Starting the conversation about PrEP with your doctor

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

You’ve probably heard about how PrEP is a once a day pill that prevents you from HIV, but when you asked about how to get it the response has been less then definitive. Up until recently, the only way you could access PrEP was through studies or through a self-importation process.

But the good news is that in April 2018, PrEP was listed on the PBS, allowing more guys than ever to access this drug across Australia. It’s also made access much easier. Getting PrEP now starts with a conversation between you and a doctor or GP (general practitioner), so let’s look at how this may play out for you and some possible issues that may come up.

Talking with my doctor? I don’t have a doctor!

I know that when I moved to Sydney I certainly didn’t bring any of my family doctors with me. For years, I’d kept a routine where I went to a sexual health clinic for my HIV and STI check-ups, and only saw a nearby doctor when I was feeling unwell.

I didn’t have a doctor I felt comfortable telling my Full and Complete Sexual History™ (see volumes 1-27) to. Generally I kept these discussions for moments around a campfire, or with close friends in some sort of Carrie Bradshaw-esque after-the-deed-debrief; suffice to say, talking about sex with a doctor is a pretty big leap.

If you are based in NSW, you might be able find a gay-friendly doctor nearby through this list.

However, if none on the list are located close to you, then it might be an opportunity to do some research. Chances are if you know someone who is on PrEP right now, they are likely to have a doctor they are already seeing regularly for a script and the regular testing that comes along with being on PrEP. Why not ask them for a recommendation? Additionally, both PrEP’D For Change and PrEP Access Now have tools to assist with finding registered PrEP-prescribing doctors.

It’s important to note, currently all doctors can prescribe PrEP across Australia; however not all are versed in gay/bi men’s sexual health, so finding a doctor who has experience can help you out tremendously.

OK, hopefully now we are feeling confident about finding a doctor, or perhaps you already have a doctor? Great! Let’s consider the next potential step.

Being open with your doctor

Essentially, by starting PrEP, you need to ‘come out’ to your doctor. But try not to get all in your head about it – it doesn’t have to be a “Doc, I have something to tell you. I’m gay” moment, it’s more so part of the conversation that will come up. While many doctors simply won’t make a big deal about it, there may be those who for personal reasons may not be as accepting of your sexuality.

Having this conversation can be intimidating, but you are taking a big step by taking charge of your sexual health, and no matter how the conversation goes you should be proud of yourself. Taking time to consider what a negative experience might look like can help prepare you if it doesn’t go well. If you think coming out to your doctor might pose a risk because you live in a tight-knit community or less progressive area and you are worried about privacy, remember that health professionals are required to keep the information you provide them confidential, and there are serious consequences for those who breach this code. However, ultimately you’ll need to make that decision yourself.

Having the conversation about PrEP

PrEP is a great tool for preventing HIV, but it’s a relatively new addition in 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 at reducing risk of HIV and I think I would benefit from it. Have you prescribed it before?”

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

Letter to your doctor

Remember, PrEP is a course of HIV treatment medication, which is taken by HIV negative people to stay negative. As HIV treatment is usually considered more of a specialised field, some doctors won’t have experience prescribing antiretroviral medication. That’s why you may find your doctor hasn’t prescribed PrEP before.  In this instance, you can print and provide a letter which 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) which is 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 prior to your initial visit with your doctor.

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

I don’t have Medicare, is getting tested for HIV and other STIs through a GP going to be expensive?

There may be costs involved when seeing a doctor in a general practice if you don’t have access to Medicare. Some overseas visitors can access Medicare through a reciprocal healthcare agreement, which is negotiated between the Australian government and some countries including the United Kingdom, Ireland, New Zealand, Malta, Italy, Sweden, the Netherlands, Finland, Norway, Belgium and Slovenia. You can visit the Department of Human Services website to determine if you are eligible to enrol in Medicare and access the Australian healthcare system cheaper.

Alternatively, you might want to consider getting a private health insurance policy that can help cover some of the costs of seeing a doctor and ongoing testing as this may work out more cost effective in the long run. You can find a guide on accessing PrEP on a budget here, with additional consideration on accessing PrEP if you are not eligible for Medicare.

Some sexual health clinics will also provide STI and HIV screening and will write a script for PrEP for those who are Medicare ineligible. However, this is done on a case-by-case basis and varies between sexual health clinics. It’s best to check with the clinic before your appointment.

Last things to consider

Feeling overwhelmed yet? It’s OK if you do. Starting on PrEP is a process, and you just have to take it one conversation at a time. Talk about it with friends, maybe even some friends with benefits, and ask lots of questions.

From one guy on PrEP to another, good luck!