Pharmacist raises concerns about the HIV preventative Black women aren't hearing about
Thousands of Black women in Ohio face exposure to an incurable virus that could be prevented by taking a once-daily pill, yet only 1 percent of those who could benefit are prescribed the drug, a Columbus pharmacist says.
Black women, who are disproportionately affected by HIV, are the least likely to receive pre-exposure prophylaxis (commonly known as PrEP) to prevent becoming infected with the virus, says Olivia Nathan, a pharmacist with Equitas Health. “This has to change.”
In Ohio, a Black woman is 11 times more likely to be living with HIV than a white woman, according statistics from the Ohio Department of Health. In 2019, white women accounted for more than 82 percent of Ohio’s female population and 42 percent of new HIV diagnoses in females. By contrast, Black women, who account for just 12.5 percent of the state’s female population, comprised 48 percent of new diagnoses, the state says.
Several factors come into play, including lack of awareness, disparities in access to health care, mistrust of the medical establishment, and the extent to which providers discuss HIV with Black women.
A lack of knowledge about the HIV/AIDS trajectory over the past three decades factors into the current dilemma, says Dwayne Steward, Equitas Health director of prevention. Since the first reported cases in 1981, much has changed about HIV, yet in some people’s minds, “HIV is still a gay disease, or it’s over in Africa,” Steward says. “People feel that AIDS is over, but the reality is that people are still being diagnosed with AIDS daily, and people are still dying of AIDS today.”
Nathan and others in the field say it’s time to open up conversations about sexual health and emphasize that heterosexual women are not exempt from HIV infection. “We don’t talk about it enough. We want doctors and other providers to make it a priority to have regular conversations about HIV prevention,” says local HIV prevention advocate DeVeonne Gregory.
Too often, advocates say, heterosexual Black women don’t realize PrEP could benefit them. “They don’t even have it on their radar. It’s a very low perceived risk,” Nathan says. “Health literacy is huge. Do these women even know to ask?”
She recalls a patient she met during her fourth-year clinical rotation who was, like her, Black, college-educated, active on social media and came from a loving family. She came to Nathan suffering from nausea, vomiting, skin rashes and night sweats after recently being diagnosed with HIV. The red flags were there—she hadn’t been in a monogamous relationship or used condoms regularly and had experienced a sexually transmitted infection in the past six months —yet no provider had ever discussed PrEP with her.
Taking a robust workup of a patient’s sexual history is the norm at Equitas, a federally designated Community Health Center and one of the largest healthcare organizations serving the HIV/AIDs and LGBTQ+ communities in the U.S. That may not be the case in other settings, and particularly for women who don’t see a doctor regularly, Nathan says.
PrEP, also known by the brand name Truvada, is a daily pill that is up to 99 percent effective at preventing HIV and starts providing protection to women about three weeks after the first dose. The pill needs to be taken every day when someone is sexually active, but it’s possible to stop during extended periods of abstinence, Nathan says. “People took a break during COVID, or if there was a change in relationship status,” she says. PrEP does not prevent other sexually infectious diseases.
The cost is steep—about $1,300 for a 30-day supply— but most insurance plans, including Medicaid, provide some coverage. However, Steward says, “You should never think you can’t afford it. We will figure out how to get it paid for.”
The Ohio Department of Health’s Prevention Assistance Program Interventions initiative helps pay for PrEP-related medical costs, including co-pays. With Equitas’ TelePrEP, Black cis women can meet with a medical provider and pharmacist on their phones or laptops and in many cases, receive free delivery of PrEP within 24 hours. The prefix “cis” refers to women whose gender matches their assigned sex at birth.
In many ways, racial disparities in seen in PrEP for HIV prevention mirror those of COVID: People with the greatest need often are those who find it most difficult to access healthcare. But while demand initially far outpaced the supply of COVID vaccines, the reverse is true for PrEP. Of the estimated 500,000 people who could qualify for the medication, only 7,000 have received prescriptions, according to data released by the U.S. Centers for Disease Control and Prevention released in 2018. “The supply is infinite,” Nathan says.
“The way we pay for and the way we access care in many cases excludes Black people,” Steward says. “If we could end disparity, we could end HIV tomorrow.”
Devising innovative and meaningful ways to reach at-risk women is an overarching goal for those in the field of HIV prevention. In mainstream media, PrEP has been marketed primarily to gay and transsexual communities, and not to “people who look like me,” Nathan says. Similarly, the population of medical providers also needs to better reflect those they serve. “We can’t end this if Black women don’t have a seat at the table.”
Gregory, screening coordinator for the national African American Male Wellness Agency, says PrEP education is a growing part of the group’s uniquely grass-roots approach, which carries its message to churches, barber and beauty shops, colleges and people’s doorsteps. In the case of PrEP, the agency aims to connect with Black communities by listening to real concerns about side effects, cost and social stigma. “If you are taking PrEP, what does that say about you?” is part of the subtext of HIV prevention for many, says Gregory, who emphasizes, “Everything we do is confidential. It’s about trust. We want people not to be afraid and to become part of the solution.”
Laurie Allen is a freelance writer.