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Effective PrEP Communication
The Value of Effective Patient‒Provider Communication When it Comes to PrEP Persistence: A Patient’s Perspective

Released: July 18, 2023

Tony Brown
Tony Brown, MPH
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Key Takeaways
  • Healthcare professionals should not make assumptions about their patients’ sexual history, values, or preferences.
  • Patients need open and honest communication with their provider when discussing their PrEP options.
  • Having these effective patient‒provider conversations will allow patients to feel empowered when taking PrEP and help them better adhere to their preferred regimen.

I started taking pre-exposure prophylaxis (PrEP) in 2016 at the encouragement of my former partner. I am still using PrEP today, despite no longer being in that relationship. It’s become a habit for me, particularly during the time after that relationship when I was learning to be positive about sex and my body.

However, over the years, I have dealt with fluctuations in adherence with taking daily PrEP because I’ve experienced pill fatigue, evolving relationship situations, and fears of medication toxicity and long-term side effects, and I’ve simply had extended periods of time with no sexual encounters.  

Being Open and Honest
Having open and honest conversations with my provider was essential to support me during these adherence fluctuations. The providers who engaged me the most were those who didn’t attempt to sway my decision in any way, but instead sought to provide me with the most current and relevant information.

I had a provider who judged me for using the 2-1-1, or “on-demand,” PrEP method—you take 2 pills 24 hours before having sex, 1 pill 24 hours after the first dose, and then 1 final pill 24 hours after the second dose. Instead, they insisted I take it once daily, as prescribed. That same provider didn’t ask me about my sexual history or regular sexual activities; they just assumed that I would not have the self-efficacy to follow the 2-1-1 instructions and that it would it be ineffective with my presumed level of risk.

Even when I took the medication every day, as prescribed, I still feared a breakthrough infection when being tested for HIV. The various scenarios of “what if” can be plaguing and paralyzing. These conversations with my provider could be challenging because I feared being chastised or judged by them. What if the medication stopped working for me? What if I missed a dose and some unplanned sexual encounter happened, and my provider thinks I’m a complete idiot and is disappointed in me (giving me a feeling of personal failure) if I have a positive HIV test? What if I contracted a sexually transmitted infection? What if I had to miss a week of doses because I changed jobs and my new health insurance policy has yet to be established? To overcome doubts like these—to feel comfortable continuing PrEP—I need a provider who engages with me, not one who judges me.

What Healthcare Professionals Need to Know
It is vital that healthcare professionals have meaningful conversations with their patients about their experiences and encourage health literacy. We, as patients, are often juggling many constantly changing life situations that alter how we value PrEP and may alter our consistency with following a selected regimen. If our providers can establish open and effective communication before we resort to figuring things out independently, they could help us persist on the most effective PrEP regimen for preventing HIV.

Your Thoughts?
How do you approach discussions with patients about PrEP and the regimen options that might best fit their lifestyle and values? Join the discussion by posting a comment below.