PrEP uptake disappointing among cisgender Black women

Oh boy. The propaganda is coming fast and furious. This will be a short one, but it’s important.

PrEP, a Key HIV Prevention Tool, Isn’t Reaching Black Women

Alexis Perkins thought her OB-GYN’s office in Atlanta would be just the place to get a prescription for the type of drug that reduces a person’s risk of contracting HIV.

But during a recent visit, the medical assistant who greeted her had not heard of the medicines known as preexposure prophylaxis, or PrEP, and she seemed uncomfortable discussing it, Perkins said. Her provider had heard of it but didn’t feel confident prescribing it.

“She was at least honest enough to say that she was interested in it, but she didn’t really know that much about it,” said Perkins, a 25-year-old nurse, who decided to get on PrEP after participating in a sexual health education class and thinking more about her own risk. She’s still trying to find a provider to write her a prescription.

“If I wasn’t really confident in myself, this could have been a very discouraging experience,” Perkins said.

PrEP is a crucial tool in the fight against the ongoing HIV epidemic and, when taken as prescribed, is highly effective at preventing infection from sexual contact or injection drug use.

Wait, what happened to “>99% effective”? Now we’re just saying PrEP is “highly effective,” which gives us next to no information. Recall also that studies of PrEP among injection drug users have had inconsistent and underwhelming results.

But more than a decade after the first PrEP drug was approved for the U.S. market, one of the groups that would benefit most from the medications isn’t taking them: Black women, such as Perkins, whose gender identity align with their sex assigned at birth.

Doctors, public health researchers, and those who provide HIV treatment and prevention services say long-standing, systemic factors, such as stigma and racism, are major barriers to PrEP uptake among cisgender Black women. Transgender Black women face obstacles to PrEP uptake as well, especially discrimination related to their gender identity.

But many researchers focus on cisgender Black women, who, they say, are often overlooked by the health care system and face obstacles like: noninclusive marketing leading to a lack of awareness about who would benefit, fewer treatment options for women than for men, and medical professionals wary to prescribe it. These challenges are even more apparent across the South, which has the highest rates of new HIV diagnoses in the country.

Does it seem strange to you as well that language like “Black women, such as Perkins, whose gender identity align with their sex assigned at birth” has become extremely commonplace?

It bears mentioning as well that Henry Bauer’s work indicates that what is indicated by “HIV positivity” has been historically higher in the South throughout the entire epidemic; as well as that African Americans consistently test “HIV positive” at a higher rate than any other racial demographic, regardless of their risk group, and even in groups (such as repeat blood donors) that are at effectively zero risk at all, suggesting rather strongly that “HIV positivity” is not a contagious condition.

Taking PrEP requires regular testing and doctor visits to check for HIV infection, which can present a “tremendous barrier” to access because of cost and logistics, said Michael Fordham, a program manager at the University of Alabama at Birmingham’s 1917 Clinic, the largest HIV care facility in the state.

“We’re actually seeing PrEP patients more frequently than we see our patients living with HIV that are stable,” he said.

They’re finally saying the quiet part out loud—“anti-HIV” drugs are intended for, eventually, everyone. I’ve noticed recently that, even in my Instagram feed, more and more people are promoting PrEP for themselves and their friends. It’s very strange. Hopefully we’ve learned our lesson from the massive real time Covid vaccine trial, because, as we know from the Truvada disaster, these drugs are not “safe and effective,” and prescribing them to large swathes of the population is a recipe for disaster, and for yet more class action lawsuits.

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