How to Talk to Black Women About Sex, Plus: Why You Should Take PrEP

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Here’s the thing: I’m a black woman living in Atlanta—single for the first time since I moved here in 2005. For the first 13 years of my life in Georgia as a wife and mom, the conversation in my doctors’ offices was clear, concise and respectful: my physicians, charged with keeping me at my healthy best, hit me with that good preventative care and addressed any concerns I brought to their attention with focus, care and respect.

But damn if that courteous relationship between doctor and patient didn’t fly out the window when I got a divorce and started walking into those medical offices sans a wedding ring. The tenor of those conversations got way more intense—a lot more disrespectful. Full of assumptions. Focused, weirdly, disrespectfully, on my lady parts and what I do with them. I’d go in with a cough and stuffy head during flu season, wanting to be checked out for the flu, and my doctor would ask me if I wanted to be tested for gonorrhea and chlamydia. I’d head in for my annual gynecological visit and get lectured about using condoms during sex. Always—always—the assumption seemed to be that I’m some irresponsible dimwit who had neither the capacity nor desire to make sound, reasonable, smart, healthy decisions about my sexual health.

This kind of thinking falls directly in line with a larger narrative when it comes to black women in Atlanta and the healthcare system charged with caring for us. Just a few months ago, the Centers for Disease Control and Prevention (CDC) put out an all-points-bulletin comparing Atlanta’s high rate of HIV infections with that of third-world countries—CDC stats show that 1 in every 51 Georgians is likely to contract the virus. Downtown Atlanta’s rates are “as bad as Zimbabwe or Harare or Durban,” Dr. Carlos del Rio, co-director of Emory University’s Center for AIDS Research, told reporters. Doctors and HIV experts weighed in, strongly urging black women in particular to take PrEP (pre-exposure prophylaxis), an HIV preventive medicine recommended for people who are at substantial risk of getting the virus.

Media outlets and the people who follow them took that quote and ran with it—swinging their gaze toward black women in a way that felt stigmatizing. Like we’re a bunch of hot-in-the-ass sexpots just running around downtown Atlanta with our legs spread wide, just one romp in the bed away from becoming a statistic.

It was infuriating. And scary. And made it feel like we black women were, yet again, alternately being blamed for our community’s ills and being held solely responsible for fixing it.

And this—this is the part where stigma, indifference and systemic racism lead to negative health outcomes for us black women. Pointing fingers at black women, making demands of black women, and talking crazy to black women does nothing to improve the conditions of black women. In fact, it harms us.

Of course, I understand that the rate of HIV diagnoses among black women in general and my city in particular are alarming. Still, I’m sure there’s a better way to both encourage testing and urge us to consider using PrEP, an HIV prevention strategy that includes a daily pill that protects against contracting HIV, without making us feel like crap about it.

Here’s what I wish would happen at my doctor’s appointments—how I wish medical professionals, researchers and HIV experts would treat black women when having discussions about our sexual health: talk to me with the understanding that I’m good and grown, I’m not ignorant about STDs and HIV or how one gets infected with them, and I deserve the respect and dignity one affords a human being who is responsible for her own health outcomes, not that of an entire community. Want to talk to me about how best to protect myself from this epidemic? Holla at me at my annual physical or OB appointment, when we’re talking about my overall health and all the ways I can be healthy—not out of left field, when I’m on an emergency appointment for a sore throat.

In fact, I wish the healthcare community would flip it and talk to us in sex positive ways. Like, let’s treat solutions like PrEP as if they’re a tool in our arsenal for sexual health. Take the pill or any other birth control if you don’t want to be pregnant. Get an annual breast exam to check for breast cancer. Get pap smears to check for cervical cancer. Use condoms to protect yourself from STDs. Take the one-pill-a-day PrEP to protect yourself against HIV.

See? No finger-wagging. No doom and gloom. No treating me like I’m some fast-assed dummy too clueless about her own vagina to make good decisions about how to protect it. Just good ol’ fashioned info, without the judgement. Bonus points if my doctor says, “Hey, black lady, you so deserve a good, hearty, healthy sex life. Get it innnnnnn, sis! Have you heard about PrEP? It’s the best way right now to protect yourself from HIV if you’re not using condoms every time. Let me know if you want a script.”

I don’t think that’s too much to ask.

What Black Women Need to Know About PrEP

• PrEP is tenofovir/emtricitabine, a daily medicine you can take to reduce your chance of getting HIV. Click here to see how PrEP works.

• Daily PrEP reduces the risk of getting HIV from sex by more than 90 percent.

• Combining PrEP with using condoms and other prevention methods can reduce your risk even more.

• PrEP is for people without HIV who are at very high risk of getting it from sex or injection drug use. That includes anyone who isn’t in a mutually monogamous relationship, who has sex with a gay or bisexual man who has had anal sex without using a condom or been diagnosed with an STD in the past 6 months, or a heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection. It’s great, too, if you have a partner who is HIV-positive and are considering getting pregnant. PrEP may be an option to help protect you and your baby from getting HIV infection while you try to get pregnant, during pregnancy, or while breastfeeding.

• The most common side effects of PrEP are nausea, headache, upset stomach and fatigue, but these typically subside over the first month of taking the drug. Rare side effects include kidney and bone problems.

• PrEP is not something that has to be taken indefinitely; women can work with their healthcare provided to start/stop using PrEP as an HIV prevention tool depending on their risk of HIV transmission (and that changes over time). Not sure what your risk is? Click here to assess it.

• Find a PrEP provider near you here.

• How do you pay for PrEP? Click here.

And now, do me this solid:
Med-IQ is currently conducting a survey and would appreciate your input. The survey, which includes more education on this topic, will take less than 15 minutes to complete. Survey responses are anonymous and will be shared only in aggregate. Your responses to these survey questions will provide us with important information about how women communicate with their physicians about their sexual health. The insights gained from the survey will be used in an educational tool to provide information that may be useful in keeping the lines of communication open with healthcare teams. TAKE THE SURVEY HERE.

Once you’ve completed the survey, you’ll be asked to provide your email address if you’d like to be entered into a drawing administered by SOMA Strategies to win 1 of 8 $100 VISA gift cards. If you choose to enter, your email address will not be sold, kept, or stored; email addresses are used only to randomly draw the winners and notify them of their prize.

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I was compensated by Med-IQ to write about HIV. All opinions are my own

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