black women's health health disparities healthcare HIV/AIDS sexual health
There’s A New Pill to Revolutionize Black Women’s Sexual Health3/25/2015
by Oni J. Blackstock, MD, MHS and Kimberleigh J. Smith, MPA In the same way that the birth control pill revolutionized women’s sexual he...
by Oni J. Blackstock, MD, MHS and Kimberleigh J. Smith, MPA
In the same way that the birth control pill revolutionized women’s sexual health, there’s a new pill available to help prevent HIV infection that has the potential to do the same.
PrEP stands for pre-exposure prophylaxis and is a once-day-a-pill (also known as Truvada®) that can be taken to prevent HIV infection in persons who are HIV-negative. However, very few who could benefit from its use know about it—in particular, Black women.
Given the disproportionate impact of the HIV epidemic on Black women, this lack of awareness of PrEP is troubling. Compared with women of other races and ethnicities, Black/African American women continue to be overrepresented among women with new HIV infections. When comparing groups by race/ethnicity, gender, and transmission category, the fourth largest number of all new HIV infections in the United States in 2010 occurred among African American women with heterosexual contact. Put another way, this makes us about 20 times more likely to be infected with HIV than our White counterparts. Among transgender women of color, the disparities are even greater.
Cheryl (whose name has been changed to protect her anonymity) is a 35-year-old African American woman who lives and works in a large urban area. She identifies as lesbian/queer and has been taking PrEP on-and-off for 2 ½ years in order to conceive a child with an HIV+ friend. “Women’s experiences with PrEP fall on a spectrum,” she said. “Women need to access these tools as well as a wide range of information to help them get educated about sexual health resources like PrEP.”
In order for PrEP to have its maximal protective benefit, it needs to be taken daily. Truvada was approved as PrEP by the Food and Drug Administration in July 2012, after three large clinical trials, two of which showed that Truvada taken daily reduces new HIV infections by upwards of 90 percent. However, the VOICE trial showed that Truvada as PrEP did not work because the women in the trial did not take the drug as prescribed.
We still have a lot to learn about what will help women (and others) adhere to PrEP; but we know that PrEP will work for those who take it.
“I’m pretty good about adherence, but I’m not the queen of adherence,” Cheryl admitted. “I have all the routines and securities in place and still miss a dose. It’s a valid concern.” In order for women to be successful with PrEP, Cheryl says, “We will need to form the same kinds of adherence supports that people need for any other pill.”
Health care providers are also learning about PrEP, and many may not be familiar with PrEP as an HIV prevention option. Terri Wilder, Director of HIV/AIDS Education and Training at the Mount Sinai Institute for Advanced Medicine-Spencer Cox Center for Health, says we have a lot of work to do to reach medical providers to help them consider PrEP as an option for women. Many know PrEP as a gay male prevention option. “You can’t just add women and stir,” says Ms. Wilder. “This is a medication you can only get through prescription so inherently providers are critical to the delivery of PrEP. We have to think about all the things that [must] come before the pen hits the pad.” This includes education and training for providers and ensuring PrEP can be available for women in a range of settings—such as community health centers/clinics that provide primary medical care and obstetric/gynecologic services, as well as community-based organizations.
In the future, we may have more PrEP options such as injectable PrEP where one shot lasts several months (just like injectable Depo-Provera for contraception). It is also important to know that PrEP does not protect against other sexually transmitted infections such as chlamydia or gonorrhea. It is covered by most commercial health insurances and a drug payment assistance program is also available from the makers of Truvada. States like Washington and New York now have PrEP assistance programs, where the state pays for the cost of care for PrEP.
Learn more about PrEP and your other sexual options. If you think that PrEP may be for you, ask your healthcare provider about PrEP. To find out more about PrEP, visit http://www.cdc.gov/hiv/prep/pdf/PrEPfactsheet.pdf and share this information with your family, friends, communities, and health care providers.
If we don’t look out for us, who will?
Oni Blackstock, MD, MHS is a physician-researcher and Assistant Professor at Albert Einstein College of Medicine/Montefiore Medical Center in the Bronx, NY. Kimberleigh Smith, MPA is a policy advocate, Vice President of Policy and Advocacy at Harlem United, and member of Governor Andrew Cuomo’s Ending the Epidemic Task Force, which was established in October 2014 to create a blueprint to end AIDS in New York State by 2020.