HIV prevention enters salons, barbershops

by K. Aleisha Fetters and Sheila Dichoso
March 12, 2009

Sitting under a dryer with her hair soaked in red dye, Tameka Jackson, 24, listens to Women’s Collaborative health educator Dorienne Canada talk about the female condom. Jackson watches her demonstrate how to use it.

Jackson gets up from under the dryer and makes her way to Canada. She wants more information.  Jackson,  a shampoo assistant at the salon and a security guard, is African-American.

Four out of five newly infected Chicago women in 2006 were African-American, according to the AIDS Foundation of Chicago. They account for 36.5 percent of Chicago's population but 55.6 percent of locals living with HIV. But they aren't receiving the prevention and education they need to reverse these trends.

The Women's Collaborative is working to change that.

A prevention program of the AIDS Foundation of Chicago, the Women’s Collaborative increases HIV awareness and primary care services for African-American and Latina women by entering more than 40 of these communities’ beauty and nail salons, barbershops and beauty supply stores.

“Women are getting their hair done, talking about what’s on TV and their boyfriends, so why not have some HIV prevention education information?” said Cynthia Tucker, director of prevention and community partnerships for the foundation.

Human immunodeficiency virus, or HIV, is an infection that weakens the immune system, making it more difficult for the body to fight off diseases such as pneumonia. HIV may develop into acquired immunodeficiency syndrome, or AIDS, once a person’s total immune system cells drop below 14 percent, according to the Centers for Disease Control and Prevention.

Although health educators focus on sexually transmitted infections (STIs) as well as HIV and AIDS during their salon discussions, they also educate women on health issues such as substance abuse, breast cancer and diabetes. When visiting older women, the educators begin their presentations with non-sex-related issues, helping to ease them into the conversation.

The Women’s Collaborative health educators are employees of the program's three local partners: Christian Community Health Center, South Side Help Center and Project VIDA. These sites also serve as a referral service for women—and their partners—to get tested.

HIV symptoms don’t show up right away. Usually two to four weeks after being infected, a person may develop a flu-like illness that may include a fever, rash and swollen lymph glands. Still, many infected people don't notice any symptoms, increasing the need for testing.

Of the 5,000 women the Women’s Collaborative speaks to annually, it tests between 500 and 1,200 people. The program has diagnosed seven women with HIV, three of whom were tested at salons. The program has also identified three HIV-positive men in salons.

"A lot of women call their boyfriends and they’re like, 'I’m at the salon. You can come down and get a free test.' It’s unbelievable how many guys actually show up," Tucker said.

Combating local trends with awareness

The Women's Collaborative raises awareness for prevention's sake.

STIs and HIV disproportionately affect African-Americans because some don't understand the risks, Tucker said.

In the beauty shops the Women's Collaborative frequents, educators have encountered women who believe that HIV is just another STI. They aren't worried about contracting the virus because they believe a pill eradicates it.

“It’s amazing that in 2009, we still hear that,” said Tucker, who believes such falsities thrive due to a lack of prevention education and health care services.

While antiretroviral medications have lengthened the life expectancy of men and women living with HIV,  there still is no cure for HIV or AIDS.

“(These women) want to know how they can talk to their partners or husbands about HIV, where they can talk to someone one-on-one about it,” she said. “They want us to dispel the myths."

But many myths have a long history, making them challenging to dispel.

“For years, African-American women were not identified as part of the HIV epidemic because it started off as a gay white man’s disease,” Tucker said.

Tucker modeled the Women's Collaborative after an earlier program in Raleigh, N.C. that used beauty salons as a place to talk to women about breast cancer and HIV. Men and women don’t always feel comfortable going into a health agency, she said.

"There's a distrust of the (medical) system," said Dr. David Pitrak, director of the University of Chicago adult HIV program and chief of infectious diseases. "Testing programs don't work unless you include people from the population you’re working with. You really need to include facilitators from those groups to get the information across."

