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“Women who are having sex with men may not think their partner is at risk for HIV, and so they don’t feel at risk,” said Sadia Haider, MD, MPH, interim chair of Obstetrics and Gynecology at RUSH and co-leader of the study. “For more than 10 years, medications have helped prevent countless cases of HIV. But the medication isn’t reaching everyone who needs it, especially heterosexual women and Black women in particular.”
A key strategy of the project includes co-locating HIV prevention services within family planning centers, providing education and medication at some Planned Parenthood of Illinois health care centers, where women seeking contraception and other reproductive health services can learn about and access pre-exposure prophylaxis (PrEP).
“As one of the leaders of sexual and reproductive health care in Illinois, we are thrilled to take part in this study,” said Dr. Amy Whitaker, Chief Medical Officer for PPIL. “This will have a real-world impact on patients’ lives, and we are excited to learn and grow through this study so we can provide the best care for our patients as possible.”
Other strategies that will be implemented and evaluated during the project include:
Training medical providers on how to assess increased need for HIV prevention, how to talk to women about HIV and counsel them, and when to prescribe PrEP.
Using patient navigators at PPIL heath care center sites to help increase access to HIV prevention options, medical care and medications.
Working with an advisory board from the Black community to help develop the project strategies from a patient perspective, increase use of preventive medication and increase HIV awareness amongst the community.
The research, fully funded by a five-year $2.97 million NIH grant (R01MH134264), will use strategies based on previous studies that showed promise, said Haider. She and study co-leader Amy K. Johnson, PhD, of Lurie Children’s, have collaborated on related research. If the new study leads to an increase in PrEP prescriptions, the concept could be worth adopting in other parts of the country or nationwide.
Johnson stressed the importance of the project in addressing inequity in HIV prevention. “The first issue we need to address is in awareness,” she said. “Women need to be provided with all the HIV prevention options available so they can make informed decisions with their providers about what feels right to them.”
Why Black women?
In the U.S., cisgender women accounted for almost 20% of new HIV cases in 2019, and Black women made up more than half of those new cases, according to the Centers for Disease Control and Prevention (CDC). The organization also reports that women are prescribed PrEP at a low rate, and yet white women are far more likely to be prescribed PrEP than Black women.
When taken as prescribed, before exposure through sex, PrEP is highly effective, reducing the risk of getting HIV from sex by 99%.
Many factors affect the under-prescription of PrEP among women, according to Haider and Johnson. The patient-provider relationship is key to prevention. Women may be uncomfortable discussing their sexual activity with a health care provider. Likewise, some providers are uncomfortable bringing up HIV prevention. Ongoing provider training and patient education may shift this dynamic. Also, the promotion of PrEP medications has generally focused on men, with male couples featured in the advertisements, leaving Black women under-represented in PrEP uptake campaigns.
Cisgender women need to know that there are high rates of HIV in Chicago and elsewhere, and that patients should be aware of their risk, Haider said. There are a lot of resources for getting PrEP medication and this study aims to increase awareness for Black cisgender women to take action to protect themselves.
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