ArticleHealth & justice2026
'Oh, they can prevent It?': a structural agency framework for understanding HIV prevention among black women in community supervision programs.
Article in Health & justice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDespite efforts to end the HIV epidemic, new transmissions among Black women in the U.S.' Deep South remain disproportionately high. This study examined condomless sex experiences and PrEP non-engagement among Black women in community supervision programs (e.g., diversion, probation, parole) in Alabama.
methodsAs part of Project E-WORTH South, we used a phenomenological approach and conducted 16 semi-structured interviews to explore factors influencing condom use and PrEP engagement. Participants (n = 16) were selected through criteria-based sampling: Black or African American individuals, female at birth, aged 18 years or older, English-speaking, and current community supervision involvement. Interview transcripts were double-coded using a phenomenological coding technique to identify general themes. The codes were then grouped into themes and subthemes.
resultsAnalysis revealed four distinct forms of agency that participants employ in sexual health decision-making, mapped along two dimensions: structural constraints/coercion and HIV prevention knowledge/resources. Despite 37.5% engaging in self-initiated HIV testing, 87.5% were unaware of PrEP/PEP existence, with 50% reporting condomless sex. We identified two novel agency forms: deprived agency (knowledge gaps limiting autonomy) and traversed agency (bidirectional override of initial intentions).
conclusionThis study introduces a novel structural agency matrix framework and identifies previously unrecognized forms of sexual health agency among Black women under community supervision. The paradox of high health-seeking behaviors alongside near-zero PrEP awareness reveals systematic information dissemination failures rather than individual barriers, demonstrating need for matrix-informed interventions that simultaneously address structural constraints and knowledge gaps.
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