HIV Prevention and the Role of Therapy: To PrEP or Not To PrEP?

Person with large glasses, beard, and short hair uses computer to do researchI am frequently asked by sexually active people in therapy, particularly gay men, what I know about PrEP for the prevention of HIV infection and whether it might be right for them. This is an excellent question to bring to a knowledgeable therapist, as choosing to begin this form of HIV prevention can bring up a host of feelings and mental health concerns. However, because at its core HIV prevention is a medical issue, I always suggest people have a similar discussion with their primary care provider.

What, exactly, is PrEP? PrEP stands for pre-exposure prophylaxis, a preventive measure taken before possible infection with a virus—in this case HIV. PrEP is for individuals who are HIV-negative and involves taking HIV medications on a daily basis to lower the chances of becoming infected with HIV.

PrEP can stop HIV from taking hold and spreading throughout the body. The medication approved for this treatment is called Truvada. Truvada is a combination of two HIV medications: emtricitabine and tenofovir disoproxil fumarate. According to the Centers for Disease Control and Prevention (CDC), “Daily PrEP reduces the risk of getting HIV from sex by more than 90%. Among people who inject drugs, it reduces the risk by more than 70%. Your risk of getting HIV from sex can be even lower if you combine PrEP with condoms and other prevention methods.”

Numerous questions, feelings, and emotions could arise before beginning PrEP, including those related to:

  • Anxiety over what side effects, if any, taking Truvada will have
  • Relief, knowing the risk of contracting HIV can be significantly reduced in sexual encounters
  • Readiness to commit to taking medication on a daily basis and to being tested for HIV and other sexually transmitted infections (STIs) on a regular basis
  • Willingness to take stock of alcohol and substance use/abuse, as this can greatly affect the ability to take medication on a daily basis
  • Ability to pay for potentially expensive medication and/or access to medical insurance

All of the above are important issues to discuss with a therapist before making the decision to begin PrEP. For some individuals, therapy can help with not just the question of “should I or shouldn’t I,” but also “why do I want to begin PrEP?” On the surface, the answer to “why?” seems obvious enough: the chance to avoid infection with a potentially life-altering or life-ending virus. However, for many people, the possibility of being able to have sex without condoms is a powerful motivating factor.

It is important to also remember that dispensing with condom use may put a person at increased risk for infection with STIs other than HIV. So individuals taking PrEP, particularly those no longer using condoms, should still be regularly tested for STIs.

Although research shows using condoms along with PrEP reduces the chances of becoming infected with HIV even further, some individuals on PrEP choose to stop using condoms during sex. In my professional experience, gay men in particular have voiced several reasons for stopping condom use while on PrEP:

  • Greater sense of physical intimacy with partners
  • Removal of an object from sexual encounters that was a constant reminder of HIV and AIDS
  • No longer worrying about allergic reactions to latex, losing an erection while using a condom, or interrupting an encounter to search for one

For some people, these might not seem like significant concerns in comparison to avoiding becoming infected with HIV, but for many, the desire to do away with condoms is powerful. It is important to also remember that dispensing with condom use may put a person at increased risk for infection with STIs other than HIV. So individuals taking PrEP, particularly those no longer using condoms, should still be regularly tested for STIs. There must be a level of trust and comfort with medical providers to discuss these personal issues openly and honestly. A good therapist can help build on this process, helping the individual explore barriers to trust and honesty.

All these factors considered, the question of “why” one wants to begin PrEP is significant enough to warrant some time in a therapeutic setting.

