Page 37 - Layout 1

HEALTH CARE

Figure 1:

We need to reach out to and test more adolescents, because new HIV diagnoses nearly doubled among 15- to 24-year-olds in Texas
between 2005 and 2014 [3]. Unfortunately, only about 4 in 10 HIV-infected youths realize that they are infected [3].

These are chilling numbers. We in healthcare have a moral obligation to intervene, especially now that we have an effective preventive
measure. PrEP falls squarely in the purview of family medicine and general internal medicine. It’s like any other medicine where you see a
patient every three months and do a reassessment, not so different from managing high blood pressure or diabetes. The medication is covered
by all major insurers and is free to low-income patients under the manufacturer’s Medication Assistance Program. Emerging evidence
indicates PrEP may even be effective if taken only intermittently, before and after sex [4].

Figure 2:

For doctors, providing PrEP means being comfortable asking, “Do you have sex with men, women or both?” and “Is there anything you
do to reduce your risk of sexually transmitted infections,” such as condoms, mutual monogamy, and avoiding alcohol and drugs before sex.
To become comfortable with these questions — and to understand why routinely inquiring about sexual orientation is important in primary
care — consider taking free CME modules available at LGBThealtheducation.org.

For patients, asking about PrEP may mean coming out to their doctors. This can be scary, as many in the lesbian, gay, bisexual and trans-
gender (LGBT) community have had negative experiences with the healthcare system. Doctors can signal that patients can feel safe coming
out to them by something as simple as a rainbow sticker or LGBT-friendly waiting room materials.

Among both physicians and patients, we need an attitude shift. I hear people ask, “Won’t people be more likely to have unprotected sex
if we give this medicine?” Consider how we manage other conditions that are less stigmatized than HIV. If I prescribe a statin for high cho-
lesterol, might the patient start eating more ice cream? A few might, but most people either continue their current behavior or with luck

continued on page 38
visit us at www.bcms.org 37