Who’s ’PrEP-ared’ for Black women?
When one Black woman asked her doctor for the HIV-prevention drug PrEP she got an answer she didn’t expect
I asked my gynecologist if she knew how a middle-aged straight girl could get on PrEP. It was something of a whim to ask during my annual pap smear four years ago, but I had done my research.
My research revealed this medicinal prevention drug had a 99% effective rate against contracting HIV. It also revealed alarming rates of cis Black women in their 40s and 50s contracting the virus through intimate encounters with men. Many of these women believed themselves to be in monogamous relationships.
“Black women in my age demographic are among the highest rates of new HIV infection cases. Black women your age and younger have even higher infection rates than us.” My doctor didn’t know about these stats.
I was prepared for my gynecologist to outline the different options for taking PrEP as well as which clinics in the great metropolis I lived in would be best for me to schedule a consultation. Instead, she offered me a quizzical look. A hint of confusion filled her eyes as she asked, “You want to be on PrEP?” The “why” was implied.
For context, I was not in a monogamous relationship, neither was I trying to find my way to one. I was simply aware that while I was indifferent to finding forever love, I fully intended to continue enjoying the pleasures of the flesh with men I liked enough to invite into my bed. Even when I was younger and more impulsive, I never foolishly left the fate of my sexual health in the hands of a man, whether he was my boyfriend or just a hook up. I became sexually active in the ‘90s when HIV had officially been proven to no longer be just the gay man’s burden. I’d curtly ask for my bra back the moment a man even flinched when I pulled out condoms. By my 30s, a full STI panel was a routine part of my annual wellness check with my primary care physician.
Though the virus had been “tamed” in the decades since I began having sex, it is still a threat to me: A Black woman who has sex with men.
A Black woman herself, my doctor appeared to be somewhere in her 30s. Because she’d talked about her son in previous visits and mentioned she and her husband wanted to have more kids, I assumed she, too, was straight. Clearly, she would understand why I would want to have an additional layer of protection against HIV.
“I have three patients on it now,” she said. She explained they were queer and had partners who were HIV+, so they had no choice but to go onto PrEP because they wanted to remain negative. In other words, if I wasn’t having sex with someone who I knew to be positive, why would I need to be on PrEP? She admitted that she didn’t know much about the drug, vaguely stating there were adverse side effects, and if I opted for pills instead of an injection, the regiment for oral administration was very specific and prone to human error.
“The liver damage and blood clots stuff was disproven several years ago,” I informed my medical provider. I also asked if she had read about what I discovered through the research of sexual health researcher Ashley Cobb.
“Black women in my age demographic are among the highest rates of new HIV infection cases. Black women your age and younger have even higher infection rates than us.”
She didn’t know about these stats.
She told me she’d do some more digging and would let me know what options were available to me.
For even more context, when I was having this conversation with my gynecologist, I wasn’t sexually active. And I didn’t foresee being moved enough by the few guys I’d met here and there to remove my clothing for them. I knew that could easily change because I’ve been a woman who enjoys sex for 30 years. Sometimes that dude who annoyed you on date two suddenly says something funny or thoughtful on date three, and much to your surprise, you want to crawl on top of him. I wasn’t currently in a circumstance that warranted an extra layer of protection against HIV, but that didn’t mean I shouldn’t pursue access to it.
My gynecologist never got back to me. Not even that following year when I was back for my annual. She had noted my interest in PrEP on my chart, yet she never brought it up again. Not even to say, “Oh yeah, I remember you asked about PrEP last year.” I delved a bit more into the research on PrEP but never pushed the issue with her. I decided since she wasn’t bringing it up, maybe it really wasn’t a pressing issue for a patient like me. We were both Black women who felt comfortable in what we believed to be reliable (enough) HIV prevention: She was in a committed relationship and I wasn’t having sex at the moment. Why try to figure out this “new” drug and all the ramifications of going on it?
Then Ashley Cobb, the renowned sex educator and researcher who sparked my interest in PrEP in the first place, started a whole new series of posts on her page. They all began with the same phase ... “I’m a cishet woman who’s in a long-term relationship. I’m on PrEP because ...”
To find out why Ashley Cobb is on PrEP, tune in for part two of this series on PrEP and Black women.
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