Dr. Olivia Nathan has some facts she wants you to know:
- Rates of new HIV diagnoses in Black women are 14x higher than the rates of white women.
- Black women make up 57% of all new HIV diagnoses, while only representing 13% of the population.
- <1% of PrEP (pre-exposure prophylaxis) prescriptions go to Black women, despite the pills being 99% effective at preventing HIV.
These sobering statistics formed the backbone of a recent TEDx Talk that Nathan—a Columbus-native and pharmacist at Equitas Health—delivered as part of TEDx King-Lincoln Bronzeville, an offering of the famed inspirational speaker series that commemorates the history and contemporary vibrancy of this historically African-American area in Columbus, Ohio.
“Not only are Black women disproportionately contracting HIV, but we are not utilizing the one drug that can be used to prevent HIV through sexual transmission,” said Nathan on stage. “I see this every day in my practice and it is a huge weight to carry.”
The Buckeye Flame spoke with Nathan about her TEDx Talk, what brought her to this work, and what we can all do to get PrEP into the hands of Black women.
I watched your TEDx Talk (below) and I think this is my first time ever fangirling a pharmacist.
[laughs]I love that!
Before we get into things, you have to tell our readers about your dad.
My dad is an incredible incredible person. Super shy, super quiet, but when he gets in his groove, he is super amazing. He was my only representation of a pharmacist growing up and really is my entire inspiration in becoming a pharmacist.
And a trailblazer too!
Absolutely! Back in Columbus in the 70s and 80s, he was one of the only Black pharmacists. For me, I didn’t know how difficult that was until almost 30 years later, when I was going through the same type of inequalities and representation and realized how much of a trailblazer he was.
How is the scene for Black female pharmacists?
You know, we’re pretty scarce. In the South I think there is more representation, but in the Midwest and especially in Ohio, our numbers are really low. I think we could do a lot better with representation for sure.
Let’s pivot to the topic of the TEDx Talk. How did you get involved in thinking about this intersection of race and PrEP?
I started at Equitas Health in 2018 and that February, we had a Black History Month celebration. There was largely no representation, so I stepped up and said we should do something. I coined it “Kwanzaa” and I got a lot of pushback from my colleagues because February obviously isn’t the time we celebrate Kwanzaa. But I really wanted to encourage them to use the principles of Kwanzaa that are really important 365 day a year, not just for that one week at the end of December. And one of those principles is “community” and the idea of building community together.
I thought it would be important to engage the community in this topic because Black people and specifically Black women are very much behind when it comes to PrEP access, PrEP uptake, and really the knowledge about PrEP. So it started with a small staff meeting about “community” and it pivoted to that TEDx Talk, where the theme was, coincidentally, Kwanzaa 365.
What should people know about PrEP as a baseline?
PrEP stands for pre-exposure prophylaxis. Simply put, PrEP is a medication you can take every day to prevent acquiring HIV through sexual transmission. If you are having sex with an HIV positive partner, if you are engaging in sexual activity with someone where you don’t know their status, if you don’t use condoms consistently, and if you have a history of sexually transmitted infections: those are the categories where you want to think about PrEP. The side effects are very minimal, so I talk to my patients like we’re friends and let them know that they should really take ownership of their sexual health and start PrEP if they fall in one of those high risk communities.
You throw out some statistics in the TEDx Talk that should make anyone stop in their tracks. What’s the first thing they should do after they digest those stats?
I think that we need to make sure that Black women are a part of conversations. If we don’t include Black women in conversations and leave HIV how it was initially branded—which is essentially as a gay, white male disease—then we won’t won’t have the participation in PrEP and we won’t change that data. That was the mission of my TEDx Talk. If even one person left my TEDx Talk with the knowledge of PrEP, that was enough for me to be a success.
It’s really about getting people the information and, once they have it, making sure that they trust the drug. Because there’s a lot of history of mistrust in the Black community. We have to beef up the numbers of healthcare providers who look like me, and then we have to make sure that patients then trust the medications that we are encouraging them to use.
I think about the gay male community and all the barriers to talking about PrEP, which may be more social than cultural. Where do we start with normalizing conversations about sex and sexual health in the Black community where there might be more cultural barriers?
I think it really starts at home at your kitchen table with having conversations with your children. Children and young adults are engaging in sexual activity much earlier than we would like to think. People think that if we have that conversation about sex, then we open up a can of worms. But from my perspective, we really don’t. We empower children and young adults to take ownership of sexual health and give them the tools that they need.
These conversations start at home with your mom, with your grandmother. In the TEDx Talk, I talked about how we have conversations about food that we eat in the Black community, collard greens, recipes that we pass down from generation to generation. But we don’t have those structured conversations at home about sexual health. I think that the kitchen table is where it starts. It doesn’t start at your doctor’s office with a cis white male who you don’t trust. We have to start much earlier and that’s where we can have impact.
- Watch Dr. Olivia Nathan’s TEDx Talk.
- Learn more about TelePrEP. With TelePrEP, Black cis women can meet with an Equitas Health medical provider and pharmacist on their smartphone or laptop – in many cases, an Equitas Health pharmacy can provide free delivery of PrEP within 24 hours. Most Ohioans can receive PrEP at no cost. Black cis women living in Ohio who have a negative HIV status and make less than 500% of the Federal Poverty Level ($62,450 annually for a household of 1) can receive PrEP at no cost through the Ohio Department of Health’s Prevention Assistance Program Interventions (PAPI).