Less than half of individuals diagnosed with HIV in South Africa, the country with the largest HIV epidemic in the world, receive adequate treatment. Ever since her first research project related to HIV testing in South Africa in 2004, Ingrid Bassett, MD, MPH, has been focused on connecting vulnerable populations with available services. “Failing to link to care became a defining part of what my research was trying to grapple with over the next 10 years,” she said. “It was a defining study for me.”

Concept Origins

It was this issue that came to mind one Monday morning several years back when one of her young research assistants in Durban, South Africa, came to work with a new set of hair extensions and braids. After finding out that the salon appointment had lasted upwards of three hours, Dr. Bassett and her team began to brainstorm. “We just started to think about all the ways in which a hair salon could be a supportive and conducive environment to offer health interventions,” she said.

These conversations led to a fascinating new pilot study that Dr. Bassett, an infectious disease physician at the Medical Practice Evaluation Center and a Weissman Family MGH Research Scholar, and her team hope to roll out this year. Stylists trained with talking points and literature at three Durban hair salons will initiate conversations with their clients about HIV testing, treatment and contraception and refer those interested to an on-site nurse.

“People feel good when they go to a salon, and hopefully we can capture that sense that this is part of being well as opposed to feeling like this is a burden,” Dr. Bassett said. “We’re trying to meet them where they are.”

Businesses See Benefits

Over 90% of salon owners, stylists and clients Dr. Bassett polled were willing to offer or receive health or contraception education, and only slightly fewer were willing to offer or receive HIV testing and education. Salon owners and stylists thought that this initiative would be good for business by encouraging repeat customers, while patrons were excited about the convenience as well as the appeal of discussing sensitive issues in a safe, exclusively female environment.

The introduction of pre-exposure prophylaxis, or PrEP in South Africa could vastly increase the impact of Dr. Bassett’s initiative. PrEP, an antiretroviral medicine taken by at-risk HIV negative individuals, can reduce the risk of contracting HIV by up to 90% when taken regularly. Educating salon patrons about PrEP could significantly reduce the nearly 2,000 new HIV infections every week among women age 15-24 in South Africa.

Local Applications

Dr. Bassett is working with a colleague in Boston to determine if a version of this program could promote PrEP among Latino and Black men who are sexually active with other men and at high risk for HIV infection. “One of the things that is interesting to me about working in both South Africa and in Boston is where are the lessons and translations between the contexts,” she said.

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