In the South, Preventing HIV Among Black Women Starts at the Salon

At the Wize Guy barber shop and beauty salon in New Orleans’ Mid-City neighborhood, three barbers are at work edging up their male customers. On the other side of the salon, a hairstylist works on a female client’s weave while three other women wait their turn.
It’s these women who Catrina Coleman, a health educator for the local nonprofit CrescentCare, is trying to convince to get on PrEP, a category of preventative drugs designed to stop the spread of HIV. Wize Guy is one of a dozen or so salons around New Orleans that Coleman visits in her outreach to women and their stylists about HIV and how to avoid it.
On this day she also turns her attention to one of the men in the shop, who’s taken his young son in for a trim. He tells her he doesn’t need to be on PrEP. Why not, she asks. His response: “Because I’m not gay.”
It’s an answer she’s heard before. For years — decades, really — sex education around these parts has been mostly limited to lectures on abstinence as the only way to prevent STDs, pregnancy and AIDS. And with that has come a myriad of misconceptions around how HIV is transmitted and who is most at risk.
“I can’t tell you how many times people come up to me and say that they’re not a certain type of person, so they don’t need to be on PrEP,” Coleman tells NationSwell. “It’s that level of education we’re dealing with.”
Her outreach efforts are sorely needed, especially in Louisiana, where the state’s two largest cities — New Orleans and Baton Rouge — have ranked in the top five of U.S. metro areas for new HIV transmissions for 10 years running. Some of the infection rates rival those in sub-Saharan Africa, according to the World Health Organization. Though Southern black men who have sex with other men continue to be the most vulnerable population, women make up a quarter of all HIV diagnoses in New Orleans. What’s more, black women living with the virus in the city outnumber their white female counterparts by nine to one.
As a result, CrescentCare and Coleman have turned their attention to the city’s beauty salons, where a lot of black women go to discuss everything from politics to their health issues and family life. The shops operate as de facto community health centers.
“In the black community, women go to their hairstylists for advice, and that’s where they’re also getting their education on health,” she says.

A health care center in New Orleans is making it easier for black women to get on the HIV preventative drug known as PrEP by meeting them where they often gather: at the beauty shop.

So multiple times a month, Coleman goes to a dozen different salons and sets up a table with fans, pins, condoms and lube, and talks to the barbers, stylists and their clients about the importance of pre-exposure prophylaxis, or PrEP, known in the U.S. by the brand name Truvada.
She has her work cut out for her.
“We’ve had PrEP since 2012, and in certain populations, we’ve seen pretty good reductions, but nationally we are basically status quo. It’s as if PrEP didn’t exist,” says James Krellenstein, co-founder of the activist campaign PrEP4All. “This is a situation where a public health response will work. But there needs to be push to do it — just like we did with polio.


Truvada, available by prescription, has the ability to reduce the risk of HIV infections in at-risk people by more than 90 percent for those who take it daily. It’s been hailed as a miracle drug, but actually getting the pills can be prohibitive for many. Truvada is expensive; a year’s supply costs close to $20,000 without health insurance.
HIV already disproportionately affects poor communities across the South, and the price of the drug is keeping it out of reach of those who need it most. Consider that just 30 percent of PrEP users are Southerners despite the fact that the region makes up more than half of all HIV diagnoses in the U.S. And that’s a hard pill to swallow, especially in light of a recent study that confirmed HIV diagnoses are declining in states with the highest use of Truvada; the inverse is happening in states with the lowest use.
Though it was originally developed to treat people who already had HIV, Truvada is also incredibly effective at preventing the disease. A combination of the antiretroviral drugs emtricitabine and tenofovir, the pill works by forming a barrier around the cells targeted by HIV, which then stops the virus from replicating inside those cells. The medicine doesn’t stay in a person’s system for long, so taking it daily is crucial to its success. Since the drug was approved for preventative use, there have been only two known cases of HIV transmission in Truvada users.

                 “Now that HIV has moved south, your

                 risk is really about place. Simply living

                 in New Orleans, you’re at risk.” 

Initially, only a few thousand people took the drug, which is manufactured and sold by Gilead Sciences. That rate soon spiked, with a 523 percent increase in Truvada users between 2012 and 2015. The overwhelming majority of Truvada takers are male; women make up an estimated 7 percent of all users. As the pill’s popularity skyrocketed, so has its sticker price, jumping by 45 percent since it was introduced. That translates to nearly $2,000 for a 30-day supply (Gilead does offer coupons and waives up to $7,200 of copay costs per year).
The CDC has determined that those living below the nation’s poverty level, currently set at $25,100 for a family of four, have the same risk of contracting HIV as people in Ethiopia and Haiti. The issue is even more acute in New Orleans, where more than a quarter of residents live in poverty.
“If there is any example of the dysfunction in the American pharmaceutical system, it is this case,” Krellenstein told NPR in June. “We have the most effective tool for ending the HIV epidemic, and one reason we’re unable to scale up is because it costs so [much] unnecessarily.”
PrEP4All, the activist group Krellenstein co-founded, has been targeting Gilead’s pricing structure through its #BreakThePatent campaign to open up the U.S. market to generic pills. By its estimation, the company has inflated the cost of Truvada by a whopping 25,000 percent.


