A small qualitative study of a group of early prescribers of Truvada (tenofovir disoproxil fumarate/emtricitabine) as pre-exposure prophylaxis found the clinicians did not see widespread increases in sexual risk taking among their patients on PrEP.
Publishing their findings in AIDS Patient Care and STDs, researchers interviewed 18 medical providers about prescribing PrEP to their patients, speaking with the clinicians between September 2014 and February 2015. PrEP’s popularity, which began to rise in late 2013, had gathered considerable steam by this period.
The clinicians ranged in age from 31 to 53 years of age, with an average age of 34. Seventy-two percent were male. Thirty-nine percent were white, 33 percent were Asian and 44 percent identified as LGBT. Ninety-four percent were medical doctors, and 77 percent were infectious disease specialists.
Ninety-four percent of the clinicians had prescribed PrEP as a part of their clinical practice to a median six patients, ranging between two and 56 patients. Thirty-nine percent had prescribed PrEP as a part of a research study, to a median 145 patients and a range of one to 300 patients.
The clinicians did not relay data about any changes in sexually transmitted infection rates (STIs) documented among their patients after starting PrEP—a potential objective indication of shifts in sexual risk taking. Studies have been mixed in their findings of whether starting PrEP is related to an increase in STI rates.
The study members reported subjective findings about sexual risk taking among their patients on PrEP, specifically reported condom use rates. They found that their patients’ behavior patterns with regard to condoms tended to remain consistent after starting PrEP, particularly if they were already consistent about never or always using condoms (as opposed to inconsistently using them) before starting PrEP. According to the clinicians, subsets of their patients on Truvada as HIV prevention reported both increases and decreases in sexual risk taking.
The researchers found that the health care providers’ attitudes about PrEP tended to fall into three general themes. The clinicians:
- Saw themselves as source of support for their patients in making informed sexual health decisions.
- Believed that the HIV risk reduction gained from taking PrEP outweighed any potential increase in sexual risk taking among their patients.
- Considered PrEP unduly stigmatized by individuals both within and outside of the health care community. For example, excess risk taking relating to starting cholesterol-lowering statins, such as eating a poorer diet, are not similarly stigmatized.
Some of the providers acknowledged that they had evolved in their own thinking about PrEP over time, overcoming ambivalence about prescribing it and ultimately looking more favorably on the risk reduction method and its potential relationship with shifting sexual risk taking.
To read a press release about the study, click here.
To read the study abstract, click here.