New Year, New Conversations: Talking to Your Doctor About HIV Prevention

Erin Duhaime, PA-C, AAHIVS

Credit: MD Progressive Care

For many people, the start of a new year comes with a familiar to-do list: annual physicals, routine lab work and long-overdue health conversations. But one topic that often gets overlooked, or feels uncomfortable to bring up, is HIV prevention. Even as awareness grows and prevention options expand, many patients still aren’t sure when, how or with whom to start the conversation.

Erin Duhaime, PA-C, AAHIVS, a physician assistant and HIV specialist at MD Progressive Care, believes annual checkups are an ideal, and often underused, opportunity to talk openly about sexual health and HIV prevention. In a Q&A with The Educated Patient, she explains why these conversations matter for everyone who is sexually active, how patients can ask the right questions without fear of judgment, and why education, transparency and shared decision-making are key to protecting long-term health.

Many people are scheduling their annual health checkups. Why is this an ideal time for patients to talk with their health care provider about HIV prevention?

Erin Duhaime, PA-C, AAHIVS: For both health care providers and patients, there is never a bad time to be talking about HIV prevention. But especially, as we head into the new year, health and wellness are often top of mind for everyone, and this creates an opportunity for an intentional touchpoint for doctors and patients to have broader discussions about sexual health and wellness in the context of overall, whole-body health.

This includes talking about topics like your sexual practices, sexually transmitted infections (STIs), reasons for HIV prevention, contraception, etc. Regardless of what our patients are doing sexually, it’s essential that we’re having open and honest conversations with them because, as health care providers, these are the kinds of things that help us determine how we can keep our patients safe and align on a health plan that will best support each person heading into the new year.

What are the most important questions patients should ask during a visit if they’re curious about HIV testing or prevention?

ED: In general, it’s so important for patients to be as transparent as possible with their health care providers. It’s critical that we establish strong, trusted relationships with our patients to ensure they feel comfortable raising their concerns during visits.

In my practice, I do my best to set the tone for openness — this is a no-judgment zone. Knowing more information about my patients’ lives will only allow me to be better at my job, so I’m asking questions like how many sexual partners have you had in the last 30 to 90 days, what are you doing sexually, do you know your partners’ HIV status, what percentage of the time are you using condoms, are you having chemsex, and so on. This way, I can assess an appropriate care plan for each person based on their experiences, whether it be testing or considering medication.

This also gives me an opportunity to reference their chart and health history and show them why they may have reasons to consider HIV prevention. As a provider, I want my patients to come to me to discuss available options for HIV prevention and pre-exposure prophylaxis (PrEP) so we can make decisions together about what best suits them.

I had a patient say, “Hey, I saw something on a dating app about this injectable that’s administered every two months. What do you think about that?” And that gives me an opportunity to discuss long-acting injectable (LAI) PrEP and explain some of the benefits for long-acting options, like less frequent dosing compared with daily oral PrEP, as well as the chance to discuss LAI considerations like safety and tolerability. It also gives me a chance to reinforce that PrEP should be used as part of a comprehensive toolkit, along with condoms and other tools, to help protect sexual health and wellness. I want everyone to be empowered to raise these kinds of topics and questions, even if your health care provider isn’t asking you first.

How can patients talk openly about HIV prevention with partners, family members or friends in a way that feels safe and supportive?

ED: As I mentioned before, transparency is key. I’ve often found that talking about HIV prevention with loved ones can happen more organically in casual settings where everyone is comfortable. We’re also currently in a bit of a sex revolution where talking about these things is becoming less taboo and less stigmatized, and people are encouraged and feeling more empowered to talk openly and honestly about HIV and PrEP to help prevent HIV transmission.

Talk to your friends, talk to your family — ask what other people are doing. Everyone can learn something from having these conversations, and the more you talk about it, the easier it becomes. Be educated and be empowered by the fact that there are more HIV prevention options available now than ever before. New year, new me — let’s start talking more about what we’re doing to protect our sexual health and help prevent HIV.

You’ve spoken about your own experience using cabotegravir for HIV prevention as a cisgender woman. How has this shaped the way you talk to your patients about PrEP, and why do you feel it’s important for everyone, regardless of gender or background, to understand their HIV prevention options?

ED: Yes, my personal experience has certainly shaped how I can support my patients. For many people, they show up to their doctor’s office and can feel like they’re only being talked to or talked at. Each patient-provider relationship is unique but, in my practice, I take a more personalized approach and am very honest with my patients about how I protect my sexual health and which HIV prevention medicine I’m taking to facilitate a trusting, open environment. I invite them to ask me questions as well, so our conversations aren’t just about what options are available, but they’re also about my experience taking those medicines.

I have a unique perspective to offer as both a provider and someone with this personal experience, so I always share that with my patients. It helps us build a strong, trusted relationship so they also feel more confident and comfortable having these discussions with me. If they have a side effect, they know they can come to me and tell me more about it, when and how it started, etc. In my practice, I’ve learned that in addition to the data, my patients really value real-world information from me as their provider.

To answer the second part of your question, HIV prevention is important for everyone to know about, because we all have the same goal of staying as healthy as possible for as long as possible. HIV treatment has come so far — people with HIV can live long, healthy lives; however, when a person is living with HIV, they have a higher risk of comorbidities and other health complications. It doesn’t matter what a person’s background is — if a person is sexually active, they should be educated about HIV and prevention options.

I encourage people to take their sexual health and wellness into their own hands, and I want everyone to be equipped with the latest information and education on HIV prevention to help them feel more confident. More education about HIV generally and HIV PrEP will only help bring us closer to meeting our goal of ending the HIV epidemic in the U.S. for good.

What are some common concerns patients share when learning about PrEP for the first time, and how do you help address them?

ED: A common concern I hear about is patients being interested in decreasing their risk of HIV but not wanting to take another pill, as many are already taking a lot of other medications. Or they may have heard about other people who have side effects from their HIV prevention medication and are hesitant to start PrEP because of that. When it comes to long-acting PrEP options, people ask about injection site reactions and nodules. Many of my patients are already doing their own research and coming to me informed and with questions about side effect profiles of PrEP medicines during our visits. Some of my patients also come to me with questions about how often they’d have to come into the office for an LAI injection, and I use that as an opportunity to focus on the positive and reinforce the importance of these touchpoints in talking about other concerns for their overall health.

If someone is hesitant or feels embarrassed asking their provider about HIV prevention, what would you want them to know?

ED: A lot of offices like mine have become equipped with electronic health records through a patient portal, so if patients aren’t comfortable talking about their sex practices, I encourage them to utilize that portal and communicate with me there. This can also be a helpful tool if someone forgets to communicate something during their visit or feels like their health care provider may not be comfortable discussing certain topics.

But as I said before, speaking openly with your doctor is so important, so make sure you find a care team that you can connect with and feel comfortable sharing the information you need to protect yourself.

Duhaime was compensated by ViiV Healthcare for her participation in this story.