A full, satisfying sexual and emotional life—and access to the reproductive and sexual health services that make that possible— is an integral piece of living a pleasure-filled, self-determined existence. Few groups know this better than people living with and affected by HIV.
While HIV is medically very simple to prevent and manage, stigma compounds barriers at every stage of care, including even knowing your HIV status. If stigma, racism, and medical gatekeeping are stumbling blocks impeding one’s ability to exercise their freedoms, then autonomy, education, and person-centered treatment are the building blocks of a more compassionate system of care.
Racial disparities in HIV prevention and support
Data consistently reveals HIV’s disproportionate impacts on minoritized people. Black and Latine women, transgender men, and other people who can get pregnant experience higher rates of HIV, but their needs are often overlooked.
Black cisgender women, in particular, make up 55% of new HIV diagnoses despite being less than 15% of the population. 1 in 10 women living with HIV doesn’t know she has it. Black women living with HIV report that a sense of isolation shapes their experiences—including isolation from loved ones, isolation in medical care, and a lack of culturally resonant resources. Too often, we normalize these disparities instead of naming and reducing the impact that bias and stigma have on people navigating siloed medical services.
Disparities in access to preventive care set the stage. PrEP (pre-exposure prophylaxis) is medication (a daily pill or injectable) that people can take to reduce their risk of contracting HIV. However, only 10% of women who could benefit from PrEP use it. Though exact rates are unknown, similar access barriers exist for PEP (post-exposure prophylaxis), medication that someone can take if they’ve been exposed to HIV.
It’s time we stop overlooking cultural and personal needs and start listening to Black women about what they need and want when it comes to their sexual health and wellness, including information about HIV.
Increasing access to services for Black women and other people who can get pregnant
We don’t have to stay in this world where Black women face disproportionate HIV impact, reduced support, and stigmatization. One way Black women are leading the way is through Risk to Reasons, a critical initiative supported by ViiV Healthcare, to shift conversations from talking about sexual health through a fearful lens to talking about reasons that motivate people to take control of their health through a lens of empowerment. Core components include:
- Rethink stigmatizing language of “risk.” Terms like “at risk,” “high risk,” and “risky behaviors” aren’t just unspecific, stigmatizing, and off-putting. They overlook the systemic factors, like medical racism, contributing to sexual health disparities.
- Emphasize freedom from shame and fear. Black women’s sexuality has been policed and pathologized throughout history. Instead, find language and approaches that support people’s desires, address their unique circumstances, and avoid shame, stigma, and re-traumatization.
- Embrace whole-person care. When care providers acknowledge the multifaceted aspects of Black women’s lives, they better connect and leave with their needs met. Encouraging self-love and self-care keeps individuals feeling empowered and motivated to take care of their sexual health.
Building on the Risk to Reasons framework, Provide convened an advisory board of Black women stakeholders to develop culturally resonant online resource guides that help integrate these positive messages into more spaces. Clients can use an easy-to-navigate phone-based tool to explore self-care resources and components that shape overall sexual health and wellness. Providers can find similar support in a desktop tool that includes guidance for affirming, person-centered care and health education. Both tools use an interactive sexual health wheel to encourage self-guided exploration and increase access to reliable resources for relevant healthcare services, including:
- HIV prevention, testing, and treatment
- pregnancy prevention, including emergency contraception
- pregnancy options, including abortion
- cancer screenings and other preventive care
- healthy relationships
- harm reduction
- gender-affirming care
- and more!
Together, these tools equip communities to have stigma-free conversations that meet the sexual health needs of Black women. Importantly, the tools also fill an information gap and provide links to carefully vetted, evidence-informed resources in a time where much of the expert guidance from government websites is no longer available or trustworthy.
Black women and other people who can get pregnant deserve tools to explore their needs, desires, and pleasures as reasons to support their health. When providers approach conversations through a lens of sex positivity, empowerment, and autonomy, we accompany them there.
