In 2004, two violent anti-LGBTQ attacks at historically Black colleges and universities prompted one of the largest gay and trans lobbying groups, the Human Rights Campaign, to start an outreach program for HBCUs.
Almost two decades later, an expansion of that program has set a different goal: to protect HBCU students before they're at risk. Launched in 2022, the PrEP Ambassador Program is designed to fight stigma around HIV and AIDS and educate students about testing and treatment options.
This type of education is particularly important at HBCUs, experts say, as Black people and young people are at a disproportionate risk of contracting HIV.
Pre-Exposure Prophylaxis, better known as PrEP, describes preventative medications for people who are HIV negative but could be exposed to it. PrEP reduces the chance of getting sexually transmitted HIV by about 99% when taken as prescribed, according to the Centers for Disease Control and Prevention.
Through the PrEP Ambassador program, HBCU students learn about health equity, HIV and its prevention options. They also learn to talk to their peers about these subjects and receive a $1,500 stipend so they can create PrEP awareness campaigns and organize teaching programs on their campuses.
The first cohort of ambassadors from seven colleges, a mix of students who identify as LGBTQ or straight, are participating during the 2022-2023 academic year. Through their efforts, about 25 students got on PrEP and many more became familiar with advances healthcare has made in HIV treatment, according to Leslie Hall, director of the HRC Foundation's HBCU Program.
"This was the very first time that many of these students had even heard about PrEP. These biomedical interventions haven't existed for long," he said.
Fundamental to the program is the idea that students will be more receptive to conversations around PrEP if they're initiated by other young people in similar situations.
"We wanted their Black peers — students on campus that look like them and go to the same homecoming and events like them — to be able to talk to them competently, without judgment, about their sexual health," Hall said.
Growing the reach
Despite making up just 12% of the U.S. population, Black people represent 43% of HIV diagnoses, according to the Kaiser Family Foundation. And CDC data shows that 1 in 5 new diagnoses are made for those between ages 13 and 24.
Thus, HBCUs attract students who are particularly at risk for contracting the virus, according to Robert Fullilove, professor of clinical public health and associate dean for community and minority affairs at Columbia University’s public health school. He also co-chaired the CDC’s Advisory Committee on HIV and STD Prevention.
Stigma is still killing students. It's still killing communities.
Director of the Human Rights Campaign Foundation's HBCU Program
Fullilove backed the assertion that peer-to-peer advising can help break down stigma and help people seek treatment.
"Since its very beginnings, HIV, like many health conditions, has had a dramatic impact on communities of color," he said. "Having the conversation with someone who has the same values, the same lifestyle, makes it that much easier to have a difficult conversation and proceed effectively."
In its program, HRC is focusing on colleges in the South — understandable given that's where most HBCUs are located. But there's another motivating factor, Hall said. Among people receiving new HIV diagnoses, 51% report being in the South.
Students ages 19 to 23 attending an HBCU in Georgia, Alabama, North Carolina, South Carolina or Florida were able to apply to be a member of the 2023 ambassador cohort.
Location affects healthcare access as well. Programs like one from the U.S. Department of Health & Human Services cover the cost of PrEP medication. But the cost of clinic visits and lab tests still fall to patients if they're uninsured. Some states, like California and Colorado, run their own programs to help bridge the gap. But in Louisiana, for example, there are very few, if any, local HIV programs that cover PrEP and the costs associated with it, Hall said.
"Infectious disease doctors tell us early detection is the best key to living a long, healthy life," he said. "Stigma is still killing students. It's still killing communities."
HRC worked with Q Care Plus, a subsidiary of healthcare company Avita Care Solutions, to distribute PrEP through a telehealth option designed to cut down on stigma.
"You could do everything from your mobile phone, even have a provider appointment," Hall said. It's a significant help to students who want access to preventative medication but don't want their families to know. And it's a strong alternative to campus health services.
"Many LGBTQ students do not feel comfortable going into the medical centers on campus and getting the type of sexual health treatment that they need," Hall said. Campus health centers, while a valuable resource, can have medical staff who are unfamiliar with LGBTQ care, he added. And nursing students might work there, creating a challenge for LGTBQ students who aren't out yet.
The graduating class
Erica McPheeters, a student at Kentucky State University, was chosen as one of the program's first participants. Before applying, she was already active in her university's student government association and advocating for LGBTQ support services.
But attending the HRC training in Washington, D.C. with her fellow ambassadors affected her in a way she hadn't experienced before.
"That was honestly one of the most transformative experiences I've ever had, simply because I was with like-minded people who were so passionate about the things I'm passionate about," McPheeters said.
Once she was back on campus, McPheeters began collecting survey data about her peers' perceptions of PreP, HIV and AIDS, and sexual health more broadly.
Based on her findings, McPheeters developed outreach programs to address some of the stigma and misconceptions she heard.
"People would tell me that my talking about it was only exacerbating the problem. I was a little taken aback," she said.
To reach people she couldn't talk to in person, she created an information campaign called HIV Education — HIVE for short — and used Instagram as a resource outside of events.
"We don't have gender studies here," she said. "There's not a lot of training like this other than the strides that the students are making."
Students can only serve as ambassadors once, in an effort to reach students at many colleges. But Hall and McPheeters are discussing ways she could serve as a mentor for the next cohort.
Last year, roughly 40 students applied for the ambassador program, according to Hall, and 10 ultimately served. HRC is hoping to grow the next group to around 15.
"I love having a lot of applications because it shows there's an appetite for this type of program," Hall said.
McPheeters' first piece of advice for new ambassadors?
"Be patient with yourself," she said. "Student leaders are really diligent, especially when they care about something. But in a lot of cases, you don't always receive the opinion or the response you thought you would. You have to be kind to yourself."