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Barriers to PrEP Within the Black Community


In 2012, HIV Pre-Exposure Prophylaxis (PrEP) was introduced to the market as a once-a-day pill used to keep HIV-negative people from contracting HIV. Also known as Truvada, the drug was marketed as a miracle in the industry, with the hopes of immediately reducing the epidemic-level numbers that HIV still had in many communities.

Unfortunately, PrEP has not made the drastic change in the numbers of new infections one may have hoped in the Black community, particularly that of Black women and Black gay men.

This is not without cause, though, as PrEP is still very new to the market and there are various barriers that need be addressed when discussing why the “miracle drug” has not taken off as one would have hoped within marginalized communities.

So here are some barriers to PrEP:

Initial Marketing of PrEP

The initial marketing for PrEP was towards women. This choice to initially market the product to women rather than the various communities affected by HIV made the roll-out to those markets delayed. PrEP was also marketed as a drug for those who were involved in monogamous relationships with HIV-positive partners.

This initial decision made it hard for Black gay men and Black women, those who were not in relationships but sexually active, to obtain treatment. There were many obstacles that came from this marketing, as insurance companies were slow to approve the new treatment, and many doctors for several years had not heard of the treatment because of its initial marketing strategy.

History of Healthcare Discrimination

African Americans have faced discrimination within the healthcare system for several generations. The Tuskegee Syphilis Testing is one of the most known occurrences of this discrimination, in which Black men were unknowingly not treated for this disease and studied to see what the long-term effects of syphilis would have on the body. This experiment continues to be referenced within the Black community when discussing the very real fear of trusting our health with a system that has proven itself to be anti-Black, and criminally against us.

PrEP’s introduction into the market and its fast track to approval left many in the community skeptical about the treatment and whether it was safe to use for the long term. Because PrEP has not had a ten-year study, there is no data on what the long-term effects may be in those who are HIV-negative, which is why many have opted to wait before making the decision to go into treatment.

Poor healthcare is a generational issue within the Black community, as well. Many families have certain health patterns and, over time, pass down the fear of systematic health care due to this fear of discrimination.

Stigma

HIV is still very much a taboo subject in the African American community. Sexual health and accountability go hand in hand with how we discuss STIs, as well as the lack of education and resources being provided within the Black community. People still die from HIV, despite the numbers having decreased. However, the thoughts and stigma around the virus have not left the community. Many still discuss HIV as something one contracts due to promiscuity, and they aren’t even aware of how the virus is transmitted.

PrEP unfortunately also carries its own stigma. Because sex is so stigmatized within our community, the action of taking something to prevent STIs is automatically correlated with being risky. Much like how birth control is treated in this country, there is an underlying belief that if you are having “safe” sex, then there is no need to be on a prescription preventative. This logic is dangerous. And like the abstinence theory, it doesn’t play out well in real life.

Resources and Education

There are still too many people who do not understand what PrEP treatment is or that the treatment exists—including healthcare establishments. There are many doctors who don’t know about the existence of PrEP, primarily those who are general practitioners. Because most people don’t see a specialist, and general practitioners may not have the resources and knowledge to be making the best decision for Black gay men or Black women when discussing HIV, as those populations are still two of the highest infected, there are barriers to getting a prescription for PrEP.

Resources, access, and utilization are also an issue. There are still many insurance carriers that don’t support PrEP. The approval from many of these companies took several years. Thankfully, many of the pharmacy providers understood the importance of getting the drug into the market and offered vouchers for clients who were either uninsured or didn’t have the proper coverage. However, the lack of education around the pill still creates an issue that even with access, many are going to be unwilling to utilize it until we break through several of the prior discussed barriers.

PrEP prescriptions continue to grow each quarter, not at the pace many wanted, but there is still hope. As more people speak out about their use of PrEP and encourage others to get on treatment, our community can finally make the shift towards ending the HIV virus once and for all.