journey to prep
HIV/AIDS

More Black Women Should Join the Journey to PrEP

It’s Friday night. You walk by a beautiful, tall, dark and handsome man. He says hello; you say hello back. The next thing you know, you’re 20 minutes into a conversation and realizing he checks off several of your boxes. The two of you decide to exchange numbers, leaving you to go on with your evening giddy a handsome man chose you out of a room full of beautiful women.  

After several amazing outings and interactions, you begin to think about next steps. And then he drops a bomb on you. The almost perfect man before you, who owns a home and car, has great credit and prides himself on his upwardly mobile career, reveals to you that he’s living with HIV.

Wow.

Now you’re faced with a problem—or are you?

***

Two years ago, when I started dating again after a broken engagement, I met the man described above. After saying to him I didn’t have a problem with his diagnosis, I knew in my heart this was true, but I also had more questions. Much of my introduction to HIV was through losing my favorite uncle to the disease in 1994. Although I was only four, I still remember the dress I wore to his funeral, the ribbons my parents adorned my hair with and the look on my mothers face when she had to explain to me I would never see him again. This contentious relationship with HIV propelled me to connect with friends engaged in HIV research to ask questions and plan out several courses of action. This process was relatively painless, given my networks, and I wish to offer them all to you for your consideration.  

 Things to Consider

There are several things for black women to consider as we think about dating in general, and as we consider the possibility of partnering with someone with an HIV diagnosis.  

First, be willing to ask difficult questions. Asking someone you’re interested in about the last time they were tested or how often they speak to their doctor about sexual health is an important dialogue in any dating scenario. Being with someone who was willing, but not necessarily required, to disclose reminded me of how important this is. 

Secondly, think about your comfort with condom negotiation. Many women are uncomfortable negotiating condom use. It is easy to say a man must do something but to then get lost in the moment and not continue to advocate for ourselves. Worse yet, there’s a trend of men stealthing women and removing condoms in the midst of intercourse. Feeling confident with conversations around condoms is an important part of HIV prevention. But there are some moments where power dynamics make this difficult for us to do. It is for this reason that I take PrEP as an extra precaution. 

Lastly, know that you, too, can go on the journey to PrEP. Taking PrEP can be an involved process, and that’s another story for another day. However, for women who make the decision to research the once-daily pill and to add it to their healthcare regimen (e.g. birth control, showers, breast exams, etc.), one of the added benefits is not having to disclose this if you do not want to. What you take, how often and why, is protected information between you and your doctor. Taking PrEP can offer an added layer of security as you grow more comfortable with condom negotiation and asking questions about sex.

Related:
Is Sex Good for Your Heart?

Steps You Can Take

Black women spend a lot of time caring for others. Between child rearing (often alone or for longer periods alone) and supporting the aspirations and experiences of black men, we often neglect ourselves–I know I did. PrEP, however, is one of many options we can explore to ensure our personal wellness and as part of a larger defense against the spread of HIV. So how can you learn more about PrEP? What steps can you take?

  1. Talk to your doctor about PrEP. Many healthcare providers are starting to advocate for the use of PrEP to combat HIV transmission. However, your mileage may vary with this given it is possible after reviewing this post and through your own research that you know more about PrEP than your doctor. Know this is not uncommon and you can push your doctor and advocate for yourself. 
  2. Know your rights. It is important to know that if a doctor downplays or otherwise refuses to support your desire for a PrEP prescription, it is well within your rights to ask her to add a notation in your chart that she declined to support your self-advocacy for your sexual health. This offers you a layer of protection in the future and could even cause your doctor to rethink how she may be negligent in providing sufficient care for your overall health.
  3. Utilize online resources. There are several websites that offer insight into PrEP and HIV prevention. Check out the Black Women’s Health Imperative, CDC and advocacy organizations like The Well Project. Your local health department will also have resources you can use.
Related:
Blacks Make up More Than Half of New HIV Diagnoses

Though the aforementioned steps and considerations are serious, know it’s not all bad nor is it all about the meds. I started taking PrEP because I wanted to be responsible for my own wellness and have an added layer of protection while dating. In the midst of this, I have also been privileged to see the real joy in being in partnership and in community with people living with HIV. 

I’ll be honest with you: Joy was not something I typically associated with HIV. It was, after all, the disease that took away my favorite uncle and one that has long maintained a consequential presence in my home city of Atlanta. But the more time I spent with people living with HIV, the more I realized the serious joys of being in relationships, kinships and friendships with people with a positive diagnosis.

For one, they’re people like you and me, and it is an honor to get to know them and their stories. I recognize my life would be poorer without their presence. Second, you’ll always have candid conversations about sex as a part of ongoing practices around health and self-care. And lastly, people living with HIV often provide thoughtful and provocative meditations on life that only those who have truly grappled with their own mortality can do. I say this not to romanticize HIV, but as a nod to the very real ways my life has been forever changed by taking seriously my sexual health and making the decision to use PrEP and talk to others about it. 

It’s on Us

As black women who engage in sex with men, we must be responsible for our sexual health as much as we expect men to carry this load. This is especially true for those of us who are dating in communities with higher associated risks for HIV transmission. This means being aware of all of our options and considering adding PrEP to our overall practices for wellness. My journey to PrEP was a response to necessity, but yours can be one of preparation for possibilities that might otherwise be missed. 

Black women deserve good, healthy, sex without HIV stigma and shame permeating their dating decision making. It was for this reason I decided not to allow HIV to control who, when and where I date. Taking PrEP once daily, although I am no longer dating someone with HIV, continues to keep me protected for the moments I do decide to take the next step.

Maybe you should, too. 

—Brittany M Williams, Ph.D.

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1 comment

Rachel June 27, 2019 at 6:33 pm

Thank you for sharing your story about your experience navigating access to PrEP. These options are out there and available, yet black women may not be aware of them or may not think these resources are for them. However, you’re showing there are options for black women to protect themselves and to have healthy and happy romantic relationships.

Trust is key between the partner and the healthcare provider. Providers should be assisting women in obtaining these options, but when that help isn’t there, they have to have the skills to be assertive. Thank you!

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