Is Homophobia Keeping Doctors from Prescribing PrEP to Those Who Need it Most?

Even though a healthcare provider’s role is to assure the best interest of a patient’s health, new research shows that their personal values and moral judgments are likely to interfere when prescribing PrEP, a daily drug preventing an HIV-negative person from contracting HIV during sex.

Sarah Calabrese of Yale University presented research at the HIV Research for Prevention conference showing that medical students were less likely to prescribe PrEP to gay men who were not monogamous, as well as to men who acknowledged not using condoms. Contrastingly, men who were at low risk of contracting HIV had a better chance of being prescribed PrEP.

These findings were discovered after medical students were given hypothetical situations, and asked to answer them honestly. All 111 students were recruited online from two medical schools in the United States. Each of the hypotheticals revolved around gay men at high risk, AidsMap reports.

One question that stood out was whether or not they would prescribe PrEP to a gay man in a monogamous relationship with an HIV-positive man — 93 percent of the students said they would prescribe PrEP if the couple planed to use a condom as well. That number dropped to only 53 percent if the couple said they didn’t use a condom, and 27 percent to those who planned to stop using condoms altogether after being prescribed PrEP.

“This pattern is paradoxical to patient risk,” Calabrese said. “The patient who is at lowest risk is the one who is going to sustain his condom use, but he is the person who has the best access to PrEP… It is critical that PrEP access be governed by science and not by personal values.”

Furthermore, 86 percent of medicals students said they would provide PrEP to a gay man with multiple partners of unknown status, so long as he used a condom. But if he was already not using condoms, only 45 percent would prescribe PrEP. If that gay man planned to stop using condoms altogether after PrEP, only 28% of medical students said they would provide it.

Calabrese also suggested that heterosexism may be in play.

When medical students were asked about reasons that were “acceptable” for couples to stop using condoms, 69 percent said conception was acceptable. But only 13 percent said improve sexual functioning was an okay reason, while 14 percent listed an increase in pleasure, and 23 percent said an enhanced intimacy or emotional connection. Calabrese argues that in considering the risk of HIV contraction, the reason why anyone would stop using condoms is irrelevant.

This information supports studies that show only one in three doctors know about PrEP. As Plus previously reported, a survey of healthcare practitioners found that the third most common reason practitioners don’t present PrEP as an option to their patients was that these medical professionals felt they lacked the training to appropriately prescribe the prevention treatment. Other reasons included a “lack of demand” and “lack of insurance coverage.”