The Centers for Disease Control and Prevention’s 2022 HIV surveillance report indicates that among cisgender women, Black women accounted for 50% of HIV diagnoses. Among transgender women, Black women accounted for 41% of HIV diagnoses.
HIV has been at the forefront of my life since the ’80s. Back then, many Black people suffered and died in silence because of the increasingly high stigma in our communities. I would hear others say, “He had a bad case of pneumonia” or “She was with the wrong crowd.” HIV was seen as terminal.
Today, HIV is not a death sentence. Preventative medicines such as pre-exposure prophylaxis, widely known as PrEP, and further education empower Black women to thrive with a better quality of life.
The prospect of hope began over a decade ago when the Food and Drug Administration approved PrEP for use. Studies show that consistent use reduces the risk of an HIV infection from sex by nearly 99%. PrEP is highly effective, yet Black women—particularly in the Southern United States—face the greatest barriers to access. Despite being disproportionately affected by HIV, Black women remain underrepresented among PrEP users.
There is a deeper issue surrounding Black women’s limited access to and use of PrEP, which is affecting Black people in general. An online experiment conducted during the prevention research study “Identifying Primary Health Care Providers’ Biases as Barriers to Provision of Equitable PrEP Services” indicates that some physicians are less likely to discuss and prescribe the medication to Black patients because of a preconceived notion about Black patients’ ability to adhere to PrEP. Shortly after the research results were published, it was reported that Black people comprised only 31% of PrEP users in the South. Nationally, Black people represented 14% of users.
Coupled with systematic inequities preventing equitable access to PrEP, Black women’s increased risk of contracting HIV can be attributed to psychological dissociation.
Some Black women may suffer from dissociation that causes us to minimize our autonomy when engaging sexually in casual and committed relationships. Various factors can influence dissociation, such as social and mainstream media and generational iniquities inherited from observing household relationships between family members. Subliminally, the iniquities shape our attitudes and actions while engaging in sexual relationships. Along with dissociation, generational iniquities are endangering our whole health.
Generational iniquities and dissociation can contribute to Black women not asking or insisting that their sexual partners take an HIV test before and after sex or wear a condom during intercourse. Thus, contributing to an increasing number of HIV infections, especially in the South. The overwhelming statistics associated with Black women and HIV have prompted me to outline steps in increasing our knowledge and accessibility to preventative education and medicines.
- Meet Black women where they are. Educate Black women about HIV and available community resources in unconventional spaces such as community festivals, social and faith-based gatherings, and popular retail spaces.
- Advocate for your health. Empower Black women with self-advocacy tips to use when speaking with their doctors to ensure they receive education and medicines to maintain and improve their sexual and overall health.
- Always know your status. For collegiate Black women, many colleges and universities have on-campus health centers that offer free testing for HIV and sexually transmitted infections (STIs). Other Black women can get tested at their doctor’s office, local health departments, and community agencies offering free testing.
- Talk to your sexual partner about HIV. Always know your and your sexual partner’s HIV status. Before sex, talk to them about HIV and other STIs and complete testing together. Also, talk to your partner about consistently practicing safe sex.
- Use condoms during sex. Practice safe sex by telling your partner to wear condoms. Research states that the male condom offers over 90% protection against HIV. Transmission is reduced by 85% when condoms are used 100% of the time correctly.
- Share knowledge and love. Black women must uplift one another. We can help reduce the number of HIV infections by sharing prevention knowledge and resources on social media, among family, friends, and colleagues, in our social and civic groups, and at church.
I urge Black women to remain diligent in the struggle against systemic health inequities that intentionally reduce our access to preventative medicine and education. We must also refrain from endangering our whole health for the sake of sexual relationships. Historically, the consequences outweigh the risks. Our victory is unclaimed until the number of HIV infections among us is significantly reduced or wholly eliminated. We are in this together to end this together, not to become endangered.
Black women stay vigilant, stay the course, stay safe!
Maisha Standifer, PhD, MPH, is the Director of Population Health at the Satcher Health Leadership Institute at Morehouse School of Medicine in Atlanta, GA. Dr. Standifer is a community-based engaged researcher with extensive training in sexual health and the transmission of HIV in marginalized populations at high risk for traumatic stress and health equity.
