While the study itself is the work of Dr.’s Randolph and Johnson, the idea of a formal training for stylists as conduits for HIV/AIDS prevention education actually came from stylists themselves. “In fact, providing continuing education units from the state board of cosmetology for the training was the idea of two beauty salon stylists who served as consultants on this project,” says Dr. Randolph. “In our formative work we conducted focus groups and individual interviews and stylists told us that conversations around sexual health and relationships were common in most beauty salons, which the literature has supported for some time now.” 

Beauty salons have long been important community resources for Black women, and stylists are considered trusted leaders. By enlisting the stylists in the fight against the negative perceptions of PrEP, Dr.’s Randolph and Johnson were able to bypass barriers to reaching Black women and meet these women where they are most comfortable and receptive to intimate conversations and receiving new information.

The stylists went through two 2-hour workshops on HIV, PrEP, and infection control as well as training on how to be community opinion leaders. After that they were given signage to display in their salons in order to spark conversations around HIV/AIDS prevention. “Stylists were very receptive to the workshops,” says Dr. Johnson. “There was lively discussion and a lot of questions about HIV transmission, PrEP as prevention, and other sexually transmitted infections as well.  Stylists had the opportunity to practice communication with each other using case-based scenarios. They were really willing to learn from each other’s communication styles and develop their own comfort level.”

On the receiving end, 105 women from three urban counties in North Carolina were recruited into the study. Of those women, 72 (69%) completed the pretest survey, with 44 of them (42%) going on to complete the post-test survey. Dr.’s Randolph and Johnson found that among the women who had been unaware of PrEP prior to the study, knowledge of PrEP and HIV/AIDS prevention increased significantly, as did their views on use of PrEP itself. Intention to use PrEP changed for 15 of the participants in the study, with 1 participant going on to begin PrEP usage and another 10 indicating that they had moved from “precontemplation” of use to “contemplation” as characterized by the Motivational PrEP Cascade. Perhaps most importantly, the study indicated that a majority of women were able to personally relate to the messaging around PrEP, a vital step in making PrEP stand out as an option in protecting their sexual health.

“I think the main thing that stands out to me is the excitement from women in seeing themselves in a storyline that provided for them information about PrEP,” Dr. Randolph points out. “Women customers consistently reported, ‘I didn't know this was for women; I saw commercials about it but never knew it was for me.’ This reinforces the urgent need to include Black women in the development of health communications and messaging for HIV prevention.”

For the pair, this study was a vital tool in furthering Duke University School of Nursing's commitment to advancing health equity. “In the context of PrEP as a prevention tool for HIV, there are multiple known social determinants of health and barriers that contribute to why this population has less than 2% usage of PrEP - accessibility, trust, providers not informing them of its use, cost, stigma, just to name a few,” says Dr. Randolph. “We have developed with Black women implementation strategies that try to address all of the barriers.”

“And we didn't do it alone,” she adds, “this was a community-partnered project that considered real-world delivery and sustainability. Two components that are critical to addressing equity.”

Dr. Johnson agrees. “I see this as an exemplar of Duke University School of Nursing's goal of advancing health equity,” she says. “HIV has had disparate outcomes in the Black community for far too long, and Black women especially have not been prioritized. Partnering with Black women to design a project that they wanted, enjoyed, and were willing to lead and share with others is exactly the format to advance health equity.”

A synopsis of the study can be viewed on the New England Journal of Medicine’s website.