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       When Parrish Brown reassures patients nervous about regular injections to reduce the risk of sexually transmitted HIV, he’s not only doing his job as a community health worker, he’s speaking from experience.

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       He sometimes forgot to take PrEP (pre-exposure prophylaxis) as a daily pill, but can manage a shot every other month — an option that experts say could improve HIV prevention in the District.

       “Hey friend, I’m on this, too,” he tells his patients at Whitman-Walker Health, many of whom worry about the size of the needle or side effects. He and his colleagues have been administering injectable PrEP, or Apretude, for months at the 14th Street Northwest clinic.

       The shots are available starting this week at Whitman-Walker’s newly opened Max Robinson Center in Southeast, which serves a greater percentage of Black residents who until now have had to cross the Anacostia River for care.

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       Brown says he’s eager to expand access to Apretude, which the Food and Drug Administration approved nearly two years ago, calling it more effective than a daily pill for people with substance abuse concerns, depression, and those facing poverty or who have a need to take PrEP discreetly. But, as with PrEP access in general, the people most likely to benefit from the medical innovation often face barriers such as a lack of access, transportation, child care and insurance.

       “We see where PrEP exists in communities not necessarily matching where the need might be most dramatic,” said Lindsey Dawson, associate director of HIV policy and director of LGBTQ health policy at KFF, a health policy research and news firm. “The disparities that we see in PrEP uptake reflect in part at least the fact that people of color face intersectional stigma and discrimination in a whole range of aspects of life, including in health care.”

       Of people eligible for PrEP who had prescriptions last year, 94 percent were White, compared to 13 percent who were Black and 24 percent Latino, Centers for Disease Control & Prevention data show.

       While new HIV diagnoses in the District are at a fraction of their peak in 2007, a February report from the D.C. Department of Health shows new cases are climbing among Black residents, who account for about 44 percent of the city’s population but nearly three-quarters of HIV cases. Yet Black residents and Black women in particular are underrepresented among PrEP users, city officials say.

       At the PrEP clinic at Whitman-Walker Health, 184 patients are receiving the shots; and only 13 people have dropped off taking the shot, all of whom cited personal reasons such as not being sexually active or traveling too much to return for the shots. About 100 people were denied coverage by their insurance provider, said Michael Golden, the clinic coordinator.

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       But patients can be easily discouraged from taking the long-acting injectable medication, especially those with lingering mistrust of the medical establishment or those who face the stigmas that are still associated with HIV in some communities — all barriers that community health workers are trying to combat, creatively.

       “I call this the White Lotus room,” Golden said with a flourish during an interview with The Washington Post, moving aside to reveal an exam room with a tropical island backdrop, a plastic palm tree and a plush parakeet — a kitschy but calming oasis. Spa music played as water flowed on a Buddha screen saver.

       The most common fears that Brown, 27, and Golden, 26, encounter are needle-phobias and worries about injection site pain, which they liken to the soreness felt after receiving a coronavirus or flu vaccine — which generally improves with gentle movement. Apretude is injected in the gluteal muscle using a 1.5-inch-long needle one month apart for two consecutive months and every other month after that.

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       “That timeline and frequency of having to have an injection can be a little scary for some folks,” Golden said. “However, we’ve learned to kind of combat that.”

       Brown and Golden were trained as part of a program that emphasizes trust-building and patient comfort, which was developed by Rupa Patel, a clinical scientist and Whitman-Walker’s PrEP clinic medical liaison.

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       Since the 1990s, she said, researchers have found that bringing in a trusted community member known to patients dealing with a disease as stigmatized — and criminalized in some states — as HIV is an effective approach to treatment. The health center hired people already skilled at having nonjudgmental, de-stigmatizing conversations and trained them to provide clinal care, phlebotomy, advanced testing and injections.

       “We want to be able to see people who look like us, treat us,” Brown said, adding that he wins over patients by being himself, treating them with kindness, and explaining that the drug is for everyone: men who have sex with men, cis women, trans women and anyone at risk.

       Maranda Ward, an assistant professor and director of equity in the Department of Clinical Research and Leadership in George Washington University’s School of Medicine and Health Sciences, said clinicians often rely on marriage status or age to determine if someone should be screened for HIV or PrEP services, a bias that can leave out those who most need treatment.

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       “It’s not that being Black is the risk factor,” Ward said. “Racism not race is actually driving patients not knowing about opportunities for PrEP and HIV testing. Without that, the onus is on the patient to say: ‘I saw an ad for PrEP …’”

       Matt Sipala, 46, said he was eager to begin injectable PrEP to eliminate the hassle of a daily pill. He developed a habit of flipping the bottle after each dose, a trick that failed him when he left for a two-week trip to Colombia without packing the bottle.

       “So this has been a lot easier and I think it’s been working,” Sipala said before his third injection. “It’s been great. I hope that more people have access to it.”

       Whitman-Walker Health offers thorough HIV care, Dawson of KFF said, noting most clinics are unable to devote the resources and staff to developing an injectable PrEP program.

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       “Some of these problems are not going to be erased by [injectable prep] but it does have the potential to reduce some barriers,” she said. “It’s long been a tenant of HIV work, having a no-wrong-door approach provides the best access to public health.”

       Even at Whitman-Walker, about half of patients on injectable PrEP are White, about 30 percent are Black and 20 percent are Hispanic, clinic data show.

       “It’s one of our goals to increase the uptake of PrEP in everyone but especially in our people of color in the District and women,” said Clover Barnes, senior deputy director for D.C. Health’s HIV/AIDS, Hepatitis, STD and TB Administration.

       Mayor Muriel E. Bowser on Monday cut the ribbon at the ceremonial opening of the Max Robinson Center, on a medical campus anchored by Cedar Hill Regional Medical Center, as part of plan to remake health care in a long-underserved part of the city.

       About half of city residents are enrolled in Medicaid or DC Healthcare Alliance, a locally funded program for those not eligible for Medicaid, both of which cover Apretude, Barnes said. Some private insurance companies, however, have put up roadblocks to coverage, forcing providers to navigate a maze of prior authorization, letters and phone calls, requiring countless staff hours, said Erin Loubier, who is in charge of insurance eligibility and enrollment and health care reimbursement at Whitman-Walker.

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       The stakes of those delays, which can stretch from a number day in to weeks, are high, she said.

       “There is a really significant incentive from a public health perspective to get people on this medication so they don’t become HIV positive from a prevention perspective, and from a treatment perspective so they are virally suppressed and not able to infect someone else,” Loubier said.

       Patel, the scientist, said she saw the same phenomenon more than a decade ago when the FDA approved the pill Truvada, the first HIV prevention drug, and later, Descovy.

       “It didn’t have to be this way,” she said.

       Fenit Nirappil contributed to this report.

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