Sam Whitehead | TNS – Kaiser Health News
Alexis Perkins, a 25-year-old nurse in Atlanta, visited her OB-GYN’s office hoping to obtain a prescription for preexposure prophylaxis (PrEP), a drug used to reduce the risk of contracting HIV. However, Perkins was met with an unfamiliarity and discomfort from the medical assistant and lack of confidence from her provider when it came to discussing and prescribing PrEP. Despite her determination, Perkins struggled to find a provider who could prescribe the drug. The story highlights the barriers faced by Black women, like Perkins, in accessing PrEP and addressing the ongoing HIV epidemic.
PrEP is a highly effective tool in preventing HIV infection through sexual contact or drug injection. However, Black women, particularly cisgender individuals, are not utilizing PrEP as they should be. Stigma and racism, deeply embedded in the healthcare system, are significant obstacles preventing PrEP uptake among this population. Transgender Black women also face hurdles, particularly related to discrimination based on their gender identity. Noninclusive marketing, limited treatment options for women, and healthcare professionals’ hesitation to prescribe PrEP further exacerbate these challenges. These barriers are even more prevalent in the Southern region, which has the highest rates of new HIV diagnoses in the United States. Recent data from the Centers for Disease Control and Prevention (CDC) reveal that women, predominantly cisgender Black women, accounted for a considerable proportion of new HIV infections in 2021.
Tiara Willie, an assistant professor of mental health at the Johns Hopkins Bloomberg School of Public Health, emphasizes the need to address systemic issues in order to effectively support Black women. The lack of change in the healthcare system will result in continued failures for this population. The U.S. Food and Drug Administration (FDA) has approved three PrEP drugs: Descovy, Truvada (also available as a generic version), and Apretude (an injectable drug). Descovy, although more desirable due to its smaller tablet size, has not been tested on cisgender women. This gender disparity in drug testing has sparked criticism from HIV researchers and advocates, who argue for a more inclusive approach.
Gilead Sciences, the manufacturer of Descovy, has announced ongoing trials focused on the drug’s use among cisgender women. The CDC has also allocated an $8 million grant to fund studies aimed at increasing PrEP uptake among Black cisgender women. Despite these efforts, Black women face additional hurdles due to resource disparities. Census data shows that Black Americans, particularly women, are more likely to live in poverty. The cost and logistics associated with PrEP, which require regular testing and doctor visits, pose significant barriers to access. Michael Fordham, a program manager at the University of Alabama at Birmingham’s 1917 Clinic, emphasizes the importance of reducing these barriers to increase PrEP utilization.
While the CDC has updated its PrEP guidelines to align with the latest science and drug approvals, some providers still find them burdensome. Robyn Neblett Fanfair, acting director of the CDC’s Division of HIV Prevention, acknowledges this concern and states that the agency is working towards more timely and nimble guidelines. Fanfair also highlights the need to reduce the costs associated with taking PrEP. Currently, the federal government requires private insurance plans to cover PrEP, but there have been cases of uncovered costs. Policies, such as Medicaid expansion, can improve access to PrEP, especially in the Southern states where many have yet to expand their insurance programs for low-income individuals.
Nevertheless, financial barriers are not the sole obstacles to PrEP access. Physicians and nurse practitioners may feel uncomfortable discussing HIV and other sexually transmitted infections, particularly in the socially conservative environment of the “Bible Belt.” Anitra Walker, vice president of operations at Mercy Care, states that social stigma not only prevents Black women from discussing PrEP with medical professionals but can also jeopardize their domestic relationships and livelihoods. Mauda Monger, an assistant professor at the University of Mississippi Medical Center, emphasizes the need to address broader issues, such as access to good jobs, affordable healthcare, and stable housing, to empower Black women and enable them to take control of their health.
Furthermore, researchers argue that messaging and marketing strategies for PrEP need to be more inclusive. Jessica Sales, an associate professor at Emory University’s Rollins School of Public Health, conducted focus groups with Black cisgender women to better understand their perspectives on PrEP advertisements. The participants expressed that they felt excluded from the campaigns, which mainly featured gay men or transgender individuals. To address this gap, Sales is partnering with SisterLove, a sexual health nonprofit in Atlanta, to train influencers who can hold informal conversations with community members and improve PrEP knowledge, interest, and uptake among cisgender women. The Healthy Love curriculum developed by SisterLove, supported by the CDC, enables Black women to have open conversations in a safe and supportive environment.
Dázon Dixon Diallo, the founder of SisterLove, warns that failing to prioritize the needs and access of cisgender Black women to PrEP undermines efforts to combat the HIV epidemic. Centering Black women in the fight against HIV is crucial for progress. Undoing the damage caused by longstanding systemic issues requires collective action and a comprehensive approach. Without centering and empowering Black women, the fight against the HIV epidemic will be futile.
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