By Lector Morales, Community Mobilization Coordinator at Gay City
There are a lot of people who have their concerns about taking a preventative medication like PrEP, the daily pill that can prevent HIV. Part of those misgivings may center around a slew of historical topics that continue to haunt some communities to this day. PrEP has become an effective way to reduce the rates of infection for anyone, and is an important tool for those who identify as gay and bisexual men, trans people who have sex with men, and those who see themselves as high risk. While it can be an expensive medication, fortunately insurance plans do cover it and for people with high out of pocket costs, there are a number of programs that can cover co-pays as well as the Washington State PrEP Drug Assistance Program which acts as a safety net program to ensure access to PrEP for those who can benefit. Making sure that people sign up for insurance can increase the likelihood that high risk individuals can access the services and care needed. It’s important, however, to make sure you are aware of what your insurance will and will not cover and what associated costs may be with your plan. There are other barriers that need to be addressed as well.
There are two examples in recent history that created ongoing barriers for marginalized communities to trust information from health institutions. Those problems created a distrust between marginalized communities and health institutions. The two examples below illustrate how that distrust is still reflected in public health today.
In the African American community the name Tuskegee Project is synonymous with horrific medical experiments. It 1972 a major news story broke detailing doctors at the Tuskegee Medical Institute in Alabama were conducting unauthorized medical research on syphilis patients without their consent. The patients were never told of a cure that was discovered decades earlier and were barred from receiving those treatments. Essentially they were withholding treatments for those clients for the sake of research. It was magnified further by the fact that all the patients and their affected families were African American.
The disastrous research project laid bare the horrors of medical experimentations conducted and licensed by Government officials. This had the lasting effect of imprinting on the minds of many African Americans a deep sense of distrust of the medical establishment. That distrust in many ways is still evident in its universal acknowledgement by many older African American citizens who saw the reports both on the news and in the newspapers of that time. That magnified the cultural divide and issues of racism, income inequality, sexuality, religion, and gender identity are topics that have added to this issue of distrust.
Another example affected the LGBTQ community. When the first cases of the HIV virus appeared in the US in the early 80’s, government officials were dismissive of requests to help combat this mysterious ailment. Throughout the 80’s and early 90’s the government’s continued lackluster response and indifference was astonishing. Key politicians’ relentless reluctance to even acknowledge its existence caused distrust and stigma to ensue. It would not be until the mid-90’s that government officials would begin an aggressive campaign to find out ways to combat this ever increasing epidemic. By then, thousand patients had succumbed to the horrors of the disease and thousands more would be unknowingly diagnosed with it. There were many in the LGBTQ community who felt, and still feel, a distrust of health institutions due to their delayed actions in the epidemic’s early days.
These are just two examples of governmental and health institutions past roles and how segments of communities were impacted because of the insensitivity of medical clinicians and providers. It is vitally important for all of us as providers and educators to learn how to professionally tailor our messaging and interactions to be as inclusive as possible and not harbor judgements when our roles are to serve affected communities.
PrEP is a game changer, but not being able to break through these barriers may make it difficult for Providers and educators to interact and dialogue with concerned populations. Creating an awareness of PrEP and creating a comfortable conversation with certain populations may be a key factor that should be explored.
Stigma has placed barriers on the importance and impact of HIV in our communities. Those barriers have become significant in how we address HIV and what needs to be done. In many ways you cannot address the issue of HIV without addressing the fundamental barriers that impact certain communities. A recent CDC report projects that 1 out of every 2 African American MSM will become positive in their lifetime. Not only that, HIV infection rates are on the rise for African American women (CDC, 2015). Now is the time for a call to action.
The barriers I have read, seen, and heard are clear; poverty, lack of access to care, lack of information, and internalized stigma play a huge roll in how Community Educators like myself get the message out. These barriers need to be aggressively tackled. Additionally, finding participants or foot soldiers who can go into an affected community and start building the bridge where a foundation of information already exists. Building that bridge is essential in combating and defeating HIV. Combating those barriers is essential.
Having another powerful tool against HIV, along with condoms, having dialogue with your partners, and getting tested just makes sense. PrEP is a game changer. It’s much needed and there’s much more to know and talk about it. In the 3 years that PrEP has been available, people have been actively seeking it out and have been rather curious about it. I have worked in HIV Prevention and Education for over four years. In that time I have come across an entire scope of people’s thinking around PrEP, sex, and the nuances around it all.
Our community is now engaging in conversations around PrEP and the important details regarding it. We need to make the most of this conversation. As long as we are aware of and sensitive to the reasons some may be distrustful of public health messaging, we should be able to reach the marginalized communities that need PrEP the most.
Lector Morales is one of the Champions of the End AIDS Washington Campaign. As one of the Champions his goals is to foster collaborative projects and events addressing the four “Calls to Actions” initiated by the campaign. He proudly serves the LGBTQ community of Seattle and for four years has worked as a Community Mobilization Coordinator and HIV/STI Tester for Gay City. He has been active in promoting HIV Prevention and Education. When he is not the Champion of Gay City or EAW, he lovingly applies his talents as an artist and writer toward developing a Sci-Fi/ Fantasy novel with a heavy slant around Afrocentric and Latino Centrist narrative, which can be found at LectorMorales.com. He has lived in Seattle for over five years and originally hails from the state of Texas.