African-American Women Need Culturally Competent Information About PrEP, Panel Says
Because of the relatively high HIV prevalence in many communities of color, explained Charlene Flash, M.D., M.P.H., of Baylor College of Medicine and PrEP Houston in Texas in a recent webinar, African-American women are at higher risk of contracting the virus simply because of where they live. This is reflected in statistics from the U.S. Centers for Disease Control and Prevention: In 2014, 19% (8,328) of new HIV diagnoses in the U.S. were in women, most of whom (87%) had contracted the virus through heterosexual sex. Sixty-two percent of these women were African American, even though African Americans only accounted for 13% of the total population according to the U.S. Census Bureau.
Given these statistics, many African American women may benefit from the use of pre-exposure prophylaxis (PrEP) for HIV prevention. When told about pre-exposure prophylaxis (PrEP) in focus groups, many women of color are quite angry that they haven't heard about this HIV prevention method before, Judith Auerbach, Ph.D., of the University of California, San Francisco, and Martha Cameron, M.P.H., of the Women's Collective in the District of Columbia, said in the recent webinar hosted by the Well Project. "They think information is being withheld from them," Auerbach explained. Women of color, including African American women, must see themselves reflected in the informational material, Cameron stated. Low literacy rates in some communities also need to be taken into account, as do the social media platforms used by different groups -- for example, Instagram for younger women, Facebook for the older generation -- she added.
It takes longer for effective drug levels to be established in vaginal tissue than in anal tissue (20 daily doses versus seven doses), and levels drop faster in women if a dose is missed, explained Flash. Providers therefore must stress the importance of adherence, but do so in a non-judgmental way, she said. According to Cameron, older women find the daily medication and regular screenings needed for PrEP easier to manage than younger women, but are more concerned about interactions with blood pressure or diabetes medications. Younger women, on the other hand, might wonder about potential interaction with birth control pills, she added.
For historical reasons, many in the African-American community distrust the medical system and government, panelists said. Focus groups and surveys also showed that women did not believe that their medical providers were sufficiently well informed about PrEP, they added. If women ask about PrEP, they can push their providers to get that information -- but women can only ask if they know about the existence of PrEP and its availability for women, they concluded.