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PrEP as a Reproductive Justice Issue for Black Women

Valerie Rochester, Vice President for Program Strategy, AIDS United
Venita Ray, Deputy Director, Positive Women’s Network – USA

It’s no surprise that the racial, ethnic and gender inequalities that have persisted in our society
since its inception are the primary drivers of the negative health outcomes of minorities today.
As Black women, we know all too well the toll that chronic conditions like heart disease,
diabetes, and cancer, have taken and continue to take on our community. Infectious diseases
are not immune to this phenomenon either. The HIV epidemic in this country is a textbook
example of a condition whose impact is focused most severely on minority and marginalized
Disparities can be seen in all aspects of the HIV epidemic, from access to HIV treatment, testing,
and even new prevention strategies. Black and Latino gay men, transgender individuals
(especially those of color), and Black women, bear a disproportionate burden of the epidemic.
They also suffer higher rates of HIV overall, later diagnosis, delayed linkage to care, and as a
result, these populations experience poorer health outcomes overall than their straight, white,
cisgender and male counterparts.
Take pre-exposure prophylaxis (PrEP), for example. PrEP is a powerful approach to HIV
prevention that involves taking an anti-HIV medication daily and it reduces one’s risk of
contracting HIV by more than 92 percent. As with all aspects of the epidemic, severe disparities
exist in the availability and uptake of PrEP among minority populations, especially Black women
who represent 60 percent of the epidemic among women.
This is a shame, because women of color who are more vulnerable to HIV are prime candidates
for PrEP. The strategy has the potential to be an empowering tool for women experiencing
intimate partner violence – a risk factor for HIV – as it does not require negotiating use with
your partner (like a condom) and can be taken without their knowledge. Unfortunately, many
women are not aware of its availability and few providers are encouraging them to use PrEP.
We hope the recently released draft guidance from the U.S. Preventive Services Task Force
(USPSTF) on PrEP that rated it “grade A” for high risk individuals may change providers’
willingness to discuss it with Black women and would also require most insurers to provide the
drug to individuals with high vulnerability for HIV acquisition at no cost to the patient.
Fully 93 percent of all individuals prescribed PrEP in the U.S. have been men. And figures
released by the drug’s manufacturer show that for those whose demographic data were
available, only 12 percent were Latinx, and just 10 percent were Black…making this both a
racial and reproductive justice issue. Additionally, more than half of new HIV diagnoses occur in
the South, but only 30% of people taking PrEP reside there.
A woman’s reproductive and sexual health reflects the conditions in her life and the extent to
which she can access accurate, relatable, culturally relevant, and comprehensive information,
as well as medical services from a health provider of their choice. For Black women, all these
conditions serve as barriers to accessing the care they need, and are further complicated by
racism, sexism, and classism.
Historically, Black women have been denied the ability to make decisions about our own
bodies. We must work to ensure that women are supported in their efforts to practice self-care
and adopt action plans that take the very real-life circumstances faced by real women every day
into consideration. We must stop blaming Black women for their vulnerability and high rates of
HIV. We must be prepared to meet the ongoing challenge of HIV by ensuring Black women and
all women have access to the latest information, tools, and strategies to best protect
themselves and their sexual health…starting with PrEP.