While Women’s History Month typically spotlights professional achievements and social progress, March of 2023 reminds us that gender inequities in healthcare remain, particularly for women of color.
Recent headlines broadcast that Black women have the highest rate of new HIV diagnosis in the country. Research shows that the COVID-19 pandemic has exacerbated inequalities behind the disparity, especially in the Southern United States.
The headlines missed the ambitious and forward-looking research underway to address health disparities that impact Black women—and that Black women are leading the way.
In 2022, the California biotech company Gilead Sciences awarded $5.3 million in grants for concurrent research projects focused on HIV and Black health equity in the Southern United States. The Black women researchers behind these projects are Dr. Maranda Ward, director of equity in the Department of Clinical Research and Leadership at George Washington University (GWU) School of Medicine and Health Services in Washington D.C.; Dr. Maisha N. Standifer, Director of Population Health in the Satcher Health Leadership Institute (SHLI) at Morehouse School of Medicine in Atlanta; and Dr. Kathleen Kennedy, Dean of the College of Pharmacy and founding Director of the Center for Minority Health and Health Disparities Research and Education (CMHDRE
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Dr. Ward’s work breaks down race and culture-based clinician bias and miscommunication that severely compromise the quality of care that Black women receive from the healthcare system. The mission is a personal one. “As a Black woman who grew up in urban America, I’m always observing threats to justice, even in my own healthcare,” she says. “That is why I’m so committed to preparing the health workforce to address the challenges of health equity and racial equity. We’re not going to eliminate health disparities until we eliminate racism.”
High rates of HIV diagnosis among Black women in the U.S., particularly in the South, is a stark example of how
clinician bias leaves this population especially vulnerable. Dr. Ward notes that Black women are largely uninformed about PrEP, an effective regimen for preventing HIV, because clinicians aren’t communicating the benefits with patients they don’t perceive to be at risk.As principal investigator on the Gilead grantee program, Two in One: HIV and COVID Screening & Testing Module, Dr. Ward is midway through an 18-month research and educational training for primary care practitioners that pairs HIV screening with COVID screening and vaccination. “The goal is to make the ‘two in one’ protocol the standard of care for all patients so that those who are most in need can benefit from prevention and early detection,” Ward said of the project, which targets 10,000 primary care practitioners nationwide, both in practice and those still in the training/education pipeline, principally HBCU medical students and trainees.
“At the end of the program, we will prepare a set of policy recommendations to update HIV screening guidelines along with recommendations on how to implement them in a culturally responsive way,” she said. “We’re talking system-level change that challenges bias and harmful stereotypes that interfere with equitable care. That is what advancing Black health equity looks like.”
Dr. Ward’s colleagues, Dr. Maisha Standifer at Morehouse, and Dr. Kathleen Kennedy at Xavier, collaborate on another Gilead-funded project, End the Epidemic: Examining the Health Equity Implications of Health Systems, Policy, and Data Gaps for People Living with HIV in the Southern U.S. The project targets structural barriers in the healthcare system and within Black communities that hamper access to HIV testing, treatment, and ongoing care.
The Morehouse campus sits in the City of Atlanta, which has the highest rate of new HIV diagnosis in any U.S. city, particularly among Black Atlantans. Dr. Standifer’s research delves into the structural and system factors behind the numbers, what she calls “the intersection of policy and equity.”
“Black health is being impacted by policies,” Dr. Standifer says, noting that social policy across all areas—from housing to education to criminal justice—contribute to health disparities in Black communities. “My professional dedication is to look at the impact of those policies, bring in some solid analysis, and inform legislators and policy influencers in their work to address health inequities.”
Crucial to the project’s success is the SHLI Health Equity Tracker, a data collection platform that can provide comprehensive insights into factors that determine disease impacts and outcomes. Persistent stigma and mistrust in Black communities surrounding HIV, along with the community’s complicated history with the healthcare system, has hindered data collection in the past, according to Dr. Standifer.
She believes, however, that Morehouse and Xavier are well positioned to overcome those obstacles: “Gilead has chosen to connect with us because we are trusted in the community, we advocate for the community, and we are the community.”
Dr. Kennedy agrees. As director of Xavier’s Center for Minority Health and Health Disparities Research and Education, she leads efforts to replicate the Morehouse research model in Louisiana, specifically New Orleans and Baton Rouge. She views the research and data collection as essential to effective policies and practitioner training that translates into culturally competent care for Black people impacted by the HIV epidemic. “Community engagement is the most important thing we can do,” Dr. Kennedy says. “You have to respect people where they are—their culture, their beliefs, and their history. You have to listen to what they think their needs are so you can better serve them.”