CDC: not enough doctors are prescribing PrEP

Timothy Kincaid

November 25th, 2015

As I have discussed in a series of articles, obtaining pre-exposure prophylaxis (PrEP) for HIV is not simply a matter of asking your physician. Depending on your health insurance, it may be extremely difficult to get a prescription for Truvada, the medication that with proper use prevents HIV infection. For example, for the 10 million residents of Los Angeles County, there is only one clinic that provides PrEP and accepts Blue Shield HMO coverage.

It would appear that this scarcity is not limited to Los Angeles, and this concerns the Centers for Disease Control. (

“PrEP isn’t reaching many people who could benefit from it, and many providers remain unaware of its promise,” said CDC Director Tom Frieden, M.D., M.P.H. “With about 40,000 HIV infections newly diagnosed each year in the U.S., we need to use all available prevention strategies.”

“PrEP has the potential to dramatically reduce new HIV infections in the nation,” says Jonathan Mermin, M.D., M.P.H, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “However, PrEP only works if patients know about it, have access to it, and take it as prescribed.”

The CDC is now recommending that about 25% of gay men take PrEP, based on a number of criteria. It has awarded about $216 million to organizations that are targeting at risk communities.


November 26th, 2015

I’m not as regular a BTB reader as I used to be, but wanted to let you know how much I’ve enjoyed your recent posts about your efforts to get onto PrEP. I’m really happy to know that you’re protecting yourself, and delighted that you’re sharing your experience so publicly. As some of the comments here have shown that can draw some unwelcome heat from people making assumptions and judgements (not that you’re a stranger to that!).

I noticed a comment from an earlier post from someone named Jody inviting you to join the PrEP Facts Facebook group. You’d mentioned that you had trouble finding it (because Facebook’s search engine is often useless!) so in case you’re still looking here’s a direct link:

PrEP Facts Facebook Group

It’s an amazing resource for learning about PrEP, getting help navigating doctors and insurance companies, sharing frustrations, and often hearing breaking news before it’s widely reported (like the other day when it was announced the other day that France will begin providing PrEP *for free* to people at high risk of infection!).

Apart from that, I wanted to offer the opinion that you should not have to go to any kind of specialist to be prescribed PrEP. I know that (as the CDC emphasised in the link above) many providers haven’t even heard of PrEP, much less had experience prescribing it, but the process of prescribing Truvada for PrEP requires no specialised skills or knowledge.

When I was in the States earlier this year on my first visit to my new doctor I printed out the relevant pages from the CDC’s guidelines and explained that I wanted a prescription and what tests he’d need to run. He’d never prescribed PrEP, wasn’t particularly familiar with gay clients or HIV, but he looked things over and ordered the tests.

I realise I’m fortunate that it was so straightforward for me—I’d never met the guy before and was prepared to argue if I needed to—but I’d encourage anyone looking to get onto PrEP to start with the doctor they have and go in prepared to get what you want. Don’t be discouraged if they are reluctant, you’ve got the FDA, CDC and WHO on your side. Besides getting what you need, it’s also an opportunity to educate the doctor so the next person who asks about PrEP won’t be met with a blank stare, skepticism or judgement.

That’s a different issue than insurance, but there are resources available that can help a lot with that as well (this comment’s long enough at this point I think, so I’ll just mention that folks at the PrEP Facts FB page are a great resource for dealing with different insurers in different states).

So thank you, Timothy, for this great series. Hope you’re having a wonderful Thanksgiving.

Joe Beckmann

November 27th, 2015

Why not Post-Exposure Prophylaxis?? (PEP?) Doesn’t it take fewer pills and less time? Is PrEP being promoted by Gilead? And, if you’re not a sex worker, how frequent are encounters that justify treatment?

If so many caregivers don’t know about PrEP, even fewer know about PEP, yet both have been around for decades. Isn’t that a major issue for AIDS Service organizations to finally address with a serious program of public education? Or are they addicted to treatment only?

Timothy Kincaid

November 27th, 2015

Thanks werdna. I hope your holiday is joyous as well.


November 29th, 2015

No, Joe. PEP uses more drugs and requires higher doses than PrEP does. It would also need to be repeated every time one has sex (particularly consider married/monogamous couples of mixed serostatus).

Actually, most doctors are very aware of PEP since occupational exposure to HIV is a risk many healthcare workers face. Every clinic/hospital/facility has a protocol to follow in the event of an accidental needle stick. Studies supporting PEP predate those supporting PrEP by about 13 years (1997 vs 2010).

As to your “serious program of public education,” I think that’s exactly what we’re starting to see. It’s a two-pronged approach to reducing the incidence of HIV infections: treatment as prevention (TasP) for HIV-positive people and pre-exposure prophylaxis (PrEP) for HIV-negative ones.

PEP must begin within 72 hours of exposure, before the virus has time to make too many copies of itself in your body. PEP consists of 2-3 antiretroviral medications and must be taken for 28 days.

PEP is the use of antiretroviral drugs after a single high-risk event to stop HIV from making copies of itself and spreading through your body. PEP must be started as soon as possible to be effective—and always within 3 days of a possible exposure….

PEP should only be used right after an uncommon situation with potential HIV exposure. If you are often exposed to HIV, for example, because you often have sex without a condom with a partner who is HIV-positive, repeated uses of PEP are not the right choice. That’s because, when drugs are given only after an exposure, more drugs and higher doses are needed to block infection than when they are started before the exposure and continued for a time thereafter.

(Cardo, Culver, Ciesielski, et al. “A Case–Control Study of HIV Seroconversion in Health Care Workers after Percutaneous Exposure” N Engl J Med, 1997)

(Grant, Lama, Anderson, et al. “Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men” N Engl J Med, 2010)


November 29th, 2015

PEP floods your body with drugs to fight an enemy that has already established a beachhead and must be met with overwhelming force. Having gone through a similar protocol for rabies (also incurable and, until quite recently, invariably fatal), I can unreservedly quote my gran, “An ounce of prevention is worth a pound of cure.”

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