Reaching Women Where They’re At: Setting Up a Safe Space for HIV Prevention Conversations
July 9, 2024 | HIV, Leadership, Women in healthcare, podcast
“I always enjoyed solving problems and putting puzzles together,” says Harmony Garges, MD, CMO at ViiV Healthcare and a pediatric infectious disease specialist. “So for me, infectious disease was a perfect fit from a medical perspective because often you’re the consultant who is pulled in to solve those puzzles, to examine someone who has an unexplained symptom.”
The other piece that drew her in to HIV specifically. was understanding the impact these diseases have, and that in many cases they’re preventable. “I wanted to be a part of advancing the field and raising awareness about prevention, and the importance of getting tested and getting on appropriate therapy,” she says.
For Rupa R. Patel, MD, MPH, FIDSA, HIV Research Branch, CDC, and Community Health, Whitman-Walker Health, the social aspect also was compelling. “MY aha moment came when I was taking care of a transgender woman that was newly diagnosed with HIV, and realizing that our clinic and staff and myself were the safe space.” This person was rattled by their new diagnosis, and very isolated because they didn’t have the social support from their family. “They were missing the kind of safe space they had once found in church,” Patel says. It wasn’t just about providing medication: Patel also needed to understand this person’s life to help them truly succeed. “It’s the interaction with communities, as well as the meaningful relationships you can create, that must be woven together to successfully treat patients and help stop the spread of infection,” she says
With a wealth of medical expertise between them, these physician leaders are pioneering new ways to get information and preventive medicines to at-risk women. According to a recent CDC report, out of 31,000 new HIV infections in the U.S, almost 20% were women, a number that hasn’t budged in recent years. Of those on preventive medicine (PrEP), 92% are men and only 8% are women — “so we know that HIV prevention currently is not reaching women effectively,” Garges says.
What are the challenges and stumbling blocks? Stigma is the big one, and finding ways to overcome it is the search for the Holy Grail, they say. Creating a safe non-judgmental environment for seeking care, and even integrating conversations about sexual health into routine settings, is key.
“Back when I trained, HIV was treated by specialized infectious disease clinicians because in the early days it was quite complicated,” says Garges. “Thankfully, we’ve evolved to a place where HIV can be treated, typically, with one pill once a day,” which enables a broader medical community, including primary care providers, to lean into the HIV space and start taking care of people living with HIV or who want to access prevention. So a woman can simply go see her GYN like all her girlfriends do, like everyone else in the community does. She doesn’t have to seek out an HIV specialist to have these conversations, so it normalizes the experience and empowers her to take control of her health in a comfortable way.
“A woman has needs dynamically throughout her life,” says Patel, “and that requires flexibility in terms of where you reach her.” Maybe she has a job and transportation and can get to a clinic. Maybe that means a nurse going on a mobile unit, or someone sitting in the local park doing testing once a month so a woman can get tested on her way home from the grocery store.
“There’s also some evidence around having conversations and doing testing in nail salons,” Patel says. And hair salons. “That has been tried and tested over time.” A successful program is one “that will reach women where they’re at and where they make time. They’ll make time on a Sunday to get their hair done. In the South, where religion is often a strong part of the community fabric, there have been efforts with pastors to talk about and normalize messaging.” We need to continue thinking outside the box, “and that’s why that flexibility and that community connection is so important.”
For more information, please contact Jelena Spyropoulos (Global) or Piyali Shin (US).
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