Persisting failure to protect populations at risk from HIV transmission: African American women in the United States (US).

High and steady rates of HIV transmission to African American women expose problems in the US approach to prevention. Vulnerability of African American women, rooted in the broader experience of African American communities in the United States, relates not only to individual behaviors, but also to structural factors beyond individual control. These - poverty, employment, education, and incarceration - greatly influence risk of infection, late diagnosis, and death from HIV-related causes. The creation, implementation, evaluation, and replication of US prevention programs helps explain both their benefits and specific shortcomings. Can we improve effectiveness of prevention for African American women and other underserved groups in the United States - and in some 50 countries where the US uses its own domestic approaches when providing guidance through President's Emergency Plan for AIDS Relief? Creative additions to known strategies may come from small organizations working within affected communities, but implementation, evaluation, and scale up of more effective activities will require greater government support of community-based initiatives.