HIV prevention drug: “Stigma is a thing that still exists”

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There’s no room for stigma when it comes to GPs prescribing a safe sex drug commonly used by gay men, says a top doctor.

PrEP, also known as Truvada, helps protect against the HIV virus.
Photo: New Zealand AIDS Foundation

Pre-exposure prophylaxis (PrEP) is up to 99% effective in preventing HIV, and this week Pharmac announced that it was revising the criteria for funding prescriptions for the drug.

However, safer sex advocates said doctors needed to be more confident in prescribing it, that some patients were stigmatized by doctors when trying to get a prescription, and that they wanted to see LGBQTIA+ health care s ‘to improve.

As of July 1 this year, some previous criteria for a funded prescription have been removed, including a heavily criticized stipulation that the patient had had unprotected receptive anal sex with a casual partner in the previous three months.

Instead, it now required the patient to be at risk, but test negative for HIV, and his doctor to believe it was “clinically appropriate” for him.

Mark Fisher, executive director of HIV peer support organization Body Positive, said a lot of work had been done to raise awareness of the drug, but more was needed.

“The stigma of PrEP is something that still exists,” he said.

“We have to normalize it, so it has to become like viagra or the birth control pill.”

He said his organization’s clients had been unable to obtain prescriptions because their GP did not feel “comfortable” prescribing it.

Similar experiences were highlighted by sexual health researcher Peter Saxton (who led the study on sex and the prevention of transmission), in his submission to Pharmac on the change in criteria.

Dr Peter Saxton of the University of Auckland says Pharmac's criteria for accessing funded PrEP needs to change.

Researcher at the University of Auckland, Dr Peter Saxton
Photo: RNZ / Jake McKee

He used unpublished data from the study, which included comments about a nurse saying “how all gay and bisexual men should stop being promiscuous” when someone mentioned wanting to be on PrEP, a GP saying to another person “it was disgusting” and they “should just use a condom”, and others feel judged.

Royal College of GPs medical director Bryan Betty said such experiences “would be a very unusual situation” and should not happen.

“Basically, GPs who are professionally trained and professionally registered are trained to take a non-judgmental approach to patients – and that would be the expectation of the College.

Porirua GP Bryan Betty Clinic recently raised appointment fees to cover a $130,000 shortfall

Dr. Bryan Betty
Photo: RNZ / Karen Brown

He said there was training “freely available” online for healthcare professionals to get up to speed and learn about PrEP.

Betty said Pharmac’s changes would help more medical professionals become aware of the drug as more patients get prescriptions.

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