Sowing the Seeds to Grow PrEP Access for Black Women

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Black women are still disproportionately affected by HIV, despite efforts put in place by previous preexposure prophylaxis (PrEP) Centers for Disease Control and Prevention (CDC) guidelines, according to a viewpoint published in JAMA Health Forum last week.

The most recent PrEP guidelines from the CDC were published in 2021. They encouraged healthcare providers to talk about PrEP with all sexually active adults, not just with men who have sex with men.

Despite this change, cisgender women, specifically Black women, are still 15.3 times more likely to die from HIV when compared with white women, and Black men are six times more likely to die from HIV than white men, according to the U.S. Department of Health and Human Services Office of Minority Health.

Whitney C. Irie, Ph.D., assistant professor at Boston College’s School of Social Work, and Oni J. Blackstock, M.D., a primary care and HIV physician practicing in New York City, say fixing these inequalities is like growing a garden.

“Just like the different seeds, PrEP discussions can have vastly different outcomes when presented in different contexts,” Irie and Blackstock write. “Seeds may never get the chance to sprout if they land on a path instead of rich, nutritious soil and are quickly devoured by birds. Similarly, information may never reach Black women due to systemic barriers, clinician bias, and stigma, which precludes conversations about PrEP.”

Irie and Blackstock also say that even if a woman does not need PrEP access presently, she has the knowledge to make informed decisions about her sexual health in the future.

Healthcare providers aren’t the only figures that can successfully reach a community. During the COVID-19 pandemic, providers teamed up with Black community leaders such as pastors to increase vaccination rates. Mammography rates in Black communities were also increased this way. Irie and Blackstock say that beauty salons are an example of a culturally important setting where Black women can get PrEP information.

“Seeds that thrive in nurturing soil symbolize an environment that supports and empowers Black women in their sexual health decision-making,” Irie and Blackstock write. “Optimal PrEP provision occurs in a context that facilitates cultural understanding, acceptance, access, and action.”