PrEP-ing Women to End HIV

From 2015 to 2020, use of PrEP (preexposure prophylaxis) to prevent HIV infection increased from 3 to 25 percent, according to the Centers for Disease Control and Prevention (CDC). A national plan known as Ending the HIV Epidemic in the U.S. (EHE) aims to double PrEP coverage to 50 percent by 2030 to help curb this country’s decades-long HIV epidemic. However, at-risk populations poised to benefit most from the potentially life-saving PrEP regimen lag behind overall uptake. Only 9 percent of the nearly 469,000 Black people who could benefit from PrEP, for example, received a prescription in 2020, and only 16 percent of the nearly 313,000 Hispanic/Latino people who could benefit from PrEP were prescribed the medication, according to preliminary CDC data.

Women trail in PrEP use too. Rosina Cianelli, a School of Nursing and Health Studies (SONHS) professor, notes that only about 10 percent of women versus about 28 percent of men use PrEP, with minority women disproportionately impacted by HIV and undereducated about PrEP. Data shows that HIV rates are 2.5 times higher for Hispanic women and 11 times higher for Black women than for non-Hispanic white women. Meanwhile, only about 11 percent of Hispanic women have heard of PrEP. “That is the reality we are confronting,” says Dr. Cianelli, principal investigator on two National Institutes of Health (NIH)-funded studies examining potential barriers to PrEP use among minority women in Miami-Dade County, where HIV infection rates are historically high.

The studies respond to EHE and were funded through the Miami Center for AIDS Research (CFAR) at the University of Miami’s Miller School of Medicine. Dr. Cianelli’s first PrEP study—one of just seven the NIH selected nationwide in 2020 to help reduce PrEP use barriers among heterosexual women—focused on Hispanic/Latina women who are cisgender (that is, who identify with their birth sex). That study and her current investigation—SEPA+PreP: An HIV Prevention Strategy for Cisgender Heterosexual Black Women (CHBW) to Access, Initiate, and Sustain Use of PrEP—build on a culturally tailored behavioral-change strategy known as SEPA. An acronym for Salud, Educación, Prevención, y Autocuidad (Health, Education, Prevention, and Self-Care), SEPA employs group discussions and role-playing to empower low-income heterosexual Hispanic women to negotiate condom use and better communication with male sexual partners.

Dr. Cianelli explains that a community based approach and recognition of social and structural determinants of health are key to her efforts to decrease health disparities and inequities among Hispanic and Black women. She and her co-investigators—SONHS associate professors Drs. Joseph De Santis and Giovanna De Oliveira, and Miller School of Medicine professor Dr. Jose Castro—collaborated with local women, health care professionals, and community organizations such as MUJER in south Miami-Dade to ensure a culturally appropriate adaptation of SEPA that would increase PrEP use among Hispanic women. Preliminary data showed that not only did study participants have little knowledge about HIV and AIDS, none knew of PrEP prior to the study. After evaluating the proposed intervention, participants expressed that PrEP would be excellent for preventing HIV in a “machista” (sexist) culture, where men do not want to use condoms. “Adding this biomedical component to SEPA will give at-risk women another possibility besides condoms to prevent HIV,” says Dr. Cianelli.

For the new study, SONHS faculty Drs. Renessa Williams and Regine Reaves have joined Dr. Cianelli’s existing roster of co-investigators. Over the next two years, this expanded research team will assess sexual risk behaviors, social determinants of health, cultural norms, and stigma among CHBW ages 18 to 49 who live in south Miami-Dade’s Homestead and Cutler Bay communities. “This study has the potential to bridge the gaps among research, practice, and policy by building a knowledge base that will allow us to adapt/refine SEPA into SEPA+PrEP as an effective HIV intervention for Black women,” says Dr. Cianelli. “This knowledge will be crucial for public health, for the overall well-being of the women and their families, and for informing future interventions addressing HIV testing and PrEP uptake.”