Congratulations to Schenita Randolph, assistant professor, and the entire research team for the award for their proposal to Gilead Sciences, Inc. entitled: “A Salon-Based, Multi-level Intervention to Improve PrEP Uptake Among Black Women Living in the United States South." The award is for a three-year period with a start date of August 1, 2020. 

Overview, aims

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy, yet uptake remains low among populations at risk for HIV in the United States, especially among Black women living in the southern region of the U.S. Black women comprise only 13-percent of the U.S., but account for nearly two-thirds (64%) of new HIV infections among women in the U.S. Also, individuals living in the U.S. southern states are at highest risk of acquiring HIV. Although PrEP has been found effective in preventing HIV if taken consistently, the use of PrEP among Black women is quite low. The barriers for PrEP uptake among Black women in the south are complex and warrant a multi-level approach to address the complexities involved. Lack of awareness and knowledge of PrEP, social stigma associated with HIV and mistrust of medical professionals have all been identified as barriers to PrEP uptake. Although traditional educational interventions have been developed to increase PrEP uptake, education alone does not change behaviors. Interventions have had more of a focus on men who have sex with men, have been limited to a focus on the individual level and have had little influence on social stigma and medical mistrust. Thus, the purpose of this study is to develop and test a multi-level, beauty salon-based intervention that will increase PrEP awareness and knowledge and improve social stigma and medical mistrust, which will ultimately increase the uptake of PrEP among Black women living in the U.S. south.

Multiple studies have explored awareness and knowledge of PrEP among women in the U.S. For example, A.S. Patel and colleagues [8] found that among 225 women living in the U.S. south, 72-percent were PrEP eligible. However PrEP awareness was extremely low with only 11-percent of women ever hearing about PrEP. Signage campaigns have been used, such as “Ask Me about PrEP” in clinical settings among providers, but little research has linked its effectiveness to PrEP uptake among this population. Additionally, multiple studies have explored the types of messaging women prefer to receive; however, it is still unknown if and how and whether these preferred messages improve uptake of PrEP.

Women have reported social stigma in their own attitudes towards PrEP and HIV and within their social networks when talking about PrEP and HIV. Several studies have reported that women may not take PrEP because of fears that family or friends might assume that they were taking medications because they were living with HIV. This perspective in consistent in the literature and provides evidence that social support from one’s social networks plays a crucial role in determining women’s decision to start PrEP. To this end, leveraging the social networks of Black women in trusted environments such as the beauty salon should be considered to improve social stigma. Salons and stylists provide a unique opportunity for women to increase awareness to PrEP, not only for themselves, but for networks of women that they associate with and influence. In a preliminary study conducted by the PI (Randolph) with Black women customers who frequent the salon, salon owners and hair stylists’ results indicated that, across all subgroups, a salon based intervention to promote awareness and uptake of PrEP is feasible and acceptable [10]. Women in our study provided input on content and mode of delivery for PrEP information with the use of technology (i.e. iPads, text messaging, email) being recommended. The use of technology-based approaches also has the potential to effectively target a larger number of individuals at a relatively low cost.

Black women in the south have a long history of medical mistrust that impacts their trust in the health care system and with PrEP. One way to link Black women with medical providers and PrEP is through the use of a PrEP Navigator who is linked to trusted environments which women commonly frequent- such as beauty salons. Using the socio-ecological framework as a guide, this study will use a multi-level approach (individual, interpersonal, community, systems level) to address the complexities associated with PrEP uptake among Black women in the south.

Thus, the specific aims of this study are to:

• Aim 1: To develop and test the preliminary effects of a multi-level, salon-based intervention on social stigma associated with PrEP, medical mistrust, and awareness, knowledge and uptake of PrEP among women.

• Aim 2: Evaluate the acceptability and usability of the intervention through think-aloud protocol as women customers navigate components of the intervention and individual interviews with a subsample of women customer participants and stylists.