Addressing Disparities in PrEP Uptake among Women

Black women in the U.S. are twenty times more likely to acquire HIV than White women and have 1 in 52 lifetime risk of acquiring HIV[2]. However, fewer Black women have been prescribed PrEP[1] or know about PrEP [3] than White women.  Black women face striking disparities in a wide range of women’s health outcomes. [4] Black women report feeling uncomfortable and judged in conversations with healthcare providers about their sexual health[5, 6], and as early as 2013 were “angry” and not having heard about PrEP from healthcare providers[7].

While there are not yet proven interventions to improve women of colors’ access to PrEP, women’s health clinicians can apply lessons learned from contraceptive care:

  •      Use best practices from contraceptive counseling to mitigate disparities[8]. Consider shared decision making – a model that focuses on women’s values and preferences – a way forward for supporting women as they balance competing priorities
  •      Include race and ethnicity when monitoring your program
  •      Hire clinicians and staff who reflect the racial and ethnic makeup of your clients
  •      Use client materials that reflect the racial and ethnic makeup of your clients. You can check out these campaigns for ideas and resources: PrEP4Love, PrEPforHer, Black Women’s Health Imperative’s #LetsTalkAboutPrEP
  1.      Bush S. Racial characteristics for FTC/TDF for Pre-exposure Prophylaxis Users in the US.  ASM Microbe / ICAAC; June 16 – 20 2016; Boston, MA2016.
  2.      Hess K HX, Lansky A et al. Estimating the Lifetime Risk of a Diagnosis of HIV Infection in the United States.  Conference on Retroviruses and Opportunistic Infections; February 22-25, 2016.; Boston MA2016.
  3.      Seidman D, Cipres D, Rodriguez A, Alvarez J, Weber S, Stern L. Women’s knowledge of, interest in and eligibility for PrEP at Family Planning Clinics in Northern California. HIV Research for Prevention (R4P). Chicago, IL. October 2016.
  4.      Eichelberger KY, Doll K, Ekpo GE, Zerden ML. Black Lives Matter: Claiming a Space for Evidence-Based Outrage in Obstetrics and Gynecology. Am J Public Health. 2016;106(10):1771-2.
  5.      Cipres D, Rodriguez A, Alvarez J, Stern L, Steinauer J, Seidman D. Racial/Ethnic Differences in Young Women’s Health-Promoting Strategies to Reduce Vulnerability to Sexually Transmitted Infections. J Adolesc Health. 2017.
  6.      Thorburn S, Bogart LM. African American women and family planning services: perceptions of discrimination. Women Health. 2005;42(1):23-39.
  7.      Auerbach JD, Kinsky S, Brown G, Charles V. Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV. AIDS Patient Care STDS. 2015;29(2):102-10.
  8.      Dehlendorf C, Krajewski C, Borrero S. Contraceptive counseling: best practices to ensure quality communication and enable effective contraceptive use. Clin Obstet Gynecol. 2014;57(4):659-73.

This webpage was created in collaboration with Dr. Dominika Seidman.