Tackling racism, harmful beliefs to improve Black women’s health

Many statistics about Black women’s health are grim: high rates of diabetes, heart disease and obesity. Low access to life-saving HIV prevention medication. A life expectancy more than four years shorter than white women.

There are no easy answers to such stark health disparities. But presenters at a Tuesday Annual Meeting session on Black women’s health shed light on ways to make progress, including by acknowledging the role racism plays in damaging health.

“Everything is telling us that we are inferior and we’re not as good as whites if we look at the whole of white power and privilege,” said presenter Jennifer Warren, whose research into the role of internalized racism on heart disease highlighted the damaging results of chronic stress.

“Many of us have been able to climb out, beat your way, do all kind of things to get out, to realize the full capacity of what you’re able to do intellectually and physically in this world,” said Warren, executive director of the Center for African American Health Disparities Education & Research. “But then there are others who are trapped.”

During the session, organized by the Black Caucus of Health Workers, Warren encouraged attendees to keep racism on the public health agenda.

“We need to realize that while we’re working with women on prevention, diabetes, whatever we’re working with them on, they could be dealing with internalized racism,” she said.

Two of the session’s presentations focused on how to improve access to pre-exposure prophylaxis, or PrEP, for women at risk for HIV infection. That’s a pressing concern everywhere, but especially in areas like Washington, D.C., where nine in 10 of the women newly diagnosed with HIV in 2019 were Black, said Ashlee Wimberly, program manager for the DC PrEP for Women Initiative.

A small but promising outreach program in Texas uses an iPad-based survey to help women in emergency departments both understand the benefits of PrEP and find access to the medication. Both Wimberly and Mandy Hill, director of Population Health in Emergency Medicine and associate professor at UTHealth McGovern Medical School, said PrEP use tends to be highest among white men who have sex with men despite a higher HIV infection risk for some Black women.

“There’s a mismatch between who’s most at risk and who’s using the medication,” Hill said. “We have to educate. We have to be detailed.”

Interviews with Black women in South Carolina revealed a lot about barriers to health-supporting behavior, said presenter Khristian Curry of the South Carolina Department of Health and Environmental Control.

“What we want to do is use their voices and stories to inform how we deliver care,” Curry told attendees. She and her fellow researchers highlighted a common barrier to improving Black women’s health: the “Strong Black Woman” trope that may prevent many Black women from making time to look after their own health.

“The burden of that role also led to a lot of stress and potential barriers to health-supporting behaviors for our participants,” she said. “We realized that self-care is holistic and it really means different things to different women.”

For one woman, that meant having a schedule. For another, self-care meant buying clothes and getting her nails and hair done. For another, it was setting boundaries.

Her research also found the value in linking Black women with mentors.

“Many women’s experiences with health-supporting behavior were often linked to interactions with another Black woman,” Curry said.

She plans on more research to collect and share stories that promote understanding around diabetes prevention.

“We want to shift away from taking on some of the roles and some of the behaviors that have been detrimental to our health and move more toward taking care of our bodies in ways that we may not have been able to,” Curry said. “We need continued and sustained support of positive representation and celebration of Black women.”

Photos, from top: Jennifer Warren; Ashlee Wimberly; a PrEPForHer ad used in Washington, D.C., featuring local women helps raise awareness; and Khristian Curry.