BACKGROUND: Definitions of masculinity and femininity and gender roles impact how individuals access, interpret and use HIV prevention messages in African, Caribbean and other Black (ACB) communities. These differences must be considered when designing prevention interventions. OBJECTIVE: To explore sex-based differences in ACB peoples’ HIV prevention needs. METHODS: Using a community-based approach, a purposive sample of 22 ACB community members (CM) and 8 service providers (SP) in London, Ontario was interviewed about health. Respondents represented a cross-section of ACB communities and SPs serving these communities. HIV-specific topics included: awareness, perceived risk, risk behaviours, barrier to accessing services and service needs. Interviews were divided by sex (12 female, 10 male CMs; 6 female, 2 male SPs) and analysed using qualitative content analysis to identify themes. FINDINGS: Men had greater awareness about HIV than women. Women believed their risk of contracting HIV was very low or zero due to marriage and abstinence. Men and women recognized sexual behaviours as risk factors for infection. Women also said alcohol and drug use were risk factors. Men and women said stigma and fear were barriers to accessing HIV services. Women cited literacy and discrimination as additional barriers; men cited mental health and culture. Women called for more condoms and Canadian HIV statistics. Men called for culturally-based services and family testing. Female and male SPs cited female disempowerment as a barrier to protection for women, and low condom use was a barrier for ACB men. Female SPs said ACB men need male SPs that they would access. DISCUSSION: It appears that education, awareness, and empowerment efforts specific to ACB women are needed. Information is needed about straight ACB men, and it is important to encourage them to access HIV services. A quantitative survey complements these findings; these data will be used in a needs assessment.