Doctors in the USA see few cases of risk compensation among PrEP users

26 April 2017

Most healthcare providers cite worries over risk compensation after providing PrEP, but experiences among doctors who do prescribe PrEP are positive.


Shirtless man holding a PrEP pill

Doctors in the USA with experience prescribing pre-exposure prophylaxis (PrEP) to men at high-risk of HIV saw few cases of increased sexual risk-taking behaviour among the men – one of the most commonly cited reasons by healthcare professionals for not prescribing PrEP.

PrEP is a daily pill of antiretroviral treatment taken by HIV-negative people to limit their chances of getting HIV. It has been shown to be over 90% effective in reducing the risk of getting HIV during unprotected sex, and is now a recommended HIV prevention strategy by the World Health Organization among key affected populations.

It is thought that some 1.2 million Americans are at a high-risk of HIV and eligible for PrEP, but less than 100,000 people are accessing Truvada, the brand name of the drug prescribed for PrEP.

Many healthcare professionals in the USA are under the impression that giving this vital drug to people most at-risk will increase the likelihood that they will take more chances with their health – but the evidence suggests otherwise.

In a qualitative study conducted among 18 US-based healthcare providers who commonly prescribe PrEP, researchers from George Washington University found that doctor’s experiences and attitudes towards providing PrEP broadly fit into three themes:

  • Provider’s role was to support patients to make the right decisions for their own health.
  • Protective benefits of PrEP outweighed any risky behaviour and still resulted in net protection.
  • Stigma relating to PrEP and risky sexual behaviour is still unjustifiably prevalent from within and beyond the healthcare community.

Lead author Sarah Calabrese commented: "As public awareness about PrEP increases and more at-risk individuals actively seek out PrEP from their healthcare providers, there is an urgent need to prepare providers to respond appropriately."

"This includes not only enhancing providers' comfort and competence prescribing PrEP or referring patients elsewhere for PrEP care but also educating providers about reacting to patient inquiries in a sensitive and professional way."

What is clear is that the experiences of those doctors who feel comfortable providing PrEP are different from the perceptions of the wider community, and interventions also need to target the providers themselves, as well as the populations who would benefit from PrEP.

Photo credit:
iStock/ Marc Bruxelle

Written by Caitlin Mahon

Content Specialist - HIV & Sexual Health