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Why women can consider using PrEP as a part of their sexual health self-care

Why women can consider using PrEP as a part of their sexual health self-care

Juddy Otti of Africa Advocacy talks with us about her work with Black African communities and PrEP and outlines what we can do to give people the information, help and support they need.

 

HPE

What are the things that you would want Black women to know about PrEP that we're missing out on telling them?

Juddy Otti

What do I think are the barriers? There are three main umbrellas I’d put it under:

Firstly, it’s the individual level, because we know of the really low awareness levels in women about PrEP.

Secondly, it’s the interpersonal perceptions of what is associated with PrEP.

Unfortunately, PrEP has a negative connotation to it. somehow it means you either have so many sexual partners or you’re very mischievous in your life… we need to put a positive spin on PrEP, that actually PrEP is something that puts you in control. It's something we can take to the level of self-care.

Then the last one is how do we address the structural issues around access?

We should look at accessing PrEP outside of GUM clinics and that we have to look at how we take it outside of there and put it into the community, in GP services or in pharmacies or you know, like the US is doing in vending machines.

HPE

For many women the question is ‘Why would I need it, I'm in a long-term monogamous relationship?’

Juddy Otti

The idea of that thinking that if you have many sexual partners, you need to think about PrEP may not necessarily be applicable. How do we understand the situations? I know that women may have one sexual partner who themselves has other partners. So how do they understand what that means to them in terms of their perceived risk?

It could be migrants who are transferring from one area to another, and in the hotel where they are, they have a sexual partner and then they move on.

A lot of migrants come from polygamous families, which is anormal situation for them. So, for us to then call it [having multiple partners] a riskmakes it a negative thing. How do we actually say, you know, do life, but do it safely?

The message people have responded to is ‘actually you can do you, just with PrEP’. I think it's actually a very good approach, especially for heterosexual men to understand that I'm not stopping you from doing what you're doing, but do it safely, and you can do it safely in these ways.

[For] Women who think, ‘I only have one or two sexual partners’, we help them make it a form of self-care [so] that even though you have one sexual partner, it's just equally important that you test regularly, you use preventative methods and whether it's a condom or whether it's PrEP actually that's the best thing you can do for yourself.

HPE

Do we see the same level of resistance amongst women about carrying or using condoms that we do about being seen as using PrEP?

Juddy Otti

My approach is, it's not condoms or PrEP. I'm looking at it more around choice - look at it as your wellbeing toolbox, The conversations depend on where someone is in life. It's not one or the other. It could be that at the beginning you'll decide to use PrEP, or you will decide to use condoms, and gradually that relationship settles and you decide not to use either.

If it's a woman who is in long distance relationships, we could help her understand, actually, if you're not sure that this is an exclusive relationship, then maybe start by introducing condoms. If that is not taken seriously or you feel you can't do that, then actually you can benefit from PrEP.

Sometimes when we speak to women there is this ‘no, no, no, no. I am a Christian or I am a Muslim or I am married, that is not for me.’

We also have to acknowledge the trauma that HIV holds in Black communities.

Now, even those who may have relatives who are now living well with HIV, that trauma they experienced from relatives they lost and how they saw them die in the epidemic still affects them.

There is a mistrust in new treatments and new medications which is something we have to address, and also acknowledge that it may take longer for this particular community to embrace these messages.

HPE

Following on from that, do you think there is potential in the new technologies that people are talking about around PrEP like long acting injectables?

Juddy Otti

Certainly. If we look at contraceptive methods, there's so much choice, and the reason there's so much choice is because women are different. Their needs are different, and their needs change. I think if we can put PrEP at that level of choice we will have more uptake because then there's something different for everybody.

The other thing I’m going to say is that the Black African diaspora community in the UK is very interlinked with other diaspora communities in other countries around Europe and also with their countries of origin, and we are finding that a lot of options for PrEP that have been licenced in African countries are not available in the UK, options like the vaginal ring.

So, they're like, ‘why don’t you offer that’ and when you don’t have an understandable answer for them it then affects your credibility. You don't really want to go through the NICE guidelines with them because then you're losing them and they tell you, ‘Oh, so they also don't think it will work’ and you don't want to go down that line and explain ‘no, it's because of, you know, cost effectiveness etc. etc. I think choice is really important. It's something we need to work towards.

I think the main change with these [new] guidelines is the taking away of someone in the clinical teams being the only way of assessing your eligibility for PrEP. That you should be able to just ask for PrEP and receive it.

We really have to work towards individuals being able to make an informed decision to access and use PrEP. That comes about through education and addressing cultural competences.

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