It’s unhelpful to frame the use of pre-exposure prophylaxis (PrEP) in terms of ‘risky behaviour’, Sarit Golub, professor of psychology at the City University of New York told the HIV Research for Prevention conference (HIVR4P 2018) in Madrid last week. Healthcare providers and those developing materials to educate on PrEP should focus on reasons why people might want to take PrEP other than because they are ‘high risk’, she argued.
It’s very common for PrEP programmes to use – or to try to develop – risk assessment tools. They promise an objective means of identifying the individuals who are most likely to benefit from PrEP. But they are not helpful during conversations with potential PrEP users, she said.
The information gathered may not be accurate, due to less than perfect relationships between clinicians and their patients. Significant numbers of American gay and bisexual men say that they are not comfortable talking to their primary care provider about their sexual behaviour. Black men are particularly likely to report that interactions with providers are ‘scripted’ in ways that don’t allow full disclosure.
The questions are confusing for people, she said. They tend to focus on numbers – how many partners have you had in the past six months, how many times did you have condomless receptive sex, and so on. This communicates to people that the quantity is the most important factor, whereas it’s clear for example that black gay men’s elevated risk for HIV acquisition is not due to having more sexual partners. Questions about how many partners were HIV positive reinforce the idea that it is easy to know a person’s HIV status.
“There’s a huge data disconnect in risk assessment,” she said. While having validity across a population, the tools are quite poor at accurately predicting an individual’s risk of acquiring HIV. She gave the example of a study of young black men who have sex with men in Chicago, which found that men who acquired HIV were no more likely to be eligible for PrEP – in three different guidelines – than men who did not seroconvert.