Many African-Americans, especially males, will not go to a clinic to be tested, said Canada, who works at Christian Community Health Center in Dolton. But when Canada brings testing to them, they are eager to be tested--and often.

The Women’s Collaborative focuses its prevention and testing initiatives on the South and West Sides of Chicago, where the majority of new HIV infections occur.

Poverty, high STI rates, lack of healthcare and safe-sex access contribute to high transmission rates in clusters in AIDS7these areas, said Donnise Gaffeney of the AIDS Foundation of Chicago, who tests previously incarcerated men for HIV. She said frequently heterosexual men who had sex with men in prison resume sexual relationships with women when they are released, contributing to HIV transmissions.

Tucker, who grew up on the far South Side, said promiscuity among some men and women can be a problem in areas such as Englewood and West Englewood.

“It’s not that a lot of men have HIV, but it’s that one man is passing [STIs and HIV] on to a lot of women,” Tucker said.

This trend demonstrates why men need to be informed, too. The Women's Collaborative recently expanded its salons to include unisex shops and all-male barbershops.

"Anytime you do anything with women, you have to do it with men to make sure they get the same prevention messages," Tucker said.

Limited funding, capabilities

In 2007, the Women's Collaborative added Project VIDA, a Chicago agency that offers individual and group services for Hispanic adults living with HIV or AIDS, as a partner to expand awareness to Latino communities. Now, the program has six Latino salons, two of which are unisex. The program has made minor adjustments, mainly because Latina women spend less time at salons, Tucker said.

But she doesn't expect the program's initiatives to expand to include more salons anytime soon.

Earlier this year, program educators began visiting beauty supply stores because of the floundering economy. Last year’s progress report revealed a dwindling number of women going to salons. Instead, more women are now purchasing supplies to do their hair at home, Tucker said.

Two of the salons Canada used to visit have recently closed, she said.

The Women's Collaborative doesn't have much money, either.

“We don’t have money to hire more educators or to expand the program,” Tucker said. “Trying to sustain the program is hard.”

The Women’s Collaborative began in 2005 with $60,000 in seed money from the National AIDS Fund in Washington, D.C., that continues to fund much of the program’s operations. Since then, the Women’s Collaborative has received financial backing from the MAC AIDS Fund and the Chicago Department of Public Health.

Paying the salaries of the Women’s Collaborative partners with this money is difficult, Tucker said. It pays 50 to 60 percent of the educators' salaries, while their sponsoring agencies pay the rest. Last year, the collaborative received $65,000 in total funding, which it then divided among its six health educators.

The money also pays for posters, comment cards and condoms, which sit out in baskets at all the participating sites, Gaffeney said. The money also goes toward rapid-result HIV tests.

Even though dollars are tight, the Women’s Collaborative still springs for one expense many HIV prevention organizations do not: female condoms.

“We tell women, ‘this is another option, and it’s controlled by you,'" Canada said.

Many of the collaborative's clients give in to whatever their partners want, which often means not using a condom, she said.

But women need to start asserting their sexual health to their partners, she tells salon patrons. The female condom can be the end result of safe-sex negotiations between women and their partners.

She has seen these safe-sex messages spur discussions between women and their partners. But more needs to be done, as HIV rates in the African-American community are escalating. That won't be possible without further funding.

"This is a tough time," Pitrak said. "People are losing jobs, and entering poverty. And just when we need to be doing more, we can't. The problems are only going to get worse."

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Sheila Dichoso/MEDILL

Salon patrons listen to Women's Collaborative health educator Dorienne Canada talk about STIs and HIV. She has been providing education and on-site testing services at salons and barbershops for more than two years.
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Sheila Dichoso/MEDILL

Canada demonstrates how to use a female condom, an alternative to the traditional male condom. If used properly, the female condom is just as effective as its male counterpart.
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Sheila Dichoso/MEDILL

For her presentation, Canada uses visuals, such as this board, which contain photos of common STIs and different safe-sex products.
Related Links
AIDS Foundation of Chicago
Chicago company receives FDA approval for more affordable female condom

“A lot of women have never even seen a female condom,” said Cynthia Tucker, director of prevention and community partnerships for the AIDS Foundation of Chicago.

