Provision of PrEP for HIV Prevention May Be Undermined by Clinician Bias

According to the results of a survey published in the Journal of the International AIDS Society, medical students may not be providing the recommended HIV preventive measures to eligible patients.

At this time, US clinical guidelines recommend preexposure prophylaxis (PrEP) in HIV-negative men who have sex with men (MSM) who are in nonmonogamous relationships and have recently engaged in condom-free anal sex or recently acquired a bacterial sexually transmitted infection. However, PrEP remains underused.

To further investigate this problem, the researchers distributed an online survey to 854 medical students in the Northeastern United States, of which 111 participated.

The survey presented 6 male patients who differed by condom use and sexual behavior. Condom use was categorized as sustained use, sustained nonuse, and discontinuation with PrEP. Behavior was divided into either sex with 1 male partner with untreated HIV or sex with multiple male partners with unknown HIV status. Background information on PrEP was provided.

Participants were surveyed on their willingness to provide PrEP and their perceptions of 4 reasons for condom discontinuation, including pleasure, sexual function, intimacy, and conception.

Results showed that medical students were generally willing to provide PrEP to patients using condoms, with plans to sustain condom use (93% for patients with 1 partner vs 86% in patients with multiple partners). However, if patients did not use condoms and planned to sustain nonuse, willingness to prescribe PrEP declined (53% and 45%, respectively).

These percentages dropped further for patients who used condoms but planned to discontinue (27% and 28%, respectively). Participants were less willing to provide PrEP to patients with multiple partners vs single partners.

Sixty-nine percent of participants accepted conception as a reason for condom nonuse. However, reasons such as intimacy, pleasure, or sexual function received less support (23%, 14%, and 13%, respectively).

The study was limited by its generalizability; medical students are less experienced than physicians.

“Our findings suggest a need for PrEP training curricula and clinical guidelines to explicitly support PrEP provision to patients who choose to engage in condomless and non-monogamous sex and ensure providers realize the value of PrEP as a singular form of HIV protection,” the authors wrote.

Disclosures. Multiple authors report affiliations with the pharmaceutical industry.

Reference

Calabrese SK, Earnshaw VA, Underhill K, et al. Prevention paradox: Medical students are less inclined to prescribe HIV pre-exposure prophylaxis for patients in highest need [published online June 22, 2018]. J Int AIDS Soc. doi: 10.1002/jia2.25147