References:

  1. PrEP. (2017, April 17). Retrieved from https://www.cdc.gov/hiv/basics/prep.html
  2. What is TRUVADA? (2016). Retrieved from http://www.truvada.com

© Copyright 2017 GoodTherapy.org. All rights reserved. Permission to publish granted by Joseph Robert Scrivani, MSW, LCSW, therapist in Astoria, New York

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • cassandra

    cassandra

    April 25th, 2017 at 2:58 PM

    I am not really all that sure how I feel about this method- is that okay? I mean, we spend so much of our time as parents and educators talking about the importance of practicing safe sex and yet are we looking at this as a way out of doing just that? I wouldn’t want our achievements in lowering the possibility of catching infectious diseases to be wiped out because there is concern about always having to use a condom.
    I am not saying that it is wrong, these are just things that automatically popped into my mind so I think that I would have to know more about it and do some more reading before I could develop an informed opinion.

  • Joseph Robert Scrivani, LCW

    Joseph Robert Scrivani, LCW

    April 26th, 2017 at 11:27 AM

    Thanks for your comment, Cassandra. And thanks for your honesty in expressing your ambivalence about this topic. Yes – it is certainly ok to feel this way. The point of my article was to start a discussion and a thought process for people. For some, taking PrEP is as every much a form of “safer sex” as using condoms once was. For others, PrEP means using condoms as well, and for others, safer sex still means using condoms, each and every time. I am glad to read that you want to learn more about this topic so you can make an informed opinion. That’s exactly what I want people to do. Best regards.

  • Ian

    Ian

    April 26th, 2017 at 7:33 AM

    Much of this is about education and making sure that each and every client gets the most current and informative pieces of information, as well as proper guidance on the professional end so that they know what their choices are and how to best achieve those goals.

  • Joseph Robert Scrivani, LCW

    Joseph Robert Scrivani, LCW

    April 26th, 2017 at 11:28 AM

    Ian: I couldn’t have said it better myself. Thank you.

  • Ian

    Ian

    April 26th, 2017 at 1:24 PM

    Good, because we need to stop being so harsh and judgmental about all these things we may not agree with or fully understand… and instead look for ways to reach common ground and understanding. Your choice, your life, your decision.

  • Mary

    Mary

    April 27th, 2017 at 10:29 AM

    If you are not willing to follow the regiment to a tee, then I for one would be very wary of what the future consequences could be.
    What could this do to your own health, both on a physical and psychological standpoint?
    Is this really going to have a healthy outcome for you and your partner?
    Are you interested because this is mostly a novelty or is this something that you possibly believe could make a huge difference in your life?
    All of these should be things to consider when coming to a conclusion about what s right for you.

  • Anonymous

    Anonymous

    April 27th, 2017 at 10:57 AM

    I am a gay man on PrEP. My therapist strongly encouraged me to get on it when I admitted to her that I’m not 100% with condoms. There are many gay men like me, and this is why PrEP is important. I have more protection now than I did before. I was already not using condoms before I started PrEP.

  • Joseph Robert Scrivani, LCW

    Joseph Robert Scrivani, LCW

    April 28th, 2017 at 2:39 PM

    I’m glad to know that you have a relationship with your therapist that allows you to be so open and honest with her about your sexual practices.

  • josie

    josie

    April 28th, 2017 at 11:28 AM

    Call me judgmental but goodness, how do we continue to have unsafe sex when we know what a risk it can impose?
    is seriously one great experience sexually worth risking the rest of your life for?
    Sorry but it isn’t for me.

  • Joseph Robert Scrivani, LCW

    Joseph Robert Scrivani, LCW

    April 28th, 2017 at 2:52 PM

    Thank you for your honesty. A couple of things come to mind: one, research has shown that PrEP can greatly reduce the chances of becoming infected with HIV to nearly 0%. So having sex without condoms while taking PrEP is generally not considered unsafe sex. Secondly, we aren’t talking about “one great experience sexually.” Gay men currently younger than about age 50 have had to negotiate safer-sex their entire lives. With no cure currently on the horizon, it’s safe to say that PrEP can help keep them HIV negative through far more than one sexual experience going forward. And lastly, PrEP isn’t for everyone, so there is definitely no need to apologize. Everyone’s opinions count.

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