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Condoms and the double standard in prescribing PrEP

Wednesday, 10 May 2017 Written by // Guest Authors - Revolving Door Categories // Events

From the Body Pro, an interview with Sarah Calabrese, Ph.D. byTerri Wilder, M.S.W.,

Condoms and the double standard in prescribing PrEP

To read the complete article by Terri Wilder, M.S.W., visit the Body Pro, here.

Could a provider's personal bias and beliefs about condom use affect their willingness to prescribe pre-exposure prophylaxis (PrEP)? One study surveyed U.S. medical students and found bias in terms of willingness to offer PrEP based on clinical situations. The students who were surveyed seemed to be most willing to provide PrEP to the lowest-risk consumers. And the team uncovered what looked like heteronormative biases on what was conceptualized as "acceptable reasons for non-condom use." Terri Wilder, M.S.W., spoke with study author Sarah Calabrese, Ph.D., at HIVR4P (HIV Research for Prevention) 2016, in Chicago.

Terri Wilder: I'm here today with Sarah Calabrese, Ph.D., who is an assistant professor of clinical psychology at George Washington University. Sarah, welcome.

Sarah Calabrese: Thank you. It's wonderful to be here. I appreciate this opportunity.

Could you tell our readers a little bit about why you wanted to do this survey, what was your motivation, and then just tell us a little bit about the methods?

Yeah, absolutely. As you know, PrEP is a really important new prevention tool. It's very effective. It's been available since 2012. Despite the fact that it works so well and it's been available for over four years, a lot of providers aren't prescribing it. To the extent that PrEP is a prescription-based medication, we're really reliant on providers. They are essentially the gatekeepers when it comes to PrEP access. Some of my other work has been looking at barriers to prescribing, and one of the ones that comes up in my work and in others is this issue of sexual risk compensation. When I say "risk compensation," I'm talking about providers being concerned that if they prescribe PrEP to their patients, the patients will essentially increase their sexual risk-taking in response to a perceived decrease in susceptibility to HIV.

In other words, the providers think that if they give them this pill, then the patients will abandon condoms, or have more sexual partners, etc. Providers see this as a problem. My colleagues and I were interested in what happens to the patient who says that he plans to abandon condom use, or what happens to the patient who says he's not using condoms in the first place. What does that mean for prescription decision-making around PrEP?

We surveyed 111 medical students from two universities in the Northeast, and we gave them some background about PrEP. About half of them said they had already learned about PrEP as part of their medical education, but we wanted to make sure that everyone had at least the basic background. As part of the background, we told them about the efficacy of PrEP. We told them that it was U.S. Food and Drug Administration approved. Then we asked them to indicate their willingness to prescribe. So, there are two parts to this, one being their willingness to prescribe to a variety of different patients. With these different patients they were rating their prescription willingness for, we systematically varied the condom use and intentions of these patients, as well as what kind of relationship they were in -- whether they were in a monogamous relationship or a non-monogamous relationship.

To read the complete article by Terri Wilder, M.S.W., visit the Body Pro, here.

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