A new survey of students at a historically Black college in Tennessee has revealed a striking disconnect between how much HIV risk young adults actually carry and how much risk they believe they face. The study, published in BMC Infectious Diseases by a team led by Emily R. Moore of Vanderbilt University Medical Center, found that roughly half of the students surveyed met the researchers’ criteria for being at high risk of HIV infection, yet that elevated risk bore no statistical relationship to whether students had recently been tested or even to whether they expressed concern about contracting the virus. The finding lands at a moment when public health officials are struggling to bend the curve of new infections among Black adolescents and young adults in the American South, a region that accounts for a disproportionate share of the nation’s HIV diagnoses.
The research was conducted as part of the broader Ending the HIV Epidemic initiative, a federal program launched in 2019 that concentrates resources on jurisdictions where transmission remains stubbornly high. Tennessee is one of the priority states, and the midsize historically Black college and university that hosted the study sits squarely within that geography. Between March and September 2022, researchers administered an electronic cross-sectional survey through the REDCap platform, recruiting students between the ages of 18 and 35. The instrument collected demographic information, details about sexual behavior and other HIV risk factors, history of HIV testing and pre-exposure prophylaxis use, perceived barriers and facilitators to prevention services, and responses on the HIV Testing Belief Inventory, a validated psychometric scale designed to measure beliefs about the benefits of testing and the weight of stigma.
Of the 240 responses received, 146 surveys met the inclusion criteria of reporting either a prior HIV test or prior PrEP use, and those formed the analytical sample. The demographic profile reflected the institution’s identity: 84.9 percent of respondents identified as Black, 58.9 percent as female, and 82.9 percent as heterosexual. Sexual activity was nearly universal in the recent past, with 93.2 percent reporting intercourse within the previous year. When the researchers applied their risk classification, 49.3 percent of the sample fell into the high-risk category, a figure that underscores how broadly HIV vulnerability is distributed even among young adults who may not perceive themselves as candidates for prevention services.
The statistical analysis revealed what the authors describe as discrepant concern for HIV risk. Being classified as high risk was not significantly associated with recent HIV testing, with a p-value of 0.138, nor with reported concern about HIV risk, with a p-value of 0.455. In practical terms, the students whose behavior placed them at greatest epidemiological risk were no more likely to seek testing or to worry about infection than their lower-risk peers. This misalignment is a well-recognized challenge in HIV prevention science, but documenting it in a young, predominantly Black, predominantly heterosexual college population adds an important data point, because much of the national conversation about HIV risk perception has historically centered on other demographic groups.
Where the psychometric measures did show signal was in distinguishing students who had been tested from those who had not. Prior HIV testing was significantly associated with lower concern about HIV-associated stigma, with a mean stigma score of 1.7 among those tested versus 2.0 among those untested, a difference that reached statistical significance at p = 0.023. Testing was also associated with greater perceived benefits of testing, with mean scores of 4.4 versus 4.0 on that subscale, significant at p = 0.002. These associations are correlational rather than causal, and the authors are careful not to overinterpret them, but they suggest that stigma and perceived benefit are meaningful levers in the psychology of testing behavior. Interventions that reduce the social cost of being seen at a testing event, or that sharpen students’ understanding of the concrete advantages of knowing their status, may shift uptake in ways that risk education alone has not.
The headline utilization numbers were sobering. Fewer than half of respondents, 46.6 percent, reported a recent HIV test, and only 6.2 percent had ever used PrEP, the daily antiretroviral regimen that reduces the risk of acquiring HIV through sexual exposure by roughly 99 percent when taken as prescribed. The gap between the half of the sample classified as high risk and the tiny fraction using PrEP represents one of the clearest illustrations of the prevention cascade failures that characterize the Southern United States. PrEP uptake among Black Americans has lagged far behind the burden of disease in the community, driven by a combination of limited awareness, access barriers, medical mistrust, and prescriber-level biases that have been documented in prior literature.
