Talking to Your Doctor

Talking to your doctor about PrEP can be scary. Writing a prescription is the doctor’s choice, and they may choose not to provide you with one for any number of reasons. So, when approaching your doctor about PrEP, you might want to come prepared.

Prescribing and maintaining PrEP follow-up can be done by a primary care physician. You do not need to be referred to an HIV specialist.

We recommend that you print and bring with you the following CDC resource on prescribing PrEP and how to properly manage ongoing care.

Print and bring these documents with you when you go to see your doctor.

Taken from Centers for Disease Control Morbidity and Mortality Weekly: https://stacks.cdc.gov/view/cdc/29015

For more information on PrEP see: https://www.cdc.gov/vitalsigns/pdf/2015-11-24-vitalsigns.pdf

You may also want to read this script from the Gay Men’s Sexual Health Alliance to understand the kinds of questions you might be asked during your visit and how to answer them.

Tell your doctor why you’d like to go on PrEP. Think of the reasons that apply to you and talk honestly about them.

• I have a hard time sticking to condoms, even if I want to.
• I’m having sex with poz guys, either because we’re hooking up or dating.
• I have sex when I’m drunk or high.
• I like to hook up with a lot of guys.
• I don’t always use condoms.
• I don’t know the HIV status of the guys I’m hooking up with, and I can’t always talk about it with them.
• There are things in my past that make it hard for me to make the decisions I want to when it comes to sex.
• Guys pressure me into having sex without condoms. Some say they’re negative, or that they’re on PrEP, and it’s easy to give in.
• I want to take control over my sexual health and PrEP will help me do that.
• I’ve been sexually assaulted and I want to protect myself.
• I’m working as an escort, rentboy, or sex worker.

Different doctors know different things about PrEP, and some might be more supportive than others. It’s their job to ask about the different things that affect your health, so they know what to say.

Here are some things your doctor might say to you:

Why don’t you use condoms?

Did you know that it’s recommended to use condoms on PrEP anyway?

PrEP requires a routine: You have to take PrEP every day at the same time, and you have to get tested every three months for HIV and sexually transmitted infections (STIs).

If you don’t always use condoms, tell them what really happens and why:

• I like having sex but it isn’t always easy for me to use condoms.
• Sometimes guys don’t want to talk about condom use.
• I’m encountering guys who don’t want to use condoms more often, and it’s hard to insist.
• Sometimes guys tell me that they’re negative or on PrEP, so I don’t ask for a condom.
• Sometimes I’m not totally with it in the moment I’m hooking up, because of the heat of the moment or because I’ve had a lot to drink or I’m high.
• If I can protect myself in advance, I want to do it.
• I’ve been in situations where men have fucked me without a condom without my permission.
• I’ve been in situations that make talking about what I want really hard for me.
• Like women who are on birth control, I want to use a different method to look after my sexual health than just condoms.

Your doctor might also bring up the price, which is quite high. If you have private insurance, like a workplace health plan, these cover PrEP some of the time. Or maybe you’ve budgeted it out and found that you can afford the $1000 a month or so that it costs without insurance.

If you’re thinking of approaching your insurance provider about PrEP, talk to your doctor about how to do that. You might also talk to somebody at an HIV and AIDS service organization, somewhere that does testing, or other sexual health organizations — they often know the best way to talk to your insurer.

Some doctors may worry that they’re giving you permission to have sex without condoms, take chances they don’t think you should be taking, or have lots of sex.

Make sure you explain that for whatever reason, only using condoms is not working for you. Your sexual health will be in better shape if you have PrEP as one of your sexual health strategies.

What if my doctor says no?

Hopefully your doctor won’t say no. There are a few reasons doctors might not want to prescribe PrEP: they may not know about HIV and PrEP; may not feel comfortable prescribing HIV treatments; or they may feel you are not eligible based on the guidelines they are using.

If they do say no, even though you’re sure you want to go on PrEP, you can ask for a referral to speak with someone who knows more about HIV and PrEP. Or, go to a different clinic. You can contact HIV and AIDS service organizations in your community. They might know of other providers who are prescribing PrEP.