Missed Opportunities


After a very brief visit at the Kaiser OB/GYN office in Oakland, Calif., I left feeling frustrated, disappointed and uncared for. I was experiencing vaginal irritation and wanted to discuss a few personal sexual health concerns and inquire about PrEP. Unfortunately, my primary OB was unavailable, but what the hell, I decided to go in anyway. It was a simple, "where, how long, swab, test result will be back in a week, goodbye." As the OB left the room, I sat there with a perplexed look on my face. Not only was she cold, unfriendly, and initiated no eye contact, she didn't even glance at my intake form, which clearly stated that I was in a abusive relationship and concerned that my partner was sleeping with men on the "DL".  This was clearly a missed opportunity.

I decided to reach out to my primary OB to discuss my previous visit and inquire about PrEP for the second time. It was in that moment, it dawned on me that none of my OB/GYN Kaiser providers have ever asked me about my sexual practices and/or partners. I'm a Black woman with one sexual partner, with whom I have condomless sex. I don't necessarily fit in the "PrEP candidate" check boxes, which may be the case for other women who are unaware of their partners "private" sexual encounters (with other men or women).

After asking my provider why I have never been asked about my sexual history/practices, her response was mind blowing: "Well, we talked about birth control and the possibility of you having a baby three years ago." As if sexual partners or practices do not change. Mind you, the entire communication between myself and my provider was via email. Not once did my OB pick-up the phone to call me, not even after becoming aware of my abusive relationship and suspicion of my partner's risky sexual activity. Instead, she referred me to the Oakland Kaiser PrEP provider (NP Tobias), which was the best thing she could have done for me. He was overwhelmingly amazing. During this intense two hour visit, all my needs were met, questions answered, and I left feeling extremely empowered and in control of my sexual health. We also discussed ways in which I could talk about PrEP to my now ex-partner.

Although I'm an advocate for individuals being proactive in their health, providers have a responsibility to ensure that their patients' health care needs are met by conducting thorough health assessments. There is no excuse for not reviewing and addressing any issues listed on a patient intake form. These forms can be used to help providers have those uncomfortable conversations.

HIV for Black women continues to spike, and yet there is little to no knowledge about PrEP within this community. Increasing awareness and knowledge about PrEP among Black women has the potential to also reach closeted bisexual or gay Black men who are at elevated risk for HIV acquisition.

Reality check: Had I not asked about PrEP, it would have never been offered to me.

Nikole is a 34-year-old health educator and Bay Area native who was born and raised in Alameda, Calif.