March shifts the focus to women’s history, but for some, protecting women may be seen as preserving fertility rather than safeguarding bodily autonomy or as a battle against “woke” threats to gender expression, sexual orientation, and identity. But we have not forgotten February. We have not forgotten Black history. And we have not forgotten the urgent need to protect Black girls and women.

March 10^th was National Women and Girls HIV/AIDS Awareness Day (#NWGHADD). Only one day exists to remind folks that a public health crisis impacts women and girls. In 2021, Black women constituted 54% of new HIV diagnoses among women in the United States. Black women are continuing to die from HIV/AIDS at staggering rates, 15.3 times more likely to die from HIV infection than white women. The time for change isn’t now—it was yesterday. We missed the deadline. Bold, innovative action is overdue.

Black heterosexual women are more likely to acquire HIV from a steady sexual partner and less likely to use condoms in these relationships than with casual ones. Sexual networks, overlapping relationships, and dating within the same community encourage a cycle that puts Black women at increased vulnerability to HIV. However, this behavior is not specific to Black women. Are Black women engaging in the same behaviors as white women yet facing different outcomes? Or do they have less access to care and fewer opportunities for targeted, informed outreach?

This is not about personal choices. It’s about larger systems that impact who people date, relationship power dynamics, and access to needed healthcare. To truly protect Black women, we need big changes—better healthcare access, more substantial community support, and policies that tackle the root causes of HIV acquisition. It’s not just about telling people to change their behavior. It’s about building a world where the needs of those most vulnerable are prioritized, creating a world that allows for open, honest communication within sexual relationships and embracing Black love.

Black love is a connector. It protects Black women in our communities. To address this, we (Drs. Crooks and Singer) developed PrEP-ing for Black Love a three-session program designed to support HIV prevention by fostering community and sisterhood through interactive education and skill building. Black love has been described in the literature as a shared cultural understanding that Black people are connected through race and discrimination. Black women are socialized to aspire to have Black love, often at the expense of themselves, and embrace its complexities.

When we asked women in our group what Black love meant, one woman said:

“This right here is Black love. It helps us start conversations with people now. We have new information we can share. We need to have more Black love, and we don’t have each other like we should.”

Our program prioritizes Black love—as self-love, love within Black families, and love within Black couples. Black love is not just an interpersonal experience; it is communal and felt deeply within Black communities.

But there is a gap. The same experiences of discrimination that bind Black families in love also leave them without the support they need. Where is the love for Black love?

Black love should not mean an increased risk for HIV. Black love could mean prioritizing our health, safety, and joy. Black love needs some love. Group-based care and HIV prevention education are one way to lovingly support Black women in making needed space to talk about relationships, collectively address challenges, and consider pre-exposure prophylaxis (PrEP) as an empowering method of self-protection, self-love, and Black love.

PrEP to need by demographic ratios highlights the critical need to focus on prevention-related services for Black women. It is also well demonstrated that Black communities have better outcomes when services are available from Black providers. This emphasizes how imperative it is for healthcare professionals, especially Black women providers, to place PrEP near the top of our prevention agenda when discussing culturally appropriate options with our patients.

The bottom line is HIV needs two things to spread: Someone to get it and someone to give it. We now live in a time where no matter where we are in that equation, we have the power to stop HIV in its tracks.

However, there is stigmatization associated with being infertile, as Black women have been portrayed as hypersexual or hyperfertile. These stereotypes have roots in racism and slavery and can make it difficult for Black women in 2023 to seek fertility care.

The reality is, according to the National Survey of Family Growth, Black women are twice as likely to suffer from infertility than their White counterparts, as Black women have higher rates of infertility than White women (7.2% vs. 5.5%, respectively).

This stereotype of Black women being more fertile than others is insulting and makes an already painful process even worse. As it is both Ovarian Cancer and Polycystic Ovary Syndrome awareness month, it is critical to understand the realities.

Infertility deems the woman incapable of having a baby, and blame is often put on the woman. This blame creates shame and silence among women.