When the survey asked what would make testing easier, the most frequently cited facilitator was on-campus testing events, selected by 52.4 percent of respondents. This preference for a familiar, convenient, and institutionally sanctioned setting speaks to the practical barriers that off-campus clinics can pose, including transportation, cost, scheduling conflicts, and the fear of being recognized in a small community health setting. The campus itself, in other words, is not just a backdrop but a potential delivery platform. Consistent with that theme, when respondents interested in learning more about PrEP were asked where they would turn, the largest share, 40.7 percent, said they would rely on the HBCU for information, outranking healthcare providers and other sources.
That trust in the institution is a strategic asset. Historically Black colleges and universities occupy a distinctive position in American higher education and in Black communities more broadly, with a legacy of producing a large share of the nation’s Black professionals and a reputation for serving students whom other institutions have historically marginalized. The study’s authors argue that this positioning makes HBCUs acceptable, and potentially highly effective, avenues for delivering HIV prevention services. Embedding routine testing at campus health centers, staging regular testing events integrated into student life, and channeling PrEP education through trusted campus messengers could reach a population that conventional clinic-based outreach has struggled to engage. The finding that students themselves nominate the institution as their preferred information source strengthens the case for institution-embedded programming rather than externally imposed campaigns.
The study has limitations that the authors acknowledge and that readers should weigh. The sample came from a single midsize HBCU, and the 146 analyzed surveys represent a subset of the 240 collected, raising the possibility of selection bias toward students already engaged with health topics. Self-reported sexual behavior and testing history are subject to recall and social desirability errors, and the cross-sectional design captures a single moment in time, precluding any inference about whether reduced stigma leads to testing or whether the experience of testing reduces stigma. The authors explicitly call for future work to evaluate the drivers of the mismatch between actual and perceived risk, a question the survey was designed to document rather than resolve.
Even with those caveats, the study contributes a concrete, actionable map for a population that sits at the intersection of several high-priority public health targets: young adults, Black Americans, Southerners, and students at institutions with both elevated vulnerability and unusual community trust. The Tennessee Center for AIDS Research, funded by the National Institutes of Health, supported the work, along with an appropriation from the State of Tennessee’s Legislative Black Caucus, a signal of state-level political engagement with HIV disparities in Black communities. The research team, which spanned Vanderbilt, Meharry Medical College, St. Jude Children’s Research Hospital, LeMoyne-Owen College, and partner institutions, also drew on student health ambassadors and the Memphis Connect to Protect HIV Community Coalition in designing and disseminating the survey, a community-engaged approach that mirrors the delivery model the findings themselves endorse. The next step, the authors conclude, is implementation research: rigorously testing locally tailored HIV prevention interventions delivered through HBCUs, so that the institutional trust documented in this survey can be converted into higher testing rates, wider PrEP uptake, and measurable reductions in new infections among the young Black adults who carry the heaviest burden of the American HIV epidemic.
Subject of Research: HIV testing and pre-exposure prophylaxis uptake among young adults at a historically Black college in Tennessee
Article Title: Barriers and facilitators to HIV testing and prevention services among young adults at a historically black college in Tennessee
Article References: Moore, E. R., Wilkins, M. L., Alexander, L., Davis, B., Karris, M., Lang, L., McGee, M. L., McMorris, C., Muhammad, J., Ross, A. N., Propst, E. A., Willging, C., Rebeiro, P. F., & Pettit, A. C. (2026). Barriers and facilitators to HIV testing and prevention services among young adults at a historically black college in Tennessee. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14533-7
Image Credits: AI Generated
DOI: 10.1186/s12879-026-14533-7
Keywords: HIV, HIV testing, PrEP, HBCU, young adults, HIV prevention, stigma, health disparities, U.S. South, Ending the HIV Epidemic, public health, cross-sectional survey
News Source: Kristina Jarvis. (October 5, 2026). HIV Risk Mismatches Reality on Southern Black College Campus, Survey Finds. Scienmag.
