La.’s HIV prevention efforts making national headlines
24th February 2020 · 0 Comments
By Meghan Holmes
Contributing Writer
Recent efforts on the part of the Louisiana Department of Public Health to reduce HIV rates around the state are receiving national media coverage, particularly the department’s Black Women and PrEP program, working to educate Black women about the HIV prevention drug.
African-American women rank second-highest in Louisiana for new HIV diagnoses, after Black men, and account for 82 percent of women with HIV in the state. LDH prevention manager Jacky Bingham helped start the program because, as she said, “Black women had been left out of the conversation.”
“Women didn’t know PrEP was for them, because the marketing is focused on gay and bisexual men. We also find that providers are not asking women about their sexual history, and don’t know whether or not they might need PrEP. So, we want to ensure that women are aware and empowered to have conversations with their clinicians,” she said.
Launched in March 2019, Black Women and PrEP utilizes a tool kit that the Black Aids Institute, a national public policy organization, developed for advocates, health workers, and potential patients. The program works with ambassadors across the state, people already engaged in the community and working with Black women, distributing marketing materials from the tool kit to promote PrEP.
“We identified ambassadors in New Orleans, including Mayor Cantrell, as well as Shreveport, Baton Rouge, and the Lafayette/Lake Charles/Alexandria area, and worked with them on how to engage Black women in conversations about their sexual health, and encouraging them to always mention PrEP. Our goal isn’t about getting them to take it; it’s about making sure they are aware it’s an option for them,” Bingham said.
Black women make up 33 percent of Louisiana’s women, yet, in 2017, they accounted for 78 percent of new cases of HIV in women. Of those, half were under the age of 35, according to figures released by the LDH. One in four new diagnoses in the state overall are women. Since 2017, however, the state has seen a steady decline in HIV rates. Of the state’s 989 HIV diagnoses in 2018, 686 were Black, meaning that Black Louisianians make up two-thirds of the state’s new HIV diagnoses despite being only one-third of the state’s population. More than half of the diagnoses in the African-American community represent gay and bisexual men.
Louisiana was previously among the top 10 states with the highest HIV rates in the country, but has seen a decline since the Medicaid expansion, which covers the cost of PrEP and STI testing, as well as the state’s increased efforts at treating people with HIV. Nationally, almost 38,000 people were diagnosed with HIV in 2018. Forty-two percent were Black, with 31 percent identifying as male and 11 percent identifying as female. Of the men, 80 percent identified male to male sexual contact as the method of transmission.
Around a million people in the United States are living with HIV, and 446,000 are Black. More than half are gay or bisexual men. In Louisiana, 47 percent of an estimated 25,600 people living with HIV are gay or bisexual.
In addition to Black women and PrEP, LDH also manages a TelePrEP program for people who have difficulty finding a PrEP provider, cannot travel for regular follow-up medical visits or who would prefer not to access PrEP in a clinical setting.
“We have clinicians, as well as navigators who can help people overcome financial barriers,” said Erica Sugimori, who runs the TelePrEP program. “Gilead, the company that manufactures the two PrEP drugs currently available, offers an assistance program for uninsured people. We send people to third party labs to get work done, and then they basically have Skype sessions with clinicians and we can mail their medications to any address.”
TelePrEP often provides services to rural patients, far from treatment centers where PrEP is available. The program also works with people who may be near a facility, but unwilling to visit because of the stigma surrounding HIV.
“A lot of people don’t feel comfortable talking about sexual health. A woman could have an HIV positive partner and want to take PrEP because they’d like to try to get pregnant, but they don’t want to bring up HIV with their healthcare provider,” Sugimori said. “We have had women come to us and say they didn’t feel comfortable talking about PrEP with their primary care provider.”
In addition to the stigma surrounding HIV, LDH and other public health organizations are fighting an ad campaign against Truvada – one of the two PrEP drugs available, and the only one approved for women. Personal injury lawyers purchased ads on Facebook and other sites with misleading claims about the drug’s safety, creating what some officials described as a public health crisis.
“People are trying to Google and learn about these drugs and getting results with false claims that Truvada will seriously harm them, and we have to combat that,” Sugimori said. “There is already justified distrust of the medical community on the part of many African Americans in the Deep South, and, if we want people to use PrEP, we have to convince them that it’s safe, and a better alternative than condoms.”
According to the CDC, around 200,000 people were prescribed PrEP nationwide in 2018. In Louisiana, 1,883 people were prescribed PrEP that same year, with 82 percent being male. The number of people taking PrEP nearly doubled between 2017 and 2018.
“We are planning to expand our efforts further,” Bingham said. “We now have over 100 ambassadors across the state and we will be bringing them together in the coming months to continue growing and planning. PrEP could be a life saving tool, and we have to make sure Black women also have a seat at the table.”
This article originally published in the February 24, 2020 print edition of The Louisiana Weekly newspaper.
