You Want PrEP, but Your Doctor Disagrees

By Kellee Terrell From Test Positive Aware Network

Summer 2015

If there are two things that we know about PrEP, the first is that it's super effective in reducing one's risk of contracting HIV. The second is that bringing it up at your next doctor's appointment can be particularly stigmatizing, especially for those who are trying to access the little blue pill in a traditional healthcare setting.
So what can you do to make sure that your voice is being heard?

"First things first," says Bryan Bautista-Gutiérrez, PrEP Coordinator for Howard Brown Health Center in Chicago. "You really have to do your research before you set foot into the doctor's office asking for PrEP," he emphasizes.

According to Bautista-Gutiérrez, this work can include:

Assessing your actual risk for transmission: "I see a lot of clients who come in asking for PrEP, who have boyfriends who are HIV-positive, but have an undetectable viral load, making transmission very difficult." So PrEP is an additional layer of protection that they may or may not want to consider.

Talking to your friends: It's interesting that we can talk to our friends about PrEP, but healthcare can still be a barrier. Start a conversation with your friends about whether they are on PrEP, or know of someone who is and who prescribes it to them.

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Getting online: Thanks to the Internet, you can access mounds of trusted information about PrEP including how it works, side effects, follow-up tests, and strategies to combat doctor bias. In addition, depending on where you live, there are online directories that can tell you where the closest PrEP provider is in your area. So get to Googling. (See a list of resources on page 20.)

Finding a local LGBT/HIV health clinic: We recognize that in too many areas in our country, such as the rural South, healthcare facilities that specialize in PrEP may seem like a pipe dream. But for those who do have one, opt for accessing their PrEP program in order to increase the odds that you are receiving culturally competent care, although even long-time sexual health providers and community clinics might not yet serve transgender people and people who currently or formerly injected drugs.

And once you get to the doctor's office, Bautista-Gutiérrez, stresses, "There isn't a lot of time in your appointment to beat around the bush, so use this time wisely and advocate for yourself."

Standing your ground: Communicate clearly and succinctly that you believe PrEP is an important prevention tool that you need. Don't be afraid to be assertive or ask questions about lab work processes, follow-ups, and prescriptions.

Being willing to listen: While homophobia and other forms of intolerance are real issues, PrEP is relatively new, especially to providers who may have little to no HIV/AIDS experience. What may seem like slut shaming may also be your doctor demonstrating their lack of knowledge about HIV and prevention. And if that seems to be the case, ask for a referral to a provider who has more experience with PrEP. Referrals are also a good option when providers are medically uncomfortable providing PrEP.

Speaking up and out: If you do feel that your doctor is judging you or making assumptions about you, drop them and find a new physician. Remember: You are entitled to respectful healthcare that is culturally competent and empowering.

Granted, when it comes to PrEP, not all of the responsibility should be placed on the patient. Therefore "doctors really do need to get over themselves when it comes to bias," says David Malebranche, M.D., M.P.H., a primary care physician at the University of Pennsylvania's Student Health Center in Philadelphia. "PrEP is not a hard drug to prescribe to patients, nor is the follow up."

But Malebranche stresses that in order to make PrEP a household word in healthcare settings, eradicating bias isn't enough. Doctors, nurses, and other healthcare staff are in dire need of support -- both structural support for the logistics of offering culturally competent sexual healthcare and to address barriers in the public health realm.

Kellee Terrell is an award-winning filmmaker and freelance writer who writes about race, gender, health, and pop culture. Her work has been featured in Essence, the Advocate, The Root, POZ, The Huffington Post, and TheBody.com.