PrEP is an effective method of preventing HIV that is available and can be affordable to most people who want to use it. But not everyone at risk for HIV knows about it, and many people who could benefit from PrEP believe it’s not for them.
A recent panel discussion hosted by New America Media and the San Francisco Department of Public Health explored this very issue with six representatives working in the field of HIV prevention in San Francisco.
Speaking about their work and the diverse communities they serve, the panelists shared some of the important barriers that people of color, trans women and young people face related to PrEP knowledge, access and adherence.
Who is PrEP for?
Panelists highlighted the lack of diversity in PrEP campaigns and advertisements that lead groups of people to conclude that PrEP isn’t an option for them.
“PrEP is for everyone, because HIV affects everyone,” said Tapakorn Prasertsith, HIV prevention program supervisor at API Wellness. “It’s not just for men who have sex with men. But, our communities don’t feel represented at all.”
Some trans women, said Prasertsith, are confronting stigma because early PrEP research lumped trans women into categories with men who have sex with men.
“PrEP has been presented as a ‘gay drug,’ and trans women are [referred to] as gay men. Representation has been a real struggle,” said Prasertsith. “A lot of trans women I work with will say, ‘I’m not a sex worker so I don’t need PrEP.’ So this is another stigma we’re fighting.”
Terrance Wilder, the DREAAM Project program coordinator for San Francisco AIDS Foundation, emphasized that promotional campaigns for PrEP have not visually represented people of color in an authentically visual way. People of color, women and trans people may not think that PrEP is an option for them if they don’t see people who look like them in PrEP promotional materials.
Jorge Vieto, a health systems navigator at GLIDE Foundation, works with clients who are marginally housed, who stay at shelters, who live in encampments or are recently released from jail.
One barrier, said Vieto, is that many people they work with don’t know that PrEP is available. “We also realized that most people had the misconception that PrEP wasn’t for them. PrEP uptake in San Francisco has primarily been by white gay men. When I talk to the populations I serve, they don’t see themselves in advertisements. They don’t see themselves in prevention efforts.”
Jorge Zepeda, manager of Latino Programs at San Francisco AIDS Foundation, said that it’s important for media campaigns promoting PrEP access to realize that Latinos and Latinas are not all the same. And, that there are important distinctions between Latinos born in the U.S. and those who are immigrants.
“[Realizing this] will help us understand the needs, and how we are going to support our community,” said Zepeda. “We are a beautiful, diverse group of individuals. We may share a language, we may share a continent. But we are also unique. Talk to us.”
Although access to PrEP or patient assistance programs does not require proof of residency, this is a common concern for people who are wary of accessing social services for this reason, said Michael Barajas, a PrEP navigator at the San Francisco Department of Public Health.
“This is something I have to stress to people I communicate with,” said Barajas, who serves Spanish-speaking clients in the Mission neighborhood of San Francisco. “We let them know it [residency status] doesn’t matter. We can still get them access to medication.”
Competing life concerns
The panelists all agreed that competing life concerns are a significant barrier to many people in the communities they serve.
Denny David, deputy director of LYRIC, said that it’s difficult for marginalized young people to think about taking care of their health when they feel systematically disconnected from institutions including school, religious communities, places of employment and health care.
“PrEP is more than just popping a pill,” said David. “It’s about an entire shift in point of view. It’s a sign of, I’m taking a step or stand for my self-worth. And it’s about envisioning a future self where you’re alive, happy and loved.”
LYRIC serves many youth clients who are people of color, immigrants and transgender or gender non-conforming. Many are homeless or marginally housed, and the percentage of clients experiencing homelessness is increasing every year.
“When you don’t know where you’re sleeping at night, remembering to take a pill is challenging,” said David.
Wilder, from San Francisco AIDS Foundation, expressed this same concern about the young men of African descent he sees in the DREAAM program.
“If you don’t know where you’re going to lay your head at or where your next meal is coming from, or if there are things going on in your family, it’s going to be hard to think about the daily discipline of taking a pill every day,” said Wilder.
Learn more about PrEP & find PrEP services
PleasePrEPme.org is a website linking people seeking PrEP services to PrEP providers across the U.S. The site includes a searchable directory (by state, zip code or street address) for users to find PrEP clinics and PrEP clinicians with hours, contact information and health insurances accepted for each listing.
San Francisco City Clinic offers free and low-cost sexual health care to people in the Bay Area regardless of immigration or insurance status. They offer same-day PrEP enrollment during drop-in hours:
Monday, Wednesday, Friday: 8 am – 3 pm Tuesday: 1 pm – 5 pm
For trans people, San Francisco City Clinic offers PrEP services by appointment Thursdays from 8 am – 11 am or during the drop-in hours.
San Francisco AIDS Foundation offers free PrEP services at Strut (470 Castro Street in San Francisco) and at their main office (1035 Market Street in San Francisco). Find more information and make an appointment online.
The CDC offers more info about PrEP and videos about this HIV prevention option.
Prepfacts.org provides FAQs about PrEP and other PrEP info.