But that's about to change, she said. The Chicago-based Female Health Company, which manufactures the current FC female condom, received approval Wednesday from the U.S. Food and Drug Administration for a new, more affordable female condom called the FC2.

A 6.5-inch lubricated sheath, the female condom has a wider girth than male condoms, said Jack Weissman, vice president of the Female Health Company. The condom is closed at one end to hold semen while the other end is large and open, covering much of the woman's external genitalia.

Women can place a small, flexible ring in the closed end of the condom to insert the condom and keep it in place during sex. If women find the ring uncomfortable, they can insert the condom without it. It can be inserted up to four hours before sex, said Women's Collaborative health educator Dorienne Canada.

"As long as they're used appropriately, they are just as effective as a male condom at preventing STIs and pregnancy," said Kim Alton, nurse practitioner for Chicago Women's Health Center.

But a package of five non-reusable FC condoms can cost nearly $20, making the purchase difficult for both non-profits and women on tight budgets.

The company has not yet set the U.S. price of the new FC2, but it says the cost will be much lower than the FC because of  the revised manufacturing process, Weissman said.

The FC2 has the same design as the old model, but is made of nitril synthetic latex and dipped in molds rather than being made of expensive polyurethane and glued together like the FC. These changes cut costs for the company—and its customers.

“We want to pass our savings along so more women can have access to the female condom,” Weissman said. “It’s the only female-initiated product that’s available. She can rely on herself, she’s in control.”

The World Health Organization supports the FC2 as a safe preventive measure. It is available in many locations abroad, including India, Brazil and the European Union.

Having manufactured the FC2 for these countries for more than two years, the company has already built up inventory for U.S. sales at its new Malaysian factory.

This strategy will allow the company to speed up the FC2’s release date. The company has not said when the condom will be available.

Safe sex non-profits, such as the AIDS Foundation of Chicago, eagerly anticipate the new condom, said Tucker. The lower price will allow the Women’s Collaborative to buy and distribute more female condoms, she said. It will also allow more lower income women, who are at higher risk of contracting STIs and HIV, to purchase the condoms.

Women’s Collaborative health educators, such as Canada, have been demonstrating and promoting the FC for years. Since the Female Health Company requested FDA approval, the health educators have also been telling salon patrons about the upcoming FC2.

“You do not have to depend on your partner to use a condom," Canada said.

But even at lower prices, some women may want to continue using male condoms, Alton said.

"I haven't recommended them to anyone basically because there is little interest," she said. "I've heard that they're noisy."
Where to get HIV/AIDS testing

Nearly 1,000 women in Chicago don’t know that they are infected with HIV, the AIDS Foundation of Chicago estimates. Here are several Chicago area clinics that offer free testing:

Englewood Health Center
641 W. 63rd St.
Chicago, IL 60621
(312) 747-8911

Chicago Lakeview STD Clinic
2861 N. Clark St.
Chicago, IL 60657
(312) 744-5507

Christian Community Health Center
9718 S. Halsted St.
Chicago, IL 60628
(773) 233-4100

Cook County Department of Public Health
1010 W. Lake St. #300
Oak Park, IL 60301
(708) 445-2400

Project VIDA
2659 S. Kedvale Ave.
Chicago, IL 60623
(773) 522-4570

South Side Help Center
10420 S. Halsted St.
Chicago, IL 60628
(773) 445-5445

Uptown Clinic
845 W. Wilson St.
Chicago, IL 60640
(312) 744-1935
Neighborhoods with highest AIDS prevalence rates (per 100,000 population)

Uptown 1,320.2
Edgewater 1,011.3
East Garfield Park 871.6
Washington Park 820
Lake View 787.8
Rogers Park 710
Near South Side 641.5
Woodlawn 594.4
West Garfield Park 586.5
Near West Side 570.9

(Source: AIDS Foundation of Chicago)