Although black women only make up 12% of the population in the United States, they make up 60% of emerging HIV cases among women in the U.S.
Why does this large disparity exist? Associate Professor and researcher Dr. Schenita Randolph of Duke University sheds some light on this.
“When we look at women of color, they are not on PrEP. Less than 1%-2% of black women are taking PrEP. There is a lack of awareness, and we often give that narrative as if a woman should naturally know about this tool for prevention.
My value is that we need to let women make an informed decision on if they want to take PrEP. Our federal governing agencies, researchers, and clinicians need to take ownership for why women of color are not taking PrEP and start educating them.”
Using Beauty as a Tool for Education
Dr. Randolph leads a team at Duke University at The HEEAT Lab, which consists of an interdisciplinary team of researchers, clinicians, entrepreneurs, and community members who are dedicated to addressing health disparities through equity, engagement, advocacy, and trust.
One of the ways Dr. Randolph’s team is reaching women of color with PrEP messaging is through a program called UPDOS.
UPDOS is a salon-based intervention being developed and tested in partnership with researchers and the Black community to promote awareness, knowledge and uptake of preexposure prophylaxis (PrEP) among Black women living in the south. UPDOs takes a comprehensive approach and addresses overall health of Black women in the US,” according to the HEEAT Lab.
Some of the stylists working with Dr. Randolph’s team are industry experts with decades of experience. The original goal was to pilot test UPDOs with 60 women. We were initially able to provide messaging to over 100 women in our pilot test.
Women Don’t See Themselves in PrEP Messaging
One of the main reasons Dr. Randolph and her team have determined that is creating barriers to women receiving PrEP is, “When we have engaged women in preliminary work [around PrEP], they say, ‘Well, I didn’t see myself in that. I didn’t realize that was for me.’ Through our work, we have developed educational entertainment through videos that highlight women of color.
Women see themselves in those stories. It moves the stigma and the trust they have around PrEP and improves women’s relationship to PrEP. Having trusted messengers is critical.”
Another essential aspect is redefining risk. Much of the research and messaging for men who sleep with men (MSM) defines risk as having condomless anal sex.
Dr. Randolph has found that, “Women don’t see themselves as at-risk, which goes back to clinicians and researchers. How do we use language and how is that language transferred to women in a way that they see PrEP as an option for their healthcare?”
Most commonly, women get HIV when having unprotected vaginal sex with a male partner.
The Healthcare and Research Industries have Failed Women of Color
There is a lack of trust in the overall healthcare system among women of color because of the treatment women of color have experienced within the medical system.
Dr. Randolph said, “We cannot silence these gender and racial inequities. Implicit bias impacts health outcomes, and we can’t just know that and make statements about it.
The CDC and WHO have called racism out as a public health threat. However, we must all be intentional that we actually do something about this and not in words only. What are our priorities around funding? How are we training providers around this public health threat or racism? We have a professional and ethical responsibility to do something about it.”
Dr. Randolph proposes that more organizations should start investing in the kind of work Duke University is producing through the HEEAT Lab.
“We have to be intentional, whether it’s in developing messaging or making decisions about health and health promotions. Black women should be partners and decision makers in the process. Make sure that there is representation and that women and black women’s expertise is acknowledged and that they are compensated for their work.”
Dr. Schenita Randolph, PhD, MH, RN is an Associate Professor in the Duke University School of Nursing. Her overarching goal as a nurse scholar is to address the root causes of health disparities and promote sexual health equity for racial/ethnic minority populations, more specifically, Black women, adolescents, families and communities. She uses a community-engaged approach to include populations of study in the research process and beyond. Dr. Randolph is currently the Principal Investigator of a funded project by Gilead Sciences to develop a Salon-Based Intervention to promote the awareness and uptake of PrEP among Black women living in the United States South. To learn more about the work cited in this article, please visit the HEEAT Research Lab.