“HIV used to be a virus where your sexual tendencies or lifestyle was a determining factor of risk, but that’s just not the case anymore,” says says Julia Siren, a nurse practitioner at CrescentCare, which focuses on HIV care, particularly for New Orleans’ poor communities. “Now that HIV has moved south, your risk is really about place. Simply living in New Orleans, you’re at risk.”
And it’s not just geography and poverty that black residents are up against. Funding for marketing PrEP to women has lagged behind that of campaigns for men. The CDC’s grants for AIDS organizations limits funding to address only the most at-risk populations: black men, intravenous drug users and men who have sex with other men. In addition, primary care providers such as OB-GYNs often don’t even know about the drug.
Women here believe that PrEP is designed solely for men, because that’s what the majority of the marketing says. Radio ads and TV spots and billboards on buses — nearly all show “pictures of males using PrEP,” says Veronica McGee, director of Brotherhood Inc., an AIDS nonprofit that focuses on getting members of New Orleans’ black communities tested and aware of their status. “All of our funding streams are male-specific. There are no funding streams for major PrEP programs or interventions geared toward women.”
“We have so many people who think they just can’t get HIV,” Coleman says from her office at CrescentCare, which is just up the block from the Wize Guy salon. “People still think that the only people getting the virus are gay men. They just don’t see it as an issue to be educated on.”
There is one bright spot in CrescentCare’s mission to inform women of their HIV risks. The organization uses geofencing when marketing PrEP to Facebook users who are clients of the same salons Coleman visits. They’ve found that women, especially, are clicking on ads more often and visiting CrescentCare for services. In the first 10 months of 2018, CrescentCare’s social media advertising has translated into more than 3,000 people seeking out their services in the real world.
“Even if we get one person on PrEP, it makes a huge difference,” says Coleman. “That’s one more person protected, and that’s one more dead end for this epidemic.”

This is the first installment in NationSwell’s multimedia series “Positive in the South,” which explores the HIV crisis in the Southern U.S., and profiles the people and organizations working to alleviate it.

Where Does the YWCA Go From Here?

