Women of Color Will Not Be Left Behind: Washington AIDS Partnership Rolls Out The DC PrEP for Women Initiative

Despite the growing advancements in HIV research and prevention, there are oftentimes barriers that limit access to these tools and information in certain communities. Channing Wickham, Executive Director at the Washington AIDS Partnership (WAP), and Chair of the FCAA Board of Directors, explains that the impetus for their $1 million PrEP for Women Initiative was to try and tackle one of these gaps.

“It all started with a focus group” Wickham explains. Conducted by Octane Public Relations and Advertising on behalf of the D.C. Department of Health’s HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA) and hosted by The Women’s Collective, this focus group asked women of color if they had heard of PrEP and understood how it worked. It revealed that they had been left out of the conversation entirely. “They expressed anger when asked about PrEP, because they had never even heard of it!” Wickham exclaimed.

PrEP, or Pre-Exposure Prophylaxis, is a drug that when taken regularly can prevent HIV infection if exposed to the virus. While the drug, approved by the FDA in 2012, has seen an uptick in use by gay men and other men who have sex with men (MSM), knowledge of and access to PrEP has skirted other communities.

“According to HAHSTA’s data, approximately 2.5% of D.C. residents are living with HIV,” Ashlee Wimberly, the Project Coordinator for the PrEP for Women Initiative at WAP explains. “This exceeds the 1% infection rate that the World Health Organization uses to classify a generalized epidemic.” She doesn’t mention that this also marks the highest rate of HIV infection in the entire country. While HIV is not new to the District, the growing rate of African American women infected is, with 1 in 6 new diagnoses occurring among African American heterosexual women, making them the second largest affected group in D.C., behind African American MSM.

Identifying this gap led WAP to pair up with HAHSTA. As Wickham explains it, “we began asking ourselves, ‘what would a model program to fill these gaps look like?’” With buy-in from the M.A.C. AIDS Fund, which is providing a generous $1 million, two-year grant, the D.C. PrEP for Women Initiative began. Wickham and Wimberly sat down with me to explain what came out of all of the planning, and the public-private partnership between HAHSTA and WAP.

“A major component of the D.C. PrEP for Women Initiative will be funding to support innovative projects that address one or more of the initiative’s goals,” Wickham says. He describes three categories of activities that the initiative is looking to fund:

• Educating women who are at high risk for HIV about PrEP and how to talk to their providers about it
• Supporting health providers to adopt PrEP into their organizational culture and services, especially those that serve women of color (such as Federally Qualified Health Centers (FQHCs). This includes talking about PrEP with and offering it to their patients as an option. “We need organizational buy-in from the top down, as well as the bottom up,” Wickham offers.
• Building PrEP capacity by educating health care providers through Continuing Education Units (CEU) and Continuing Medical Education (CME) so they are informed about PrEP and will begin to prescribe it.

In addition to this, WAP will partner with HAHSTA to implement multi-platform messaging through social media and awareness advertisements, like the HAHSTA #PrEPforHer bus ads. To inform the initiative and bring a wide variety of expertise together, they have appointed an advisory committee, which includes health providers, academics, community leaders, and service providers who have experience working with women of color. They represent a variety of backgrounds and perspectives that will help shape the initiative’s activities.   “It’s a totally new experience,” Wickham explains, “figuring out best practices that cater specifically to women, and utilizing the advisory committee to walk us through the questions and challenges along the way.” Wimberly will be spearheading community engagement projects “to ensure that the voice of the community is heard and is an integral part of this process.” This will include hosting town hall meetings as well as conversations at smaller community organizations for people who do not feel comfortable in large public forums.

When asked what type of programs they are hoping to support through grants, Wickham explains that WAP “doesn’t want to be too prescriptive in the Request for Applications (RFA).” They are seeking innovative applications that will represent “the perspective and experience of nonprofits that directly interact with the community in order to hear what they believe will be the most effective intervention.”

Educating women about the benefits of PrEP as a tool to protect themselves is an important public health effort. When asked about this, Wimberly offers, “This is one tool of many for women to control their risk. The perk of PrEP is that no one needs to know but the person choosing to take it. They are the sole decision maker in this process.” [They both assert that they are still big believers in the use of condoms, both male and female, as another tool in the toolkit.] Wickham adds, “PrEP does allow people to be private with their decision, although we don’t think there is anything shameful about using it, and we encourage people who would like to speak out about it to do so—but this gives them the power to choose.”

Wickham could not emphasize more how proud he was of the public-private partnership with HAHSTA, a relationship that has spanned many years and been fundamental to many initiatives they have spearheaded in the past. “We gain tremendous learning and support from the partnership.”

As one example, a particular goal for this initiative is to reach health care providers through continuing education. HAHSTA already has an established mechanism for this called academic detailing, in which clinical educators meet with health providers at their offices to discuss the latest data on a specific topic. They have done so for other topics, such as Expedited Partner Therapy, and will now add PrEP education to the curriculum. This allows WAP’s funding dollars to go even further. “There is a great synergy of working with the government as a trusted partner.”

And Wickham believes that WAP brings its fair share to the table. “There is nimbleness to nonprofits/foundations—we can hire quickly, get money out the door and turn things around quickly, adapt and evolve an initiative as new information comes to light, things that government can’t always do as efficiently– they value our partnership as well.”

As a send-off, Wickham offers up how they see this initiative contributing to the larger funding community. “We hope to be a model for other jurisdictions to roll out projects like this on their own, but also, we would love other funders to join us at the table for this project!” They have already planned a second year of grantmaking in 2018, and Wickham imagines, with an endeavor like this, “two years is a very short period—when starting at zero and trying to get up to speed—we expect that this may stretch into a three- or four-year project.”

WAP is also eager to share what they learn through this process to other funders who seek to replicate or create their own initiatives. “There’s plenty of room for collaborating on this,” Wickham offers. “In fact, FCAA’s Annual Philanthropy Summit in December 2016 will feature one of the most important voices for women and PrEP, Dazon Dixon Diallo, on a panel about health equity for women of color.” Sounds, to me, like a good place to keep this conversation going.