“I choose PrEP because I’m HIV-Possible.”
Black women need access to the HIV-prevention drug, PrEP, as much as the gay men it's been marketed to: renowned sex educator
“I wanted to get on PrEP so that I could tell other (Black) women about my journey,” Ashley Cobb says. A program manager for a public health organization in Atlanta and author of a new book about sexual pleasure, Cobb understands for cis Black women to believe PrEP could be a valuable prevention method against HIV infection, they needed to see themselves as just as vulnerable to contracting HIV as their gay cousin or their single homegirl. For her, when it comes to HIV, there are only two categories of people: those who have been infected with the virus and those who have the potential to be infected. Black women who have sex and are HIV-negative automatically fall into the latter category. Regardless of sexual orientation. Regardless of past, present or future relationship statuses.
“The Southern region of the U.S. accounts for about half of new HIV cases annually. Among all women, Black women account for more than half (67%) of new HIV infections in the South and 72% of new diagnoses among women reporting heterosexual sex. Moreover, the Southern region of the U.S. has the highest HIV incidence in the country with 15.6 diagnoses per 100,000 people.”
The data on HIV infection and access to PrEP, supports Cobb’s underlying belief: cishet (women who were assigned female at birth and continue to identify as female and heterosexual) Black women need access to this highly effective preventative measure as much as the gay men who have been the prime demographic it's been marketed to. Short for pre-exposure prophylaxis, PrEP is a prescription medicine that can be taken, on an ongoing basis, to help reduce someone's chances of contracting HIV before sexual contact with someone who has the virus.
According to The Office of Infectious Disease and HIV/AIDS Policy, an estimated 38,000 Americans are newly diagnosed each year. While new diagnoses have significantly decreased since the 1980s, 400,000 more people in the U.S. are projected to be diagnosed over 10 years, unless significant intervention methods are successful at preventing exposure to the virus. According to the Centers for Disease Control, in 2022, Black Americans accounted for 37% of new infections though they make up only 12% of the population. In that same year, data revealed infections among Black women accounted for 47% of new infections among female cases.
To understand why so many of us are represented in new infection cases when there aren’t that many of us in the country, one only needs to look at the data on PrEP. While those who identify as female make up 20% of new HIV diagnoses, only 7% are PrEP users. When exploring the disparity by race, Black women are less likely to use PrEP even though they're diagnosed with HIV at 10 times the rate of white women.
In delivering workshops to college students and older, more established Black women, Cobb came across a familiar and not so subtle mindset about STIs, in general, and what “type” of woman would be on PrEP specifically. If in a committed relationship or single and selective about who they’re intimate with, many cishet Black women see taking an extra step to protect themselves (beyond using condoms) as unnecessary.
Dr. Quinisha Logan, a gynecologist practicing in Mississippi, sees it as a much quieter indifference. “For a lot of women,” she says, “sex just happens to them.” With 15 years in the field, Logan has observed many women view sex as simply an expected part of a relationship. Therefore, PrEP is not front of mind when they come for their annual exams because sex is just one of those things a woman has done during the months leading up to her doctor’s visit. Even Dr. Logan’s pregnant patients only end up getting tested for STIs because she frames STIs as just one of many things they look for when they take blood work. A casual “just to have all the data” request is the most successful way to get her pregnant patients to agree to a full STI panel.
The gynecologist also says none of her patients have asked about PrEP, even out of curiosity. Admittedly, she’s not thought to initiate a conversation about it with any of her patients either. She knows about the drug and its effectiveness in preventing HIV, of course. However, it’s not one that even she, a Black woman gynecologist with many Black women patients, associates with the women under her care.
“Up until recently, [PrEP has] been marketed mostly to gay men in the white world.” She believes a doctor’s endorsement of an unfamiliar drug can have some impact on a Black woman taking a more pro-active approach to her sexual health.
Of all the disparities in new HIV infections, the largest one seems to be regional. In states like Mississippi, where Dr. Logan practices, Black women are contracting HIV at alarming rates. According to The National Library of Health, “The Southern region of the U.S. accounts for about half of new HIV cases annually. Among all women, Black women account for more than half (67%) of new HIV infections in the South and 72% of new diagnoses among women reporting heterosexual sex. Moreover, the Southern region of the U.S. has the highest HIV incidence in the country with 15.6 diagnoses per 100,000 people.” Dr. Logan has provided care for a patient who’s HIV+. In her home state, however, Black women are the most vulnerable to the virus and simultaneously the least likely to even know about the medication that, when taken properly, can almost guarantee them protection from it.
This is why Ashley Cobb took to her Instagram platform to be the “face” of PrEP for her more than 100,000 followers. “PrEP hasn’t been marketed to (our) people,” Cobb says. “Up until recently, it’s been marketed mostly to gay men in the white world.” She believes a doctor’s endorsement of an unfamiliar drug can have some impact on a Black woman taking a more pro-active approach to her sexual health. However, another Black woman who mirrors her life circumstance will be viewed as a much more trustworthy source for those Black women who are HIV-Possible. Note: We're all HIV-Possible.
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