Just so y’all know…
In the United States, Black women are still being diagnosed with HIV — yes HIV, also known as Human Immunodeficiency Virus — at rates higher than any other racial and ethnic group of women. In fact, let’s run the math.
Black women have a 1 in 54 lifetime risk of being diagnosed with HIV. Sadly, we represented more than 60% of new HIV diagnoses among all U.S. women in 2020. During that same year, 3,812 Black women received an HIV diagnosis. And unfortunately, these numbers have been consistently high over time.
Too often folks are absolutely shocked to hear this information. Those who work in the field of sexual and reproductive health who have been advocating for increased attention around the disproportionate impact of HIV among Black women since the beginning of the HIV epidemic in 1981, are the least surprised.
Let us tell you why.
We should be asking ourselves why are Black women so much more likely to receive an HIV diagnosis? Our vulnerability to HIV is best understood by examining our social and cultural contexts. Black women are increasingly exposed to physical and sexual violence and imbalanced power dynamics in relationships. We also experience stigma, discrimination and poverty at rates higher than our white and Latina counterparts.
We have over 400 years of anecdotal reference that show sex for Black women is often not centered around sex positivity or as a mutually beneficial, pleasure filled experience. As Black women, our abilities to insist upon using condoms is often not an option as a result of the perilous dynamics we live in.
Knowing what we know about the state of HIV among Black women, our communities who love and have sex with us should be asking, even screaming, about what additional strategies are needed to prevent HIV.
Medications Can Prevent HIV!
What we in the field of HIV and public health call biomedical tools have been considered “game changers” that could end HIV as we know it.
On July 16, 2012, the Food and Drug Administration announced the approved use of an oral medication for Pre Exposure Prophylaxis (PrEP). The medicine, originally used for HIV treatment, was a new biomedical strategy to prevent HIV.
Say what? A once-a-day oral medication could now be used to prevent HIV transmission during sex when taken every day as prescribed by a medical provider.
PrEP was introduced as a bold new strategy for HIV prevention, preventing HIV with more than 90% effectiveness. Now, a decade later we not only have daily pills for PrEP but injectable PrEP where someone can go to a clinician every other month for a shot (much like depo for birth control) to prevent HIV. For highly impacted communities like Black women, PrEP could be a gamechanger in the paradigm to reduce the burden of HIV.
But Black women are not taking PrEP. Period.
Year after year, the data shows us that Black women do not use PrEP. The Centers for Disease Control and Prevention (CDC) estimate that only 9% of the nearly 469,000 Black Americans who have an indication for PrEP are utilizing it. One study revealed that women were less than 5% of all PrEP users.
A few schools of thought among Black women about PrEP use: either we have NO idea PrEP is even a thing, or we know it’s a thing and that it’s been historically marketed to other communities affected by and at high risk for HIV, like gay men.
Some of us have even said, “we don’t trust the side effects;” “it’s too expensive;” “if I take it, my partner will think I have other sexual partners;” and “I’m not at risk for HIV, so I don’t need PrEP.” Some medical providers have decided that Black women are not at risk for HIV, and subsequently, will not offer information about PrEP.
A Call to Action to Black Women.
As Black women on the frontlines fighting HIV, we stand firm in stating the following:
Ten years into this conversation around biomedical HIV prevention, not enough is being done or said to prioritize Black women’s sexual health and we deserve better.
Additional funding support is needed to: 1) support women-centered HIV prevention messaging campaigns to increase PrEP awareness, and 2) increase research and development of new biomedical products and behavioral interventions. While oral PrEP was approved in 2020, new formulations are currently available, including a monthly injection.
Cost should not be an issue for you to access PrEP. PrEP for most people is free and can be as inexpensive as $17 a month.
Currently, President Biden is requesting $9.8 billion from Congress over 10 years to develop a National PrEP program to increase PrEP access as a strategy to end the HIV epidemic in the US.
We cannot let Black women continue to be left behind, particularly as the nation gears up to increase resources. If recent events continue to prove true, we know that if we are not at the table demanding to be prioritized, then we get passed over and deprioritized.
Now is the time to mobilize and get the resources and tools needed to protect ourselves. Ask your health provider about PrEP, educate your loved ones on PrEP and mobilize your elected officials to demand that any national PrEP program centers Black women and our communities.
PrEP is for women. PrEP is for women. PrEP is for women. Black women, talk to your provider about PrEP as an HIV prevention strategy for you.
Recent events around Roe v. Wade and the deep-seated effects of patriarchal oppression on women’s sexual health, rights and justice, remind us to take control of our choices. With that said, Black women, we love you.