After the YWCA of the City of New York sold its uptown Lexington Avenue headquarters — its home for nearly a century — and moved downtown in 2005, the organization was looking to reinvent itself. Enter Danielle Moss Lee, a former teacher and administrator with a doctorate in education and decades of experience in nonprofit leadership. After taking the reins as the YWCA’s CEO in 2012, Moss Lee expanded the nonprofit’s after-school and summer programs while redoubling efforts to reach out to girls of color in underserved neighborhoods. NationSwell spoke with Moss Lee about the new direction for a 158-year-old charity at the YWCA’s headquarters in Lower Manhattan.
What’s the YWCA’s biggest need right now?
Ensuring the future sustainability of the organization. We’ve been out of the game for a little bit. How do you make something that’s 158 years old new again, so that people care about it and want it to continue, in terms of manpower, woman-power, volunteerism? We’ve got 2,500 kids whose lives we hope to impact in some way. It’s not all the kids in the city, but we can do our best to do our part.
What innovations in your field are you most excited about right now?
I like the questions that young activists are asking, because it positions us for a different America. We can say without a doubt that all of our lives have been materially and visibly changed by the civil rights movement. But now we’re addressing issues around institutional and structural racism that I don’t think prior generations fully understood: Health services, education, the police and the banking system all really conspire together to advantage some and disadvantage others. I’m excited about these new movements. Protesting and social media campaigns are important. I hope that, at the end of this, the way we live and experience our daily lives will be similarly transformed like they were with desegregation and all of the access and opportunities that civil rights opened up.
What’s the best advice you have ever been given on leadership?
The best advice I’ve gotten over my career was to be someone that I would want to follow myself. It’s been important advice because it’s made me more conscious that who I am and how I show up is really important to the people around me when I’m in a leadership role. It keeps you honest and conscious.
Where do you find your inner motivation?
It’s always different, but one thing I think about is all the kids I’m not serving. I hear lots of folks in this sector say of college-access or girls’ programming: “We have 200 girls” or “We have 1,000 girls,” whatever the number is. But then when I think about how many girls actually live in this city, that’s what keeps me going.
Years ago, I was teaching a graduate course on urban youth policy, and one day the discussion got really personal. A young woman getting her master’s degree told this story of how her family’s apartment had burned down in Brooklyn. At first, friends and family were willing to house them. As the months dragged on, they went into a homeless shelter. At some point, her mother, in a desperate attempt to provide for her kids, made the decision to join the Armed Forces. The student said, “Do you realize we lived in that shelter with no adult and nobody noticed?” And then she said, “I didn’t know that there were middle-class black people. I didn’t know for a long time that something else was possible for my life.” A lot of mentoring is focused around Manhattan. Let’s be real, people aren’t going out to Coney Island (where the YWCA has programming) or other far-flung Brooklyn neighborhoods like Flatbush, East New York and Brownsville. It’s always at the convenience of the volunteer, but that’s not necessarily where the greatest need is. I can always recall that student’s voice asking, “Where were you?” — to which I didn’t really have an answer. She said, “All these civic organizations are always talking about all the work they do in the community, but I never saw them.” Nobody asked her if she wanted to go to college. That’s our job.
What’s on your nightstand right now?
Collaborative Intelligence: Thinking with People Who Think Differently” [by Dawna Markova and Angie McArthur]. It’s really about how you develop teams with people who just think differently. I started to think about this because there’s been a lot of emphasis in some new progressive nonprofits in the sector around organizational fit and building a specific kind of culture within their organizations to drive results. There’s a value in that. But a lot of those organizations have challenges around having a diverse staff.
I was listening to two managers have a semi-debate. A young white woman was talking about two of her staff members: Her white staff member was really great with data, Excel spreadsheets and metrics — things she really valued — but this staff person wasn’t as good at relating to young people and doing outreach to families. And so while the person of color was much more relatable with the young people in the organization, it was almost like her skill set wasn’t seen as a value. We all operate predominantly with different sides of our brain. How can we tease away some of the judgment that comes with very different strengths and make sure that we’re not using this idea of “fit” really to only work with people who look like us, share our experiences and perspective? You’re probably not growing if everyone agrees with everything you say.
What’s your perfect day look like?
No bad news, and a big check in the mail — in that order.
What’s your proudest accomplishment?
I recently had the opportunity to have a reunion with students I previously worked with at another organization. First of all, to see them now as college-educated adults and hear all the amazing things they were doing was a reward in itself. Back when I was working that job, I was also raising my daughter and going to graduate school. I remember one of those kids saying, “I didn’t know anybody else who had a doctorate. When I came into your office and saw your degrees on the wall, I knew I couldn’t just get a bachelor’s. Tell me: What do you have to do to get a master’s degree? What’s a dissertation?”
I’m just blown away by the number of students, many first-generation college students, who have graduate degrees. That changes not just the trajectory of their lives, but also their families’ for years to come. It was nice to know that I had that kind of impact.
To learn more about the NationSwell Council, click here.
Homepage photo courtesy of YWCANYC.

When These Low-Income Women Needed Help, They Found an Answer in Each Other

For all the recent innovation and developments in technology and more, it’s easy to forget that some of the best ideas for solving national challenges are relics of the past.

That’s the case with Black Women’s Blueprint, a network for women to barter for goods and services that also runs a sou-sou, or money pool, an ancient savings technique through which the members of the pool each contribute a monthly amount of cash and take turns receiving the lump sum. Through this service, Black Women’s Blueprint strives to elevate the lives of black women socially and economically.

The group is run by Farah Tanis, a woman who has spent her life helping people, from working with refugees living with HIV in New York City to serving on the board of Girls for Gender Equity, an organization that seeks to provide comprehensive development to girls and women. These roles, combined with her many projects focused on combatting domestic violence, led her to be named a U.S. Human Rights Institute fellow in 2012.

“Through our barter network we were able to barter food for the week, for a car ride for the week, and that’s what sustained many of us,” Tanis said on a panel discussion sponsored by GRITtv. “It prevented homelessness, starvation and kids being left at home alone by themselves. The barter network builds community and it builds trust.”

Tanis told Laura Flanders of Yes! Magazine that the idea came to her when she was talking with a group of low-income women about the challenges they faced. “Most of us had grown up in poverty and we started looking at what were the systemic causes of poverty for us. We started looking at economic security as a human right and an extension of the Civil Rights.”

As Black Women’s Blueprint’s barter network proves, sometimes the best ideas are the old ones.

MORE: Here’s How An Ancient Banking Technique Can Help America’s Poor


When Nobody in Technology Looked Like Her, This Woman Did Something About It

Kimberly Bryant’s daughter was never “a girly girl”—instead she was interested in computer games, and aspired to become a game tester. Instead of just setting her daughter up with the latest gaming equipment, Bryant challenged her. Why not become a game developer instead of a tester? When she was studying electrical engineering in college, computers intrigued her, but none of the other people studying computing looked like her, a black woman, so she didn’t pursue that path. Bryant didn’t want the same discouragement to happen to her daughter. Two years ago she established Black Girls Code in San Francisco to introduce technology and software engineering to this generation’s girls. In this video sponsored by American Express, Bryant explains her mission and shows some future technology leaders in action. Black Girls Code has now expanded to eight cities and counting, so get ready for the next generation of software engineers.
Source: YouTube