April 3, 2024

A Love Letter to Black Women

Even before the discovery of HIV, Black women have had to carry a larger than normal share of the burden of economic injustice and structural racism. Black women have also continued to be disproportionately impacted by HIV. Ironically, Black women have been leading and supporting the HIV movement for 40 years.

Last year’s theme at USCHA was “A Love Letter to Black Women.” Although we have much to celebrate and acknowledge about our accomplishments with Black women in society, we have much further to go to eradicate disparities experienced by Black women. Here are three areas where work can be done to improve health outcomes for Black women in the United States.

Educate Others About Women’s Health

First, advocates for health equity should educate others on the tortuous history of women’s health in the United States. As you know, even though women live longer than men, they spend more time living in poorer health. Around the world, women face greater individual and societal challenges–often stemming from historical discrimination embedded across many societies and cultures–that impede their ability to maintain good health.

Health care providers can educate others about the challenges all women face that can damage their health and well-being, including paralyzing norms that define them as primary caregivers, rising levels of gender-based violence and the lack of access to essential health services. Women’s health interventions are initiated to help those most directly impacted, but often fail to reach Black women and others for whom interventions could prevent future health problems, especially younger women. It is important for us to highlight how Black women struggle to access women’s health interventions while they are also more likely to be excluded from other health services.

Centering Black Women in Women’s Health

Second, advocates for health equity should center Black women in women’s health initiatives. In 1915, when the United States began collected data on maternal mortality rates, Black women were almost twice as likely to die from pregnancy-related complications as their white counterparts. For decades afterward, maternal mortality rates decreased due to several factors, including access to antibiotics, surgical procedures, maternity services and improved living conditions. However, around 2000, the U.S. maternal mortality rate began to rise again.

Today, Black women are three to four times more likely to die in childbirth than their White peers. Further, studies indicate that Black babies who are cared for by Black neonatologists and pediatricians in their first year of life are more likely to survive than those treated by white neonatologists and pediatricians.

Reframe Interventions for Black Women

Second, advocates for health equity should reframe interventions for Black women. Black women account for more than 60 percent of new HIV diagnoses among American women while only 14 percent of American women are Black. For years, Black women have advocated for better conversations with clinicians about sexual health and HIV prevention. Unfortunately, providers who are not versed in sexual health or HIV care can often create barriers to care themselves. Anecdotally, there are instances when Black women tell their doctors they want to be on pre-exposure prophylaxis (PrEP), but they are refused PrEP unless they admit to engaging in “’risky sexual behavior.”

Meaningful involvement of Black women in health conversations is of critical importance. Their contribution is essential to reframing these conversations in ways that resonate uniquely with Black women. Partnered with informed health care practitioners, sexual health can finally be an integral part of primary care, and not just when the patient brings it up or has a particular problem. Fortunately, the Academy has sexual health resources you can share that can help providers hone their communication with all patients.

Bridging the Gap with Black Women in Leadership

Generally, women are more likely to experience discrimination within the health care system. Particularly, women often report that they are either not believed or ignored in clinical settings. Often the women whose conditions were not taken seriously were also reporting less access to women’s health services generally.

Although Black women have pioneered many of our movement’s greatest wins, they remained marginalized in shaping the direction of our future in advocacy. Black women in HIV are not credited within health care at a rate consistent with their innovation, research and scholarly production and visibility in the field. Advocates who publish and appear in top journals or on major platforms rarely credit Black women, despite their training, practice and leadership. This omission is not accidental, but a part of a larger patriarchal structure.

Clearly women play an important role in taking care of the health and well-being of families and communities. They deserve all the care that health care entities can offer. But often they remain on the margins of health care advances all over the world.

By acknowledging this history and doing a better job of responding to the needs of women, this year can be a turning point for our progress in uplifting the care of women in the HIV movement. This change should start with health professionals.