Imagine discovering the promise of pre-exposure prophylaxis (PrEP) for the first time and determining that it can lower your risk of becoming HIV positive. You get up the nerve to go to your primary care physician and ask him or her if you are a candidate for the treatment, and your doctor either dismisses your question or, even worse, has no idea what PrEP is.
That’s a problem that some in the Miami-Dade County community—which includes Miami, Hialeah, Miami Beach and other areas—are facing. “When we have meetings with members of the community and start talking about PrEP, some of them are saying their private doctors are not familiar with it, and sometimes they’re educating the providers,” says Kira Villamizar, public health services manager for the Florida Department of Health in Miami-Dade County. For Black Americans who often have less access to health-care services than other groups, this lack of knowledge among medical providers is particularly troubling.
Luckily, Miami-Dade County’s health department isn’t taking that lightly.
Getting to the Root of the Problem
The challenge with physicians is twofold, says Susanne Doblecki-Lewis, M.D., an infectious-disease specialist in Miami who is working with the Florida Department of Health in Miami-Dade County to lessen the grip of the region’s HIV/AIDS epidemic.
Many physicians don’t know about PrEP, so that’s a knowledge gap that needs to be corrected, Dr. Doblecki-Lewis explains. However, in some cases providers are simply reluctant to address sexual-health issues. That means they don’t talk to their patients about whether they might benefit from PrEP or ask them questions about their sexual behavior, so these patients may never know the option even exists.
The Florida Department of Health in Miami-Dade County is committed to training and educating physicians so that they can be more knowledgeable and comfortable talking to patients about PrEP. “Making sure providers are educated and supported to provide PrEP in their practices is very important, but I don’t have the illusion that we’re ever going to get to the point where 100 percent of primary care providers are comfortable and appropriately providing PrEP to all of their patients who are at risk,” Dr. Doblecki-Lewis says. “So the other part is having these visible clinics or sites where it’s well-known that you can safely, without stigma, get what you need.”
A Mandate From the Top
The mission to spread knowledge and access to PrEP is not one that Miami-Dade takes lightly. The Florida Department of Health, which the county health departments (including the Florida Department of Health in Miami-Dade County) report to, came up with a plan to eliminate HIV transmission and reduce HIV-related deaths. PrEP is one of the key strategies, so counties such as Miami-Dade are looking at ways to inform residents about it. “That’s why it’s so important that PrEP services are available in the community and that we build capacity,” Villamizar says.
Also, Mayor Carlos A. Gimenez of Miami-Dade County recently convened a task force with the purpose of creating a blueprint of recommendations that would help eliminate HIV in the region; one of those recommendations was to increase the utilization of PrEP, Villamizar says.
The Florida Department of Health in Miami-Dade County is complying with the recommendations in a number of ways that can help Black communities in particular:
· The PrEP clinic run by the department has PrEP navigators who are able to get PrEP at low or no cost for members of the community, Dr. Doblecki-Lewis says.
· The department is attempting to expand the reach of PrEP in all parts of Miami-Dade by building relationships with partners in the community, such as hospitals and urgent-care centers, in hopes that they will offer PrEP.
· The outreach is mindful of racial, ethnic and linguistic differences, ensuring that people of all communities receive information in a way that resonates with them.
One reason the effort in Miami-Dade has been so successful is that the Florida Department of Health in Miami-Dade County is committed to including representatives of every race, ethnicity and social class in the fight against HIV/AIDS. The health department has invited members of the community and health-care providers to come to the table to talk about the challenges of getting PrEP out to the community, as well as possible solutions, Villamizar says. “When you bring the community [together] and you work in collaboration and in partnership, you can make it happen. That’s the way we move the agenda forward.”
Tamara E. Holmes is a Washington, D.C.-based journalist who writes about health, wealth and personal growth.