Beyond Hair Styling: Stylists As HIV PrEP Messengers

More than half of new HIV infections occur among Black women yet less than 2% of Black women preexposure prophylaxis (PrEP) that reliably prevent infection. Researchers at Duke University School of Nursing in Durham, North Carolina, are hoping that a community partnership approach to PrEP that involves hair stylists at salons and their patrons will boost awareness and use of PrEP.

The researchers, Schenita D. Randolph, Ph.D., M.P.H., R.N., as associate professor at the nursing school, and Ragan Johnson, D.N.P, an associate clinical professor, reported preliminary researchers of their salon-based intervention in the New England Journal of Medicine (NEJM) this morning that showed the program changed the intention to use PrEP and moved a sizable proportion of the patron participants from precontemplation to contemplation on a motivational scale.

The program involved 19 stylists and 105 customers in three urban counties in North Carolina, Randolph and Johnson wrote in NEJM. The stylists received continuing education credits for completing two, two-hour training sessions on HIV, PrEP and infection control that are designed to make them community opinion leaders. Black women patrons viewed a four-video “edutainment” series on health issues that addressed HIV and PrEP and Black women’s role in health.

Training and encouraging barbers and hair stylists to convey public healthcare messages and encourage their customers to take preventive health measures is a well-researched strategy. Elijah Saunders, M.D., is often created with pioneering the idea in Baltimore with “The Barbershop Program” trained barbers and stylists to take customers’ blood pressure and refer them for treatment. Similar programs targeting hypertension in the Black community have been launched and studied in New Orleans, Dallas and Los Angeles.

Randolph and Johnson describe their salon-based intervention and study as “mixed methods study using a community-partnership approach.” The intervention is Using PrEP and Doing It for Ourselves (UPDOs) and is designed to take into account, they wrote, “the interplay among individual, relationship and community factors that influence decision making for women regarding starting PrEP. “ The program was developed and designed for testing in a pilot phase by Black women, hair stylists and an advisory council.

The stylists put up signs in their salons that said “Ask Me About PrEP.” The edutainment series, wrote Randolph and Johnson, had humorous and dramatic elements. One character is in a serodiscordant relationship (one person is HIV positive and the other is not) and her storyline is designed to destigmatize HIV, according to Randolph and Johnson.

The researchers conducted survey of salons’ customers’ PrEP awareness, knowledge, motivations and uptake before and after they participated in the program, which also included providing information about contacting a PrEP navigator. Of the 105 customer participants, 72 completed a survey before the program and 44 completed one afterward. The intention to use PrEP changed for 15 of the customers and 10 moved from precontemplation to contemplation and 1 customer started PrEP. Randolph and Johnson said a majority of the surveyed salon customers participants said that “seeing themselves in the messaging made PrEP seem like a possible option for their sexual health.”