Caption: The PrEP for Women initiative program manager (second from the left), grantee staff, and our academic partner (second from the right) led a workshop at the 2019 United States Conference on AIDS (USCA) in Washington, DC.
DC PrEP for Women Initiative
The DC PrEP for Women initiative is a public-private partnership between DC Health’s HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA) and the Washington AIDS Partnership (WAP). Founded in 2017 with generous support from the MAC Viva Glam Fund, the D.C. PrEP for Women initiative was one of the first city-wide programs in the country to focus specifically on PrEP for women of color. Pre-Exposure Prophylaxis (PrEP) allows people who do not have HIV to take medication regularly to lower their chances of getting HIV from sex by over 99% when taken daily. [i] PrEP has tremendous potential to reduce the infection risk among women in Washington, D.C., where the lifetime risk for HIV diagnosis, the likelihood a person will be diagnosed with HIV during their lifetime, is 1 in 13, the highest in the country.[ii] Furthermore, heterosexual Black women represent the second largest group (16%) of persons newly diagnosed with HIV in the District.[iii] However, there is a significant PrEP awareness gap among women of color.
In its first two years, the initiative focused on preventing new HIV infections by educating young and adult women of color who are at risk for HIV and their providers about the option of PrEP. Activities included community conversations to widely share information about PrEP, provider and support staff training, social marketing and media campaigns through DC Health and HAHSTA, and grantmaking to support PrEP education for women of color and integration of PrEP in local medical and support services.
In 2019, the initiative expanded its focus to “un-siloing” sexual health services for women and investing in models that are empowerment-focused, affirming, and that acknowledge the potential impact of trauma. The concept of un-siloing is based upon lessons learned during the first two years of the PrEP for Women initiative:
– PrEP and other HIV preventative services are often siloed. All too often the conversation is only about one topic: HIV status or preventing pregnancy or delivering STI results or PrEP.
– Siloed PrEP education does not sufficiently resonate with women to be an effective HIV prevention strategy. In the initiative’s experience, women first need a safe space to learn about sexual health in general, and this must happen in the context of empowerment.
– There is persistent discomfort among D.C. providers around talking about sexual health and risk with women, which can act as barrier to receiving care.
The goal is to ensure that women both understand and have access to the full range of options to protect themselves, resulting in improved health outcomes.
DC Health HAHSTA is supporting the initiative through its social marketing efforts, including the “Sexual+Being” campaign, which aims to make sexual health part of the conversation about general health, encourage open and judgement-free conversations about sex, and reaffirm that sex is part of a healthy, normal life. The #PrEPforHer campaign along with many other campaigns now coexist under the Sexual Being umbrella. The Sexual+Being website includes evidenced-based educational information, linkage to medical providers and CBOs, and a blog partner with local and national writers and artists to cover a range of themes related to sexual health. Most recently, DC Health has launched a Spanish-language version of the site and launched at-home HIV and STI testing program, called Get Checked DC.
Current Grantee Projects
WAP’s most recent PrEP for Women grantmaking has focused on un-siloing sexual and preventive health services for women of color at community health centers in the Greater Washington region. Grantees have undertaken activities focusing on issues of accessibility; integration of health care, HIV care, and prevention education and outreach services; and addressing provider knowledge gaps and biases around women of color and their sexual health. Grantees include Family and Medical Counseling Service, La Clínica del Pueblo (LCDP), Mary’s Center, Planned Parenthood of Metropolitan Washington, and Whitman-Walker Health (WWH).
Brief descriptions of the projects are provided below:
Family and Medical Counseling Service (FMCS)
FMCS is a federally qualified health center (FQHC) that addresses the needs of the Black community east of the river with culturally sensitive, high quality health care. With Washington AIDS Partnership funding, FMCS is working to un-silo sexual health services for women at risk for HIV who receive services at drug treatment facilities, organizations that work with returning citizens, and agencies that provide supportive services for women. They are conducting small group education sessions with women who often report being stigmatized in terms of their sexual history, and limited exposure to sexual health information and safe spaces to discuss these topics. FMCS is also providing educational presentations for the staff at these organizations to de-stigmatize sexual health and HIV, and ensure that they are knowledgeable and able to effectively provide referrals to health services.
La Clínica Del Pueblo (LCDP)
LCDP is a FQHC which provides culturally appropriate, patient-centered health services for the Latinx and Latinx immigrant communities in the Greater Washington region. Their Washington AIDS Partnership-funded project is increasing the capacity of LCDP’s providers and peer health promotors to more effectively deliver holistic sexual health care, sexual health education, and HIV prevention services to Latinx women, through increased collaboration on the organizational level and additional staff training. They are also integrating sexual health education into other existing health programs. These efforts have resulted in increased access to sexual health education and clinical services for Latinx women in Washington, D.C.
As an FQHC, Mary’s Center provides health, education, and social services to more than 55,000 people each year. Washington AIDS Partnership funding supports un-siloing of sexual health at the organizational level, where they are focusing on increasing collaboration between the HIV Services and Community Education departments to better integrate HIV prevention, sexual health, and other health messaging and care. In 2019, they opened a Sexual Health Clinic, which provides walk-in HIV and STI screening and treatment services as well as other preventative services.
Planned Parenthood of Metropolitan Washington (PPMW)
PPMW provides sexual health education and reproductive health care across three sites in D.C. and Maryland with an emphasis on serving those that are at-risk, low-income, and uninsured/under-insured. Washington AIDS Partnership funding supports PPMW’s efforts to un-silo sexual health services through increased collaboration between the education, clinical services, and marketing departments. One result of this has been a new screening tool designed to support patients in identifying their own HIV risk and sexual health needs. It also helping staff to have conversations with clients about their sexual health.
Whitman-Walker Health (WWH)
WWH is a FQHC serving a diverse urban community, including those impacted by disparities, and with a special expertise in HIV and LGBTQ care. Washington AIDS Partnership funding supports WWH’s efforts to more actively include women’s perspectives in both planning and delivering sexual health services. Specific activities include expansion of sexual health services to a new service site, with a focus on Black womxn; training for clinical providers focused on un-siloing; and a new program called #NoFilter, which are monthly community events to create safe spaces for womxn to talk about sexual health in an affirming environment.
______[i] Centers for Disease Control and Prevention. “Pre-Exposure Prophylaxis (PrEP)” Webpage. May 2020. http://www.cdc.gov/hiv/risk/prep/index.html. [ii] Centers for Disease Control and Prevention. Lifetime HIV Risk Diagnosis Factsheet. 2017. [iii] DC Department of Health, HIV/AIDS, Hepatitis, STD, & TB Administration. 2019 DC Annual Epidemiology & Surveillance Report. Released 2020.