Leisha McKinley-Beach, MPH, is a national HIV expert, community mobilization trainer, and strategic planner for state HIV prevention programs.
Q: Your career is largely focused on HIV prevention in the Black community. What called you to this line of work?
I started my HIV career as a student at the University of Florida. At the time, I was not looking to focus on HIV, but I knew my focus would be on Black health. I got involved with a local student group on campus called “AIDS Peer Educators,” and the rest was history. For the past 32 years, I have been focused on HIV in Black communities, trying to do my part to eliminate stigma and ensure that communities of color have access to the same HIV prevention and treatment resources as other communities.
Q: In an interview with The Weekly Challenger, you discussed how your efforts to provide HIV resources to Black and Brown communities faced considerable pushback from a predominantly “white gay male movement.” What strategies can be used to break down these barriers, especially for HIV/AIDS advocates?
First off, we must acknowledge the structure and the legacy of “HIV advocacy.” I will never take away from the amazing contributions that white gay men provided for us as early HIV advocates. However, we must remember that there were Black advocates involved at the very beginning as well. When we tell that story, it is always through the lens of Black people being recipients of HIV services, not as being great leaders that were advocating for needs within our own communities. We also must acknowledge the structure that contributed to so many of the successes that white gay men were able to offer our HIV community. Coming from a place of privilege that opened doors, opportunities, and conversations where people of color were not invited to participate then and still aren’t to this day. We must also acknowledge that while the face of the movement has changed, the structure has not. That is part of why we are seeing difficulty in progress towards ending the HIV epidemic in communities of color versus other communities.
Q: AIDSVu just released PrEP data by race/ethnicity showing that in 2021, Black people made up only 14% of PrEP users in the U.S. but accounted for 42% of new HIV diagnoses. How can we best address these disparities in PrEP use in the Black community?
I never thought that I would be in a position where I was excited to hear that Black people represented 14% of PrEP utilization in this country. Some may not realize it, but this is an increase from where we were just about a year ago. This increase is encouraging. I must believe that community/grassroots efforts are having an impact within Black communities.
This slow uptake highlights the need for a national PrEP program. Some key components of the program should include improved infrastructure, such as increasing the number of Black-led organizations and primary care providers that prescribe PrEP. Investing in a national PrEP program that doesn’t prioritize expanding PrEP services outside of the HIV workforce structure is a disservice to Black America.
The data also highlights systemic issues such as awareness, access, and affordability of PrEP for Black communities. A national PrEP program must include strategies to address these barriers and be BRAVE enough to tackle the root cause of many of these issues, which is racism in healthcare.
Q: You mentioned that there is a lack of representation in PrEP materials for individuals assigned female at birth. How does this lack of representation impact PrEP adherence among women? How can we implement tangible solutions to better encourage PrEP use amongst women?
Women represent the majority of HIV cases globally. I don’t lose sight of that as I contribute to our HIV prevention efforts domestically. We have made amazing advances towards ending the HIV epidemic, but all populations aren’t progressing at the same rate. As there is more investment into media and marketing campaigns about PrEP, it is important that women see images of themselves in those representations.
I started a group called the Atlanta Black Women Leaders on PrEP. I founded this group because I was hearing from my colleagues in health departments, in Community-Based Organizations (CBOs), and in university settings about women not knowing about PrEP. We are 10 years into this medical advancement, and we are still struggling to raise awareness about PrEP for women. I am hopeful that the more we keep talking about PrEP—and the more we start seeing an increase in PrEP media and marketing—the more women, in all our diversity, connect with this prevention strategy being for us as well.
Q: What barriers to HIV services exacerbate problems with care for Black and brown populations the most? What can passionate stakeholders do to better support these populations?
It is important that people resist the belief that ending the HIV epidemic is an issue that only the federal government can address. Each of us can play a role in this process. Women who have chosen PrEP as a part of their prevention strategy need to let other people know that PrEP can be used by all groups. It is also a part of our responsibility in the HIV workforce to ensure that any program designs include individuals across the spectrum—that even if you do not serve women within your organization or within your program, you ensure that women are informed that “this is also for you.”
It is also important to be aware of the differences in access to HIV treatment, prevention, and care when we look at Black communities. However, there is no difference in the effectiveness of PrEP as a prevention strategy in the Black community or other communities. We should invest in making sure that all populations can benefit from this effective approach to reducing rates of HIV.
Q: 2022 marks the 10th anniversary of PrEP being FDA-approved. What message do you have for other activists and the public health community on this anniversary?
When I reflected on PrEP’s anniversary, I gave some thought to what my contribution has been as an individual who has dedicated her career to this field. We are going on 10 years of using data from AIDSVu to tell the story of where we are with HIV in Black communities, among women, and among other groups.
I discussed with my friends and colleagues in this space that I did not want the anniversary of PrEP to pass without raising awareness about where we stand on PrEP use in Black communities. Those individuals have come together under the hashtag #PrEPinBlackAmerica. On September 13th in Atlanta, we will be hosting a one-day summit that talks about just that: the state of PrEP in Black America.
Going back to the statistic that you mentioned earlier—that 14% of the PrEP prescriptions, but 42% of the new HIV diagnoses are within the Black community—there is clearly work needed to close that gap. I hope that my greatest contribution can be bringing these brilliant minds together to help us develop a plan for Black communities to benefit from PrEP.