This experience is even more complex for Black women as additional stereotypes intersect to negatively impact the Black fertility and birthing experience.

Stereotypes, such as the welfare queen– a lazy, but sexually promiscuous, single mother who would rather have more children than find work- perpetuate this narrative as Black women seek and consume more government support and resources.

This is untrue, as white Americans benefit more from government assistance.

More specifically, among all infants and children, eligible for Special Supplemental Nutrition Program for Women, Infants, and Children in 2020, 3.9 million were white, 3.2 million were Hispanic/Latino, and only 2.1 million were Black.

Although funding may be available to help Black families access fertility, the welfare queen stereotype may inhibit Black women from seeking out fertility support and resources.

A more current stereotype negatively impacting Black women is the Strong Black Women emotional restraint, independence, and self-sacrifice where Black women often care for others at their own expense.

This schema articulates how Black women protect, provide for, and lead their households and communities in the face of ongoing structural racism, including police brutality, incarceration, death, and chronic disease.

In a recent interview with Inger Burnett-Zeigler, author of Nobody Knows the Trouble I’ve Seen: The Emotional Lives of Black Women she states:  “Many Black women — including myself — wear the badge of strong Black woman with honor. It is such a deeply embedded way of life…It is pushing down the pain and putting on a smile no matter what we’ve been through.”

The strong Black woman narrative is dangerous, as this specific stereotype affects the treatment of care and perpetuates racism. More specifically, in the context of reproductive health, racism was used as a tool to establish surgical techniques in the field of gynecology.

In the 1840s century, J. Marion Sims performed experimental surgery on enslaved Black women without their consent to develop a cure for vesicovaginal fistula. These experiments facilitated two key stereotypes about Black women in the context of reproductive health care. The first is that it is acceptable to perform procedures on Black women without their consent, and secondly, that Black women have a high tolerance for pain.

The assumptions associated with the Strong Black Woman trope have created fear for Black women related to Black reproductive health and maternal health outcomes.

The CDC estimates that, in 2021, the maternal mortality rate among Black women was nearly 70 deaths for every 100,000 live births. That is 2.6 times the rate for white women, regardless of income or education.

A recent study regarding pregnant Black women’s experience in Chicago noted traumatic delivery and felt like “they had no control” of their bodies. This stereotype further dehumanizes Black women, as Black women need access to fertility care.

To combat these negative stereotypes, Black women may wait longer to have children and find themselves in a predicament like mine.

As a nurse and a single, 33-year-old, highly educated Black woman, I sought to wait to have children by freezing my eggs. I began the process by asking about my insurance coverage. I was provided with a chart of insurance coverage breakdowns and out-of-pocket costs.

When I asked questions specifically about my insurance, the nurse practitioner, and staff reassured me the company would cover this service. I had undergone my vaginal ultrasound, scheduled an appointment to retrieve my eggs on the first day of my next period, and the doctor had ordered the drugs to get my body ready to produce the most eggs.

However, that was not my reality as the next day I received an email from the fertility clinic’s financial office stating my insurance plan would not cover my procedures. I responded to the financial office asking why and if scholarships were available to support Black women and fertility.

However, I received a cold email response, and no one answered my calls.

A few days later, I received my denial letter from my insurance company stating I have six months to appeal this decision about the $14,000 cost of fertility treatments. I left feeling angry, sad, and misled as I believed money wouldn’t be an issue and my insurance would cover my egg-freezing journey.

Access to fertility care is reliant upon a classist and racist structure. Yet research has shown that when financial barriers are removed or reduced, there is an increase in the use of assisted reproductive services by Black women.

Although many health insurance policies are thought to cover fertility care, as 17 states in the U.S. mandate insurance coverage for infertility-related treatments, the extent of coverage is quite limited to specific plans.

I was denied coverage in Illinois. So I had to ask myself, is the limited access to fertility care another way for systems to take control of Black bodies?

Policymakers, healthcare providers and administrators, advocates, Black women, and all those who care about health equity and fairness, need to work to change the systems.