Researchers from Duke University School of Nursing in Durham, N.C., are turning to a ubiquitous locale -- beauty salons -- to help raise HIV prevention awareness among Black women in the South. Salons are often considered safe spaces for intimate conversations.
The numbers highlight the stark need: Black women, who make up 13% of the U.S. population, account for 64% of new HIV infections among U.S. women. They also make up 69% of all new HIV infections in the South, according to the Centers for Disease Control and Prevention. [caption id="attachment_77382" align="alignleft" width="214"]
Schenita D. Randolph, RN[/caption] Schenita D. Randolph, PhD, MPH, RN, CNE, and her research partner, Ragan Johnson, DNP, APRN-BC, both assistant professors at Duke University, developed a strategy to help prevent HIV spread in their region by focusing on Black women who have not been exposed to the virus. The strategy involves training stylists to start conversations about HIV, educating women about HIV prevention, and linking them to prevention medication (pre-exposure prophylaxis or PrEP). The research team received two-year funding from Gilead Sciences, which manufactures the HIV prevention medication Truvada, to put a pilot program in place.
Randolph explained that 44% of the people who could benefit from PrEP in the U.S. are African American (500,000). However, only 1% in that group have been prescribed PrEP, despite evidence that if taken once a day it can lower a person's risk for getting HIV through sex by more than 90%.
First Step Is Training Stylists
The multipart strategy starts with training stylists in six salons in North Carolina to look for opportunities to engage women in talks about HIV if conversations turn to sex. The salons were chosen from three counties with high rates of HIV. [caption id="attachment_77383" align="alignright" width="214"]
Ragan Johnson, ARNP[/caption] HIV is much more prevalent in the South. According to the CDC, there were more than 19,000 HIV diagnoses in that region in 2018 compared with the Midwest, which had the lowest number (just under 5,000).
"Conversations about sex are already happening in the salons," Johnson said. "What we're training the stylists to do is recognize when those conversations are happening as an opening to elevate the conversation to evidence-based information."
A client's casual comment about a sexual encounter might prompt a trained stylist to ask whether the partner wore a condom. The answer may then open the door for talk about HIV statistics for Black women, the prevalence of HIV in the area, and the benefit of PrEP. From clients at the six salons, the researchers will recruit 10-12 women to watch a series of online vignettes, in which actors convey the need for protection in an entertaining way. Included in the education is a link to a PrEP navigator who can help the women then get more information or get started on the medication.
Overcoming Challenges
Randolph and Johnson, who will personally train the stylists, said some of the biggest challenges will be overcoming distrust in the community of taking part in research and of taking the word of medical providers. Johnson notes the HIV prevention drug also is used to people who already have HIV. That may raise fears among the women that others will think they already have the virus, she said. The message to take PrEP could also come at the same time people all over the U.S. will be asked to take a COVID-19 vaccine, if current vaccine progress continues.
Stylists training for the pilot project will start in the spring. Johnson said they likely will need to add information on taking a COVID-19 vaccine to the HIV information. Another hurdle is that insurance doesn't always cover the cost of PrEP, but if it doesn't, the researchers want the women to know that there may be other organizations that can cover the costs.
Gathering the courage to talk about HIV with anyone, including healthcare providers, can be intimidating as well. Randolph said providers play a crucial role in getting PrEP to the people who need it most and that the onus must not fall on Black women to take the lead. "If we have a drug and we know Black women are at high risk, we as providers and researchers need to take some responsibility in that," she said. Randolph and Johnson acknowledge that spreading the PrEP message will require organizational and structural changes beyond salons. That, they acknowledge, is beyond their team's reach. "What is within our reach is educating the community, gatekeepers, salons who are trusted so that they can get the information," Randolph said.
Plans for Broadening the Scope
The pilot is only the start of what they see as a sustainable ongoing effort, Randolph said. The plan is to eventually train more stylists and provide them with signs that say, "Ask me about PrEP." The online vignettes can be scaled up to educate larger numbers as well, and more people can get linked to the navigators. Randolph and Johnson also hope that information shared within the salon network will spill into other networks through which Black women communicate.
"We've been intentional about our development with sustainability in mind, so when the funding is gone, it can carry on," Randolph said.
Take these courses to learn more PrEP and HIV:
The Role of Emergency Department Clinicians in Helping End the HIV Epidemic: Focus on nPEP and PrEP (1.5 contact hrs) Although HIV care has historically been considered outside of the scope of practice of emergency department clinicians, the members of the ED team now have the opportunity to play a key role in United States efforts toward "Ending the Epidemic." To maximize this role will require further developing their knowledge and skills regarding HIV prevention strategies such as post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), putting protocols in place within the ED that facilitate their use, and building relationships with HIV providers in the community with whom they can link patients after leaving the ED. Sexually Transmitted Diseases: Women Face More Risks (1 contact hr) Each year, nearly 20 million Americans, half of them between the ages of 15 and 24, become infected with an STD. The highest rate of infection is among female adolescents. Consequences of untreated STDs may include infertility, brain and other organ damage, and an increased susceptibility to HIV. Sexually active people need the correct information on preventing STDs so that they can make informed decisions about their sexual activity. All healthcare providers who are knowledgeable about STDs can help provide that information. This course describes common STDs and their treatment. Preventing Perinatal HIV Transmission (1 contact hr) An infected mother can transmit the HIV to her baby before or during birth and through breastfeeding. Multiple factors have combined to decrease the risk of perinatal HIV transmission in the U.S. to less than 1%. The most effective way to deter perinatal HIV infection is to prevent initial infection in women and encourage preconception and prenatal HIV counseling, testing, and treatment. This continuing education module will discuss risk factors for mother-to-child HIV transmission and clinical guideline-supported strategies for decreasing the risk.
