08 April 24

Ending HIV

Getting on PrEP

How to talk about PrEP with your doctor

So you’re taking the plunge. Maybe you’ve heard about PrEP online, from friends, or even from one of the guys you’ve hooked up with, and now you want to get on PrEP.

You’ve probably heard that PrEP is a pill that prevents HIV, but when you ask about how to get it, the response can vary greatly depending on where you live.

PrEP has been available on the PBS since 2018, allowing more guys than ever to access this drug across Australia. Getting PrEP now starts with a conversation between you and a doctor or GP (general practitioner).

Let’s look at how this may play out for you and solve some possible issues that may come up.

Finding a doctor for PrEP

These days, it feels pretty usual to move around a bit. When you do, you might be moving away from any previous doctors or GP practices you visited. You might have recently moved here from overseas and haven’t found a regular doctor yet. Either way – your first step to starting on PrEP will be finding a doctor you can visit near you.

Ask for a recommendation

Reach out to your friends or former partners on PrEP, and ask them if they have a recommendation. Knowing a GP has handled this type of request before can make it much easier!

If you’ve not had any luck, PrEP’D For Change and PrEP Access Now have tools to assist you in finding registered PrEP-prescribing doctors. These are doctors who have prescribed PrEP before and will be versed in gay/bi/queer men’s sexual health.

Consider the cost

With your GP recommendations or online doctor research in hand, it’s now time to consider the costs.

Accessing PrEP with Medicare

Those with access to Medicare can usually get part or all of the cost of their medical care through a GP for free. When deciding on your doctor, check to see if they offer bulk billing or private billing arrangements. A bulk billing GP will mean no cost for a visit with your doctor, whereas a private billing GP means a gap fee will be paid every time you visit – which can add up!

Accessing PrEP without Medicare

Don’t have Medicare? While it won’t be as straightforward, it’s still possible to get PrEP without it costing too much more. Public sexual health clinics are often the easiest way for people without Medicare to access a doctor consultation and tests for free and be given a PrEP script. This, however, is usually only offered for those without Medicare and on a case-by-case basis and varies between sexual health clinics. It’s best to check with the clinic before your appointment.

Otherwise, if you aren’t near any clinics but have private health insurance, it may be possible to reduce the cost of your appointments and pathology by putting a claim in with your provider.

Following your doctors appointment, another way you can save money buying PrEP is by ordering through the Personal Importation Scheme through websites like PrEP Access Now. Personal Importation allows you to purchase PrEP online with a script at an equivalent, or sometimes cheaper than the cost of getting PrEP through a pharmacy with Medicare.

Finally, you might like to reduce the cost of PrEP is by using it either on-demand or on a periodic basis. I.e. you’d be using PrEP only when you think you’ll be sexually active, making your PrEP pills last that much longer. Learn more about on-demand and periodic PrEP.

You can find a guide on accessing PrEP on a budget here or check out the community group PrEP’D For Change for more help.

Being open with your doctor

Opening up or ‘coming out’ to your doctor is part of the PrEP experience. But don’t be alarmed; it’s not destined to go the way of a TV soap opera. Instead, it’ll simply take the form of some screening questions covering the type of sex you have, who your partners are, and any previous STI diagnoses you may have had.

Many doctors won’t make a big deal about talking about your same-sex partners. However, it is good to be prepared for those who may not be as accepting of your sexuality. Considering what a negative experience might look like can help build your confidence before you get there. If it goes well, you’ve gained a person who you can trust and share your sexual health info without judgment. If your doctor is less than accepting, you aren’t required to stay for the rest of the appointment or have future visits with them.

While it may seem daunting, it’s important to remember that you’re taking a big step by taking charge of your sexual health, and no matter how the conversation goes, you should be proud of yourself!

For those who live in a regional area or an area with a tight-knit community, coming out to your doctor might pose a risk should you want to keep your sexuality or choice of partner private. Be assured that health professionals must keep personal information confidential, and there are serious consequences for those who breach this code.

Some people may feel it’s too risky and instead choose to travel to a clinic or use an online PrEP service, which is fine. Ultimately, you will be the best judge of your circumstances and must decide for yourself.

How to bring up PrEP with your doctor

PrEP is an excellent tool for preventing HIV. Still, it’s a relatively new addition to the HIV prevention space, so not all medical professionals are going to be clued into it. The first thing to know walking into the doctor’s room is that you aren’t expected to be the expert. The conversation can be as simple as:

“I’ve heard about PrEP. It’s a great way to reduce the risk of HIV, and I think I would benefit from it. Have you prescribed it before?”

If they have, you will likely have a well-informed experience ahead of you. From here, your doctor will ask you questions about your current sexual practices to determine if PrEP is suitable for you, followed by taking some blood for an HIV test and assessing your kidney function. At this point, you are more or less good to go!

Letter to your doctor

As PrEP is a form of HIV treatment medication, and providing care for people living with HIV is considered a somewhat specialised field, many GPs may not have experience prescribing PrEP.

In this instance, you can print and provide a letter that will give additional information about PrEP, its prescribing guidelines and some additional resources for your doctor to read through and consider.

The letter has been written by ASHM (Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine), a peak organisation of health professionals in Australia and New Zealand who work in HIV, viral hepatitis, other blood-borne viruses and sexually transmissible infections. ASHM regularly participates in advocacy and has developed this letter as a resource to educate doctors about PrEP. You can download the letter here and print it off before your initial visit with your doctor.

Be prepared that your doctor might still say no at first. In this case, you can wait to see if they will look further into PrEP and check back later, or instead, you might look for a new doctor known for prescribing PrEP.

Take it one chat at a time

Starting on PrEP is a process, and you have to take it one conversation at a time. Anyone who has been on PrEP has their own experience and angle to lend so talk about it with friends, perhaps some friends with benefits, and don’t forget – your doctor.

One final conversation topic you might like to share with your doctor is which dosing strategy you’d like to use! PrEP can be taken daily, on-demand, or for a period; you can even use our PrEP dosing frequency tool, which can help you decide the best type of PrEP dosing for you. So, if you have lingering questions about taking your PrEP correctly, you’ll be ready to ask your doctor.