A daily pill that drastically cuts the risk of contracting HIV has transformed how gay men talk about the disease, even to the point where the prophylactic drug is casually mentioned in dating-site profiles.
Now the District is embarking on the nation’s first campaign to make this preventive measure as widespread among black women, the second-most-likely group to contract the virus in a city still battling an AIDS epidemic.
Research shows that daily use of the drug known as PrEP by those without HIV reduces their risk of infection by over 90 percent, so D.C. authorities are trying to convince black women that PrEP is not just for gay men.
One in six people newly infected with HIV in the nation’s capital are black women. While new cases are declining, nearly 2 percent of D.C. residents are living with the virus — one of the highest rates in the country.
Condoms have been at the forefront of efforts to block sexual transmission of the virus. But some people who are sexually active refuse or forget to use them, and women may have unprotected sex with men they mistakenly think are monogamous, public health experts say.
PrEP, shorthand for pre-exposure prophylaxis, changes the dynamics of HIV prevention, they say. Women can protect themselves instead of relying on men to use condoms.
Although the drug has been available since 2012, it has been virtually unknown to women of color. To counter that, the city is running an advertising campaign on Metrobuses aimed at black women with the tagline “Dominate your sex life” and information about PrEP. Vans that offer mobile HIV testing are also providing referrals to doctors who can prescribe the drug. And the Washington AIDS Partnership in December awarded more than $370,000 to three health organizations serving women to incorporate PrEP into their routines.
“The campaign itself is really about empowering women to take control of their sexuality, control their health and know this is an option for them,” said D.C. Health Department Director LaQuandra Nesbitt.
But like condoms, PrEP is not fail-safe, and HIV prevention counselors are encountering skepticism from some black women.
Some women equate using the drug with promiscuity. Others are not sure whether they can commit to daily use, particularly if they are dealing with the chaos of poverty, mental illness or abusive relationships. And many African Americans are distrustful of public health campaigns targeted at their community because of historical abuses such as the Tuskegee experiments, in which hundreds of black men with syphilis in Alabama unwittingly participated in a 40-year federal study of the disease’s long-term effects.
Public health advocates compare the challenges of getting women to use PrEP to the rise of birth control.
“When the pill came out, that was stigmatizing. If you are on the pill, you are a whore,” said Martha Cameron, who leads HIV prevention efforts at the nonprofit Women’s Collective. “With PrEP, there are women right now who are hesitant. . . . We need some women who will come forward and say, ‘This is great, this is helping me, this is discreet.’ ”
Access to the drug, which costs more than $1,000 a month, can also be a challenge. Medicaid and most private insurers do cover it, and the drug’s manufacturer offers a discount to people without insurance. But users face co-pay fees for laboratory tests at the beginning of treatment and for follow-up visits to their doctors. District officials say they are looking into ways to cover those costs.
The push to get more black women to use the preventive pill is part of a larger effort to end the District’s HIV epidemic and cut in half the number of new infections by 2020.
The MAC AIDS Fund has awarded $1 million to fund the city’s “PrEP for Her” campaign and is closely following the work.
“We are very hopeful that this project will be a model not only for the United States but the world,” said Nancy Mahon, executive director of the fund, which operates globally.
On a recent Tuesday, employees of the Women’s Collective, a nonprofit organization that receives District funding to help prevent sexually transmitted diseases, encountered the challenges of building awareness about PrEP in Southeast Washington, where the population is largely African American.
Calie Edmonds, a testing specialist, parked a mobile testing van in the lot of a Denny’s near the Benning Road Metro station. She goes out several times a week in neighborhoods where HIV is most prevalent.
Emerging from the station with her 2-year-old son, Daniel, in a stroller, Symone Ferrell agreed to take an HIV test.
Inside the van, the 36-year-old D.C. native said she’d heard about PrEP on the radio or on the Internet. But as a single mother of three who doesn’t have sex unless she’s in a relationship, she didn’t see the point of taking it. “Why would I take it if I’m not out there?” said Ferrell, her son in her arms.
“It’s not that we push PrEP because people are out there and having more s-e-x,” Edmonds replied — spelling out the word to spare the toddler’s blushes.
“When you’re in a relationship again, you’re not like a woman who is living near the White House,” she told Ferrell. “You are a higher risk of getting it just because you are here, where you live.”
Edmonds, 22, has been on the job since July — drawn to the position after watching loved ones contract HIV.
She uses the mantra “it’s not promiscuity, it’s prevalence” to remind her neighbors in HIV hot spots that it is better to be on the pill when they find themselves in situations where they don’t use condoms or are with partners who might not be telling the truth about their sexual histories.
While Edmonds tested Ferrell, a couple approached the van, interested in testing, too.
Twanda and Arthur Hinnant often have HIV on their mind. Close relatives have the infection, and Twanda buried her brother a decade ago after he succumbed to AIDS.
As a couple married for 16 years, they are less worried about infections — but still regularly test when they go to the doctor or see a mobile van, just in case. But it was from a poster on the Women’s Collective’s van that they first learned of PrEP, and they pondered whether to share fliers about the drug with relatives and friends.
“It sounds good,” said Twanda, 43.
Her husband, 47, was more skeptical. “It’s not a sure thing,” he said.
“I would also tell them to use condoms,” Twanda said.
“Even though it’s not 100 percent, the 90 is still really good,” Edmonds said.
She gestured toward them as they walked away with several fliers in hand.
“They’re the people who are going to get PrEP out in the community,” Edmonds said. “They are going to talk to the people who run from the vans.”