The persistent HIV epidemic continues to disproportionately affect Black women in the U.S., even though effective treatments and prevention methods, such as PrEP (pre-exposure prophylaxis), have been available for over a decade. BlackDoctor.org spoke with Dr. Toyin Nwafor, Senior Medical Director for HIV Prevention at ViiV Healthcare to discuss the key strategies for combating stigma, improving care, and transforming the conversation around HIV.
The Need for Awareness Among Healthcare Providers
ViiV Healthcare recently presented the “Catalyst for Change Revolutionizing the HIV Prevention Conversation” at this year’s National Medical Association Convention and Scientific Assembly (NMA). One of the primary objectives of the session was to bring awareness to healthcare professionals (HCPs) about the ongoing HIV epidemic, particularly among Black women and other women of color. Despite significant advancements in HIV prevention and treatment, there is still a considerable knowledge gap. Many HCPs may not be fully aware that 1 in 5 new HIV infections in the U.S. occur in women, and nearly half of these infections are in Black women.
“Half of these new infections among women are in Black women, with nearly 70 percent occurring among women of color when you include Latina women,” Dr. Nwafor notes.
Dr. Nwafor, who was a panelist at the session, emphasizes the need for healthcare providers to be better informed and to actively engage in conversations about HIV with their patients. Normalizing HIV prevention as part of routine healthcare, particularly in communities disproportionately affected by the virus, is essential to improving outcomes.
Shifting from “Risk” to “Reasons” Language
Another critical part of the session focused on the importance of language in HIV care.
To combat this, ViiV Healthcare has launched the Risk to Reasons initiative, which was co-created with the Black Women’s Working Group. This initiative shifts the focus from stigmatizing “risk” language to “reasons” language—reframing HIV prevention in terms of empowerment, self-care and control.
“This initiative is community-led and driven, and it is based on guiding principles critical to any successful healthcare interaction. These principles include respect and recognition of the whole person, empowering patients, and creating spaces free from fear or stigma. Language should be stigma-free and non-judgmental. These are the guiding principles behind Risk to Reasons, making it impactful for any healthcare engagement, Dr. Nwafor shares.
The initiative also emphasizes understanding why Black women might want to engage in HIV prevention and treatment.
“The reasons revolve around normalizing self-care and viewing HIV prevention as a form of self-care, not as something stigmatizing. They also include empowering women to have control over their circumstances. The focus is not on labeling them as “high-risk” or “target” groups but rather on supporting their autonomy and desires,” Dr. Nwafor adds.
Intimacy and desire are also key areas of focus. Dr. Nwafor hopes more women will be empowered to recognize sexual health as part of their normal wellness routine.
“This approach helps avoid the stigma of being categorized as high-risk and instead focuses on personal empowerment and control,” she says.
Addressing the Stigma and Misconceptions
The stigma surrounding HIV remains a significant barrier to testing, prevention, and treatment, particularly in Black communities.
“One [stigma] is that HIV is no longer a problem or that it’s ‘taken care of,’ but we still see 32,000-35,000 new HIV infections annually in the U.S. Another misconception is that HIV only affects gay men or certain populations, which is not true. As we mentioned, 1 in 5 new infections are in women, many of whom are Black women,” Dr. Nwafor shares.
Additionally, myths about how HIV is transmitted, such as through casual contact, kissing, or sharing utensils, continue to persist. One vital message to share is “U=U” (Undetectable = Untransmittable), which means that individuals living with HIV who have an undetectable viral load cannot transmit the virus to their sexual partners.
“We need to normalize conversations about HIV and empower people to get tested so they can take control of their health, whether that means getting preventive care or starting treatment. It’s crucial to dispel myths that HIV is a death sentence; people with HIV can live long, healthy, and productive lives with the right treatment,” Dr. Nwafor adds.
Advancements in HIV Treatment and Prevention
The landscape of HIV treatment has dramatically improved since Dr. Nwafor began her career. Today, there are highly effective antiretroviral therapies (ART) that allow people living with HIV to maintain undetectable viral loads with once-daily pills or even long-acting injectables, which can be administered every two to six months. These treatments not only help people live healthy, productive lives but also eliminate the risk of transmitting the virus.
In terms of prevention, PrEP has been a game-changer. Available since 2012, PrEP offers a highly effective means of preventing HIV infection when taken consistently. Long-acting injectables for PrEP are also available, providing additional options for individuals who may struggle with adherence to daily pills. Despite these advancements, uptake of PrEP among Black women remains low.
“Only about 1 in 10 Black people who could benefit from them are using them. Additionally, only about 20-30 percent of women know about PrEP or are aware that it is for them. This lack of awareness contributes to ongoing disparities in the HIV epidemic, despite the availability of effective treatments and prevention methods. Black individuals make up about 40 percent of new HIV infections in the U.S. but only about 13 percent of the population. This highlights the need to address stigma, medical mistrust, and societal issues like racism, poverty, and unstable housing, which all contribute to these disparities,” Dr. Nwafor notes.
The Role of Healthcare Providers in Transforming HIV Care
Dr. Nwafor’s message to healthcare providers is clear: start the conversation.
“Create a clinical space that is safe, non-judgmental, and affirming. Seek out resources and training to help you have these conversations. Patients want to discuss their sexual health, but it must be done in a way that feels respectful and open,” she says. “Don’t wait until you feel you have the perfect words. Start with good intentions, learn from each interaction, and continuously improve. Start with patients you have a long-standing relationship with to build your comfort level. The more you do it, the better you’ll get.”
By seeking out resources, such as the “Risk to Reasons” initiative, and understanding the guiding principles of respect, empowerment, and autonomy, healthcare providers can better support their patients in taking control of their sexual health.
