Overview:

Black women in America are disproportionately affected by HIV, with 50% of new diagnoses among cisgender women. However, fear-based approaches to prevention have failed to protect them. Instead, a pleasure-based framework that focuses on joy, agency, and pleasure is needed. This approach acknowledges that sex can and should be a source of pleasure, connection, and intimacy, and integrates HIV prevention into broader sexual and reproductive health conversations. With new tools like long-acting injectable PrEP, prevention can be a tool for empowerment.

This Black HIV/AIDS Day, the conversation about HIV will inevitably turn to “risk.” For Black women in America, this word has become a heavy, suffocating cloak. 

It’s statistically true — Black women accounted for 50% of new HIV diagnoses among cisgender women, despite making up only about 14% of the female population. Here in Maryland, the reality is even more concentrated. The state is a critical front in this fight, being home to three Ending the HIV Epidemic priority jurisdictions: Baltimore City, Prince George’s County, and Montgomery County. In 2022, Black people accounted for 70% of all new HIV diagnoses in Maryland, with an estimated 1 in 96 Black women in the state living with HIV.

Fear Has Failed Black Women

Black women are endlessly told (directly and indirectly) that we are “at risk,” “vulnerable,” and “disproportionately impacted.” But fearmongering has not made us safer, and this language of deficit has failed us on so many levels. We’ve been told what not to do and who not to be. It frames prevention as a burden and sex as a threat. 

It’s time to approach prevention and safety through a conversation that is centered not on fear, but on joy, agency, and pleasure.

What if Prevention Started With Joy?

This was the focus of my doctoral research at the Johns Hopkins School of Nursing. My study, SHINE (Sexual Health, Inclusivity, Nurturance & Equity), was born from frustration after observing this persistent and harmful pattern. I listened to Black women across Maryland and found that even when women are aware of the “risks” they still faced critical gaps not just in access to services, but in access to conversations that affirm their entire selves, that make it safe to ask questions that further their right to a healthy and pleasurable sex life.

So what if, instead of asking, “How do we reduce your risk?” we asked, “How do we support your joy and pleasure?”

This is the heart of a pleasure-based framework for sexual health. It reframes the conversation from danger to desire, from prevention as a chore to prevention as a tool for empowerment. It’s an approach that acknowledges that for Black women, as for all people, sex can and should be a source of pleasure, connection, and intimacy.

The H in HIV Stands for Human

This isn’t radical — it’s an approach to care and prevention that centers the whole person, because the H in HIV stands for human. It means integrating HIV prevention seamlessly into broader sexual and reproductive health conversations. A woman seeking contraception, a prenatal check-up, or a routine exam should be able to discuss HIV prevention options at the same time in an affirming, non-judgmental way. So we must stop siloing HIV as a disease of “risk” and start treating it as an integrated part of sexual wellness. 

Prevention Has Changed. Our Language Must, Too

This shift in mindset is perfectly timed with revolutions in our biomedical toolkit. Previously a daily pill, PrEP (Pre-Exposure Prophylaxis) is now available as a long-acting injectable, and it’s a game-changer. As an injection every two months or even twice a year, it uncouples prevention from the daily act, from the need to carry a pill bottle, from a partner’s potential disapproval, or from the disruption of a moment of intimacy.

This is a piece of reproductive justice that women should be made aware of and should be able to access without stigma. It’s a tool that works silently in the background, allowing women to focus on the present, their pleasure, their partner, their joy, and their bodily autonomy. It is one of the most powerful tools we have to maximize both sexual health and sexual pleasure.

Pleasure Is Part of the Path to Ending the Epidemic

On this Black HIV/AIDS Day, our path forward must be different from our past. We cannot lecture our way to the end of this epidemic. We must listen, innovate, and affirm. We must dismantle the stigma that the deficit model created and build something new in its place: sexual healthcare that sees Black women not as vectors of risks, but as architects of their own joy and well-being.

Ending the HIV epidemic is still possible, but only when we as Black women finally decide to value our pleasure in prevention.

This story was originally published on Word In Black on February 5th, 2026