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PrEP and Health Equity
Why Offering PrEP Is One of the Best Practice Decisions I Have Ever Made

Released: August 12, 2025

Nikita S. Pete
Nikita S. Pete
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Key Takeaways
  • To my surprise, incorporating PrEP into my workflow has been remarkably straightforward.
  • Normalizing PrEP normalizes dignity. When I talk about it the same way I talk about diabetes prevention or flu vaccines, patients see that their health matters and that it’s okay to prioritize themselves.

When I first became a Family Nurse Practitioner, I knew that I wanted to do more than just treat illness—I wanted to be proactive about preventing it. Over the years, I have worked closely with underserved populations, and I have seen firsthand the multitude of ways in which health disparities, stigma, and lack of access can allow preventable conditions to thrive. HIV is one of those conditions, especially in the southern United States. That is why I made the decision to start offering HIV pre-exposure prophylaxis (PrEP) in my clinical practice, and I honestly wish I had started sooner.

Why I Started Offering PrEP
The decision to integrate PrEP services was not just a professional choice; it was deeply personal. I have had many patients express concerns about HIV risk but not know where to start or not feel safe enough to ask questions about how to protect themselves. I’ve seen this particularly in Black and Brown individuals, LGBTQ+ youth, incarcerated youth and adults, and women.

Too many times, I have seen fear or shame silence important conversations, and I wanted to change that narrative. I wanted my practice to be a space where patients could talk openly about sexual health without judgment. Starting to offer PrEP services was a natural extension of my commitment to health equity and prevention. I wanted to meet people where they are, provide evidence-based care, and empower them to protect their health on their own terms.

Offering PrEP Has Been Straightforward
To my surprise, incorporating PrEP into my workflow has been remarkably straightforward. Once I became familiar with CDC guidelines and best practices, everything started falling into place.

Initiating PrEP begins with a simple conversation and a routine sexual health history. From there, it moves to offering education, conducting baseline labs (including HIV testing, kidney function assessment, and sexually transmitted infection screening), and prescribing the medication. Electronic health records make documentation and lab tracking seamless.

I have also found that patients are incredibly receptive once they understand what PrEP is and how it works. Most are relieved to hear they have a proactive option that fits into their lifestyle and gives them peace of mind.

The logistics of follow-up visits every 3 months for labs and check-ins can be easily integrated into routine primary care appointments or telehealth, depending on the patient’s preference. Some patients come in for quarterly labs and combine it with their wellness visits; others opt for brief virtual follow-ups. The flexibility makes it accessible and patient-centered.

The Barriers—Especially in the South
As I celebrate the progress of expanding PrEP services, I remain grounded in the barriers my patients still face, particularly in the US South, where the burden of HIV remains highest.

Stigma is one of the most pervasive challenges. Here in the South, cultural and religious beliefs often fuel shame around sexuality and HIV. Many people associate PrEP with being gay, promiscuous, or already having HIV, so they avoid even asking about it. I have had patients whisper their questions or wait until the end of the visit to bring it up, clearly fearful of being judged.

There is also a shortage of PrEP-providing healthcare professionals (HCPs), especially in rural or underserved areas. Patients may have to travel long distances just to find someone knowledgeable and willing to prescribe it. In these cases, transportation makes quarterly follow-ups challenging. If a person must take time off from work, find childcare, and drive 45 minutes to a clinic, that is not “accessible care.”

Too many people still don’t know that PrEP exists, or that it’s for them. PrEP is not just for men who have sex with men, it’s for anyone who could acquire HIV, including heterosexual women, transgender individuals, people with multiple partners, and those in mixed status relationships. These groups are often left out of PrEP discussions.

In many practices, sexual health is not part of routine care conversations due to lack of training, lack of time, or discomfort on the HCP’s part. It is also critical to keep in mind the deep medical mistrust rooted in generations of systemic racism that makes some patients hesitant to engage at all, even when the service is available.

Cost and insurance coverage also pose significant obstacles. Although assistance programs exist, navigating them can be overwhelming. In states that did not expand Medicaid, like many in the South, low-income individuals may fall into a coverage gap, earning too much for Medicaid but too little for marketplace subsidies.

What I Have Learned and What’s Next
The biggest lesson I have learned is that normalizing PrEP normalizes dignity. When I talk about it the same way I talk about diabetes prevention or flu vaccines, patients see that their health matters and that it’s okay to prioritize themselves.

I have also learned to never make assumptions about who might benefit from PrEP. Every person deserves information and options. Every person deserves to be met with respect, not assumptions. Offering PrEP has not only enhanced my clinical practice, it has deepened my purpose.

I believe every primary care provider should offer PrEP, and every patient should feel empowered to ask about it. The work continues, especially here in the South, where stigma is still strong and access is still unequal. Change starts with HCPs who are willing to lead with compassion, evidence, and a little bit of courage.

Your Thoughts?
Have you incorporated PrEP services into your primary care practice? If you have, are there any tips you can share with other HCPs on implementing PrEP in their primary care practice? If not, what challenges are preventing you from taking this step? Share your thoughts by posting a comment.

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