Throwback Thursday: Talking to My Doctor about PrEP

Editor’s Note: National Gay Men’s HIV/AIDS Awareness Day was observed earlier this week, and promotional materials for the day included information on PrEP. This post is a follow-up to one from 2014, giving one individual’s personal perspective on PrEP. Here is an update to that conversation.

In August 1999, I wrote an article for the HHS Office of Minority Health on the difficulties that gay men and lesbians often have accessing quality health care. These difficulties were due mainly to two issues: gay men’s and lesbians’ fear of coming out to health care providers, and providers’ lack of knowledge about how to interact with gay and lesbian patients.

Sixteen years later, these concerns can still be relevant—this was true for me when it came to PrEP, or pre-exposure prophylaxis. PrEP allows people who are at risk for acquiring HIV to take medication that significantly reduces that risk.As someone who has been taking PrEP since November 2013, I feel that times have not changed that much. I made the decision to start PrEP after doing my research in sources that included HIV.gov, PubMed.gov, and medical journal articles. Although my primary care physician knows I’m gay, I was still apprehensive about talking to him about PrEP because, in 2013, few gay men—and even fewer doctors—had heard about it. What little coverage there was frequently stigmatized people who took PrEP for their sexual behaviors.

When I approached my doctor, he said he did not know enough about PrEP to feel comfortable prescribing it, so he referred me to an infectious disease specialist. While I was pleased by his honesty, I also felt like it was “throw-back Thursday.” I had a choice to go along with his referral or to educate him, just as in the past. I did both!

Now each time I see my primary care doctor for my yearly physical, I always remind him that I’m taking PrEP. I do this for a couple of reasons: 1) so that he has a reference point to discuss PrEP with his other gay patients; and 2) as a way to remind him to discuss with me other issues that might affect me as a gay man and, in particular, as a person who is taking a medication that the primary care doctor did not prescribe.

Even with my PrEP doctor, I am not always completely comfortable with our interactions. On several occasions, this doctor has asked “How long do you think this will continue?” For me, his question seems to be a way of asking how long I plan on engaging in activities that may place me at risk for infection. Like in the old days, I feel we are talking around an issue, rather than engaging in direct dialogue.

I am not sure if my doctor’s question is his way of promoting risk-reduction, or if he has concerns about long-term effects of the medication—but he says the research indicating there are no known long-term side-effects is strong. Our conversation has served as a good segue into talking about new research in this area, including new clinical trials investigating taking PrEP less often.

I urge you to read the 1999 article, and see how many of the suggestions I made then apply today. Don’t be afraid to educate yourself and your provider, or to ask questions. Remember, it’s your health—it’s your life!

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For additional information on PrEP:

• Read this blog: For gay and bisexual men, a year of excitement could lead to a decade of progress

• Clinicians seeking advice and consultation on PrEP can call the hotline at 855 HIV PrEP (855-448-7737). For more information on the services offered through the PrEPline, visit the national Clinician Consultation websiteExit Disclaimer.

• Tips on how to talk to your doctor about PrEP .

• Learn about resources for digital storytelling for National Gay Men's HIV/AIDS Awareness Day.