Lisa “Left Eye” Lopes made condoms a part of TLC’s signature style back in the early ‘90s. The girl group’s mission was twofold: to encourage young women to carry their own condoms and to spread the word about safer sex, especially during the first wave of the HIV/AIDS epidemic. Nearly 30 years later, their overall message to Black women is just as relevant — but alone, it’s not enough.
“A condom cannot save people from the structural factors that make them vulnerable to HIV infection,” says Dr. Keosha Bond, assistant professor of behavioral science and health promotion at New York Medical College in Valhalla, New York. “Education, access to care, poverty, racism, and discrimination are issues we have not solved in this country; therefore, the challenges that the most marginalized populations face are still present.”
A 2019 study by the Centers for Disease Control (CDC) showed that despite declines in HIV infections among women as a whole, Black women’s rates of diagnoses are still higher than white and Latina women.
“You need to take an intersectional approach to addressing HIV risk,” says Dr. Bond. “[Black women] are not monolithic … [our] sexual decision making is influenced by multiple factors, which include peers, partners, medical providers, and community. And Black transgender women face an added layer of discrimination and stigmatization because of their gender identity.”
One such organization pushing the conversation around HIV/AIDs to be more intersectional and inclusive is the Sankofa Collaborative, a national network of African-American and Afro-Latino health professionals and researchers. At their annual A Paradigm Shift conferences, presenters tackle everything from Black women and historical trauma to transgender health equity to action plans for the future, and more.
Nicole Roebuck, executive director of AID Atlanta and a Paradigm Shift conference speaker, says more access to programs and educational services is one necessity that can help Black women feel more comfortable with their bodies and how they work, starting at a young age.
“Break down the patriarchal barriers,” she says, explaining many women she encounters at AID Atlanta have experienced trauma. And since the healthcare system is very heavily male-dominated, some women may not feel comfortable in that perceived power dynamic. She suggests having small gatherings at friends’ houses to start a healthy dialogue about sexual wellness in a more relaxed, non-intimidating, non-shaming environment.
“I think it starts with each and every one of us who are in positions [that can help],” Roebuck says. “It doesn’t have to be big or from the government. We can do it amongst ourselves. Have those conversations … that’s how Black women relate, on a more intimate level.”
It’s in these intimate settings, away from biases of the outside world, that Black women can feel free to be their most authentic selves and dive into important discussions about how culture and society may impact their health decisions and how, going forward, things can improve.
“Black women tend to take care of everyone else ahead of themselves,” says Roebuck. “[We] put our healthcare last.” Dr. Bond cosigns this sentiment: “[Often,] Black women are taught not to prioritize their needs or [to] minimize their sexuality because they face stereotypes of being labeled as promiscuous or hypersexual.” Such labels and adultification can begin as early as preschool and have roots in slavery.
A 2018 study by The National Women’s Law Center, explained “Black girls … face adults’ stereotyped perceptions that they are more sexually provocative because of their race, and thus more deserving of punishment for a low-cut shirt or short skirt. Girls who are more physically developed or curvier than their peers also may be viewed as more promiscuous by adults.” So, it stands to reason that simply telling Black women and girls to wear condoms or alter some other individual behavior without taking into consideration the myriad variables that play into their sexual health choices isn’t going to be that helpful in reducing their risk of HIV.
“Most of the sex education that is available to young people is grounded in a risk-reduction framework but neglect the context of their lives by reinforcing oppressive gender ideologies,” says Dr. Bond. “We cannot limit HIV prevention to only one aspect of a person’s life. We need to focus on the whole person and what contributes to their well-being … I want to move beyond disease prevention and focus on sexual health and health equity.”
This isn’t to say that hip-hop culture has no place in helping spread awareness of HIV. In fact, what it may do best is help women feel empowered about their own sexuality — and an empowered woman is a woman more likely to put herself first.
“The best way to improve interventions for Black women is to include Black women,” says Dr. Bond. “We need to stop talking at Black women about what they need to do, and start supporting them in addressing the barriers that heightened their vulnerability.”