission, while most participants understood that casual contact, such as working near someone with AIDS, does not pose a risk, a notable percentage still believed in myths related to HIV transmission through kissing or sharing utensils. This suggests the idea that stigma and misinformation could hinder effective public health strategies. The findings also suggest the importance of educational institutions and formal learning environments as the main source of HIV/AIDS knowledge for the participants. Most respondents first learned about HIV/AIDS through educational channels and continued to update their knowledge through courses or presentations. However, with social media and news also playing a significant role, public health campaigns must ensure the accuracy of information disseminated across these platforms. While there is a strong foundation of HIV/AIDS knowledge among the sample, specific gaps in understanding, particularly regarding modes of transmission and preventive measures, must be addressed. These results suggest the need for continued education and public health initiatives tailored to dispelling myths, reducing stigma, and promoting accurate information across diverse communities.

The findings also demonstrate that effective HIV/AIDS interventions must address the intersections of race, culture, and gender, particularly for Black women and other women of color, who face systemic barriers in HIV prevention and treatment. Race and ethnicity not only shape individuals' identities but also create power imbalances in a multicultural society, reinforcing health inequities. Interventions that fail to consider these dynamics tend to fall short, as evidenced by the stagnant HIV intervention strategies in high-income countries (HICs) over the past four decades. Programs like the Health Intervention Project in Atlanta that targeted decreasing HIV risk among Black women show the clear benefit of tailored and culturally sensitive approaches. The project recognized the complexity of Black women's lives, incorporating the influence of male partners, motherhood, and spiritual and cultural identity. This holistic approach, which incorporated personalized action plans and motivational techniques, empowered participants to set realistic goals and address personal challenges like drug use and power dynamics in relationships. By using models like the Stages of Change and focusing on empowerment, interventions can foster long-term behavioral change.

To meet the UNAIDS 95-95-95 targets and ultimately eliminate HIV/AIDS as a health threat, more innovative, culturally responsive interventions are required. These programs need to address not only individual risk reduction but also collective health issues of marginalized communities. Additionally, empowerment theory provides a robust framework for these interventions, emphasizing the importance of increasing self-efficacy, community engagement, and access to resources. Through empowerment, Black women can gain greater control over their health and well-being, which is essential for reducing HIV transmission and improving health equity.

Data is available upon reasonable request from the corresponding author.

All authors declared that they have no competing interest

The study was approved by Fayetteville State University Institutional Review Board. All methods used in this study were performed in accordance with relevant guidelines and regulations.

No funding for this project.

EC and NA contributed to the manuscript preparation.