Prevention tools exist, but stigma is still blocking Black women from using them.
Dr. Ada D. Stewart grew up in the housing projects of Cleveland, watched her mother die of preventable breast cancer and her father of preventable heart disease, and decided she would spend her life making sure that did not keep happening to people who looked like her. Today she is a board-certified family physician, a certified HIV specialist and the first African American woman to serve as president of the American Academy of Family Physicians. When she speaks about HIV in Black communities, she is not reciting statistics. She is talking about her people.
HIV has not gone away and the numbers prove it
One of the most dangerous myths circulating right now is that HIV is a thing of the past. Dr. Stewart pushes back on that directly. HIV is now a chronic disease, she says, similar to diabetes or high blood pressure, and the goal is to ensure it does not define the person living with it.
“HIV is now a chronic disease, just as diabetes, just as high blood pressure,” she said. “It’s important that HIV should not define one. You can stay healthy and not let HIV drive how you feel or how individuals look at you.”
But staying healthy requires confronting something the Black community has long struggled with. South Carolina, where Dr. Stewart practices at Cooperative Health in Columbia, is among the top 10 states in the country for new HIV diagnoses. That figure is not a coincidence. It is the result of silence, stigma and a lack of access to information.
Stigma is the barrier blocking prevention
Dr. Stewart identifies stigma as one of the most stubborn obstacles to progress. She makes the distinction between external stigma, how others judge people living with HIV, and internalized stigma, the shame a person carries within themselves.
“Stigma is how one feels about someone else, and usually it is negative,” she said. “In our communities, HIV, or just talking about HIV, is looked upon in a negative way. Even as we look toward prevention, individuals have been stigmatized and looked upon as promiscuous.”
The solution, she argues, is to reframe the entire conversation around health rather than behavior. Protecting yourself sexually is not a statement about your character. It is a statement about your commitment to staying alive and thriving.
What Black women specifically need to hear about HIV
The numbers among Black women are moving in the wrong direction. Dr. Stewart does not soften this reality.
“The numbers of Black females living with HIV are increasing, not decreasing,” she said. “The only way to remain healthy is to ensure that not only your physical and mental health is well, but also your sexual health.”
She encourages Black women to know the HIV status of the people they are sexually involved with and to take ownership of their own protection regardless of what their partner does or does not do. “You can’t dictate what someone else does, but you can care about yourself,” she said.
PrEP and PEP are changing what is possible
Dr. Stewart breaks down the two primary prevention tools with clarity. PEP, post-exposure prophylaxis, is taken after a possible HIV exposure and must be started within 72 hours. PrEP, pre-exposure prophylaxis, is taken before potential exposure and now comes in four forms, two oral and two injectable.
The injectable options are particularly significant for Black women who may not feel safe letting a partner know they are protecting themselves. One injection every two months and one approved every six months mean protection without a daily pill that someone else might notice.
“For Black women especially, you may not feel safe having your partner know you are protecting yourself,” she said. “The injectables are the best for you because no one has to know.”
She closes with a statement that leaves no room for hesitation. With this many tools available, a new HIV diagnosis should not be happening. The tools exist. The access exists. What is needed now is the decision to use them.