Background To date, there are very few comparative US studies and none in DC that distinguish between US-born and foreign-born black women to examine and compare their perceptions of HIV risk. This qualitative study, therefore, analyzes African American and East African women's perceptions of HIV risk in the Washington DC Metropolitan area, which has the highest AIDS rate in the United States. Methods Forty in-depth, semistructured interviews and 10 cognitive interviews were conducted among a sample of 25 African American women and 25 East African born women between October 2012 and March 2013 to examine perceptions regarding HIV risk. The in-depth semistructured interviews were preceded by the cognitive interviews and accompanying survey. Study protocol was reviewed and approved by the American University Institutional Review Board. Results Adopting Boerma and Weir's Proximate Determinants conceptual framework to interpret the data, the results of the study demonstrate that African American and East African immigrant women have divergent perceptions of HIV risk. Although African American women ascribe HIV risk to individual-level behaviors and choices such as unprotected sex, East African women attribute HIV risk to conditions of poverty and survival. Conclusions Study findings suggest that addressing HIV prevention and education among black women in DC will require distinct and targeted strategies that are culturally and community-centered to resonate with these different audiences. © 2015 American Sexually Transmitted Diseases Association All rights reserved.

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education perception immigrant HIV Infections poverty human middle aged District of Columbia unprotected sex African American Human immunodeficiency virus qualitative research Sexually Transmitted Diseases United States Young Adult Humans migrant human tissue conceptual framework Adolescent psychology male Emigrants and Immigrants semi structured interview female Black person African Continental Ancestry Group university clinical article Health Knowledge, Attitudes, Practice high risk behavior Risk-Taking adult East African institutional review attitude to health African Americans