PrEP Utilization Gaps Persist—Can Cultural Messaging Drive Patient Engagement?

Grammy-winning artist Ciara is expanding her portfolio of public health advocacy, moving beyond cervical cancer awareness and nutrition to address a critical gap in HIV prevention. Recognizing the disproportionate impact of HIV on Black women—a demographic facing significant disparities in PrEP (pre-exposure prophylaxis) uptake—the superstar is leveraging her cultural influence to drive health literacy. By integrating clinical messaging into her music for the first time, she aims to normalize discussions around preventative care and reduce the medical mistrust that often hinders patient engagement in underserved communities.

The Power of a Remix

Earlier this year, Ciara’s iconic hit “1, 2 Step” was reimagined as “1, 2 PrEP” as part of a national campaign. The initiative raises awareness for long-acting HIV prevention options, including Yeztugo, the first-ever approved twice-yearly PrEP (pre-exposure prophylaxis).

At a recent SXSW panel hosted by Gilead Sciences, Ciara joined HIV advocate Dr. Leo Moore and famed radio personality Loren LoRosa for a conversation exploring how music and culture can dismantle the barriers surrounding HIV prevention.

“Being part of this conversation with Gilead at SXSW is really meaningful to me because I believe music, culture, and media can help spark new and important conversations about health. If using my platform helps break down barriers and encourages people to talk to their providers about their HIV prevention options, then that’s incredibly powerful,” she said.

Breaking the Silence

Ciara hopes that by using her platform, she can encourage more people—particularly within the Black community—to engage with their healthcare providers. Despite the medical advancements available, HIV continues to disproportionately impact women and underserved communities.

In 2024, AIDSVu reported that while roughly 600,000 people in the U.S. used some form of PrEP, the CDC estimates that up to 2.2 million individuals could potentially benefit from these preventive medications. For Ciara, the decision to use her most “precious” work for this cause was a matter of impact.

“I’ve always been so precious about ‘1, 2 Step’ in particular. There are some samples you just can’t let them just go anywhere,” she says. “I have to give the Gilead team great props. I’m like, who thought of this idea, taking my song, ‘1, 2 Step’ and go 1, 2 PrEP? This is pretty brilliant! That’s the power of music. It really has the power to influence, to shape culture, to inspire, to encourage, to uplift, and in this case, to also educate and inform. There are so many boxes that we were able to check off by using my song in this form, and I’m really proud of that.”

Trusted Messengers

Dr. Moore, a public health leader and member of the Presidential Advisory Council on HIV/AIDS (PACHA), believes Ciara’s involvement provides a necessary bridge to the community.

“I go back to the first time I heard the commercial, the 1,2 PrEP commercial, and how in my mind, I thought where I was when I first heard the song, ‘1,2 Step’ and thinking wow, now you’re watching the commercial, you’re hearing that song, you’re going back in your mind, the nostalgia you feel, and also the connection that you feel to an artist that you’ve known about for a long time. That’s why I think having trusted messengers like Ciara be involved in this conversation helps to break down barriers and helps people to have an open mind to the information that they’re receiving,” Dr. Moore explains.

The statistics remain a sobering reminder of why this work is personal. Black women account for half of all new HIV cases diagnosed among women—a fact Ciara found staggering.

“I didn’t know that, to be honest, it was very eye-opening for me,” Ciara added. “I don’t think people really know, so being able to raise awareness and get this word out through music is really important for me, and I’m excited I get to do it.”

Normalizing the Conversation

Dr. Moore notes that the biggest hurdles are often myths and a lack of perceived risk. “A lot of people still think that HIV can be spread through hugs, through kisses, through touch. We definitely need to dispel that myth,” he says.

“Your sexual health is your responsibility. So, regardless of who you’re with, if you’re single, in a relationship, knowing your status is important, also knowing about the different HIV prevention options that are available to you, from condoms to knowing about PrEP,” Moore says.

The data backs up this urgent need for awareness:

• Only 9% of PrEP users in 2024 were women, even though they accounted for 19% of new HIV diagnoses in the United States.
• Only 14% of PrEP users in 2024 were Black and 18% were Latino, even though Black and Latino communities made up 38% and 34% of new HIV cases in the prior year, respectively.

Ciara is now focused on making health conversations “cool” again, treating her own wellness as an “evolving door.”

“The confidence I feel being aware and being able to empower myself, educate myself about my healthcare, or my overall wellness is huge.”

Improving PrEP Uptake and Patient Engagement

To address the disparities highlighted by Ciara and Dr. Moore, providers can implement the following evidence-based strategies to optimize sexual health outcomes:

• Universal Screening and Risk Assessment: Incorporate routine HIV screening as a standard component of preventative care, regardless of perceived risk. Moving toward a “status-neutral” approach helps normalize the conversation and identifies candidates who may benefit from prophylaxis.
• Proactive PrEP Counseling: Do not wait for patients to self-identify as high-risk. Proactively offer counseling on PrEP as a primary prevention tool, framing it as a routine wellness option—similar to contraception or chronic disease screenings.
• Prioritize Long-Acting Modalities: For patients who face challenges with daily oral adherence, discuss the clinical benefits of long-acting injectable PrEP. These newer formulations can significantly improve persistence and provide a discreet, highly effective alternative for underserved populations.
• Mitigate Medical Mistrust and Stigma: Use culturally resonant messaging to dismantle the stigma surrounding HIV prevention. Validating a patient’s autonomy and framing PrEP as an empowering health choice can help bridge the gap in trust, particularly among Black and Latina women.
• Navigate Financial and Structural Barriers: Be prepared to provide resources on patient assistance programs (PAPs) and co-pay cards. Familiarity with these resources is essential for ensuring that cost and insurance status do not remain insurmountable barriers to high-quality preventative care.

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