Black women in the United States are disproportionately affected by HIV
In the 1990’s, while serving as director for an HIV/AIDS prevention program at a community-based organization in Brooklyn, New York, I developed and conducted HIV prevention workshops and served on the Women’s Committee for the New York State AIDS Institute Prevention Planning Group.
Under our city-funded contract, two health educators and I conducted HIV (human immunodeficiency virus) education and prevention workshops for primarily Black and Latina women through adult education classes at schools, libraries, and churches. We quickly realized that a major obstacle for participants was their reluctance to broach the topic of condom use with a partner or spouse. One woman said, “He might think I’ve been cheating, or think that I am accusing him of cheating.”
Our job was two-fold: First, convince participants that the person most likely to transmit HIV would be a spouse or long-term partner. Second, give them the language (and practice) to discuss the topic of condom use. Unfortunately, we had no way to ascertain how many, if any, of the women successfully implemented what we taught.
Some twenty-five years later, HIV disproportionately impacts Black women. According to AIDSVu, they account for 54% of new HIV diagnoses in U.S. women, “despite making up 14% of the female population … Among Black women, 91% of new HIV infections were attributed to heterosexual contact. The HIV infection rate among Black women was the highest compared to women of all other races and ethnicities.”
Which factors place Black women at higher risk?
In a May 2019 article, Shamard Charles, MD-MPH, public health doctor and medical journalist cites the challenges that contribute to the higher rates of HIV among Black women.
· Higher rates of poverty
· Lack of access to health care
· Higher rates of some sexually transmitted infections
· Lack of awareness of HIV status and stigma
Charlene A. Flash, MD, assistant professor at Baylor University (Medicine-Infectious Disease) and host of Ask the HIV Doc series says that Black women who become infected with HIV have fewer sexual partners, are more likely to use condoms, and yet are more likely to become infected with HIV because there’s more HIV in the communities in which they’re having sex
In addition, Katherine Elizabeth Morrison, Ph.D., (now deceased) coordinator and professor of the health and wellness at Curry College in Milton, MA, attributed Black women’s increased risk to a lack of education about sexual health, limited access to quality health care, and less access to contraception.
Transgender Black Women and HIV
The Human Rights Campaign website states that transgender Black women have 49 times the odds of having HIV compared to the general population. “They are an invisible population to researchers, public health officials, and advocacy organizations working on prevention, treatment, and HIV-related health care … (likewise) transphobia and the marginalization that transgender people face that may contribute to such high infection rates.
Other risk factors include, “higher rates of drug and alcohol abuse, sex work, incarceration, homelessness, attempted suicide, unemployment, lack of familial support, violence, stigma and discrimination, limited health care access, and negative health care encounters.”
PrEP
Fortunately, since my years as a health educator, HIV prevention options have expanded. PrEP (pre-exposure prophylaxis) medications reduce risk by 99 percent through sex, and by 74 percent through injection drug use. However, Truvada and Descovy (in pill form) and Apretude, an injectable, do not prevent other STIs.
Despite the availability of these HIV preventive medications, according to AIDSVu, “among all PrEP users in the U.S., 92% were male and only 8% were female, although women comprised 19% of new HIV diagnoses.”
In February 2024, the O’Neill Institute for National and Global Health in Washington, D.C. cited reasons for the low uptake of PrEP among Black women: low levels of PrEP knowledge, misinformation surrounding PrEP, stigma related to PrEP use, and limited access to PrEP.
HIV Prevention Strategies for Black Women
While PrEP is an effective tool for HIV prevention, counseling and education can help discourage risky behaviors and encourage safer ones. Case managers and peers can do outreach to Black cisgender and transgender women, provide social and emotional support, and provide educational sessions on HIV care, treatment, and adherence.
In Atlantia, GA, SisterLove, a nonprofit group founded in 1989, offers free HIV and STI testing, teaches ways to talk with one’s medical provider, and conducts “Healthy Love Workshops,” which offer culturally sensitive education on HIV/STI prevention and teaches “pleasure-based safer sex practices …”
Other practices that reduce the risk of HIV infection include having a monogamous relationship with an HIV-negative partner, using latex condoms consistently and correctly, or abstaining from sex.
Improving Access to PrEP
In May 2023, PBS News noted that Black cisgender and transgender women “face long-standing, systemic factors, such as stigma and racism … major barriers to PrEP uptake …” Transgender Black women also experience discrimination related to their gender identity.
On the other hand, PrEP advertising campaigns seldom feature Black women; they primarily target gay men and transgender people.
Cost is another deterrent to utilizing PrEP, Robyn Neblett Fanfair, director of the CDC’s Division of HIV Prevention says her division’s focus is on reducing costs associated with PrEP. which can start at more than $2,000.
Dázon Dixon Diallo, president, and founder, of SisterLove, warns, “Failing to ensure cisgender Black women have access to — and are actually interested in taking — PrEP will undermine the fight to bring the HIV epidemic under control.
“There’s “damage that has to be undone,” she said. “If we’re not centering Black women in this epidemic, we are getting nowhere to the end.”
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