Nov. 15, 2016
Physicians can block HIV
spread with a little-known treatment — if they can identify high-risk patients
and administer the treatment to them. The questions can be difficult for
physicians to ask, however. The questions can be personal, and they can be
awkward for a patient to answer; but they are necessary to determine whether a patient’s
sexual behavior or drug use puts him or her at risk of contracting HIV (human
immunodeficiency virus). When patients are at risk, doctors can prescribe the treatment,
HIV preexposure prophylaxis (PrEP), that might curb that risk drastically,
reports the Texas Medical Association’s (TMA’s) Texas Medicine
That's why family physician
Cynthia Brinson, MD, strives to get all the information she needs, including
uncomfortable-but-pertinent details on sexual behavior, when assessing patients
for the Austin PrEP Access Project (APAP). The volunteer clinic provides HIV
PrEP to patients susceptible to the virus that causes AIDS.
“I’ve heard many patients
say, ‘I don’t want to talk to my physician because [he or she] wouldn't approve
of what I’m doing,’ whether that’s true or not,” Dr. Brinson said. “And the
physicians are making assumptions by saying, ‘I’ve known my patient a long
time, and [the patient is] in a monogamous relationship.’ I think when we make
assumptions about the people we know, we’re not really seeing people in the
full context of a life.”
In the three decades since
AIDS first became the United States' biggest public health scare, panic over
the disease and HIV has largely disappeared. But the virus persists, especially
in Texas, where Texas Department of State Health Services figures show more
than 82,000 people were living with HIV in 2015.
The PrEP pill and treatment
can stop that number from growing by preventing people from contracting HIV.
Large clinical trials showed consistent PrEP use reduces people’s risk of
getting HIV from sex by more than 90 percent and reduces the risk of getting it
from drug injections by more than 70 percent, according to the Centers for
Disease Control and Prevention (CDC). But many people at high risk don’t know
PrEP exists, let alone how accessible it can be. APAP and other PrEP
clinics around the state are working to change that ― starting with the
type and tone of questions physicians ask patients.
Dr. Brinson said it’s
important for physicians to set aside what they think they know about the
patient and ask the questions they need to ask. She says when she tries to
assess a patient’s risk factors for HIV, she avoids asking leading questions.
“I’ll ask patients if they’re
involved with anyone sexually. And if they say no, I might ask them, ‘Well, if
you were to be involved with someone sexually, would that be a male, a female,
or both?’ and let the patient take it from there,” she said.
Yet physicians might not
always ask the right questions because of the demands of a clinic visit or
discomfort with taking a sexual history and discussing details of sexual
Houston adolescent medicine
fellow M. Brett Cooper, MD, a member of TMA’s Committee on Child and Adolescent
Health, said merely asking patients if they’re sexually active isn't gleaning
“For the adults right now,
you’re missing out on that 18-29 [age group] if you’re not asking, ‘What gender
are your sexual partners? Are you having sex under the influence of substances,
whether that’s drugs [or] alcohol? How many partners are you having?’ That’s
where CDC recommendations for putting people on it [PrEP] come into play, is
your behaviors,” he said.
Dr. Cooper said physicians
hope to reach the people at greatest risk more effectively. He said minorities
tend to underuse many of the available services, and the highest diagnosis
rates show up in African-American men having sex with men.
“The theory behind it is
that there’s a lot more stigma in the minority communities around [men] having
sex with men, whether you identify as gay or not,” Dr. Cooper said. “Then if
you show up at a clinic for PrEP, people will look around and be like, ‘I know
this person, I know [that] person.’ ”
Dr. Brinson agrees lack of awareness
and patient trust prevent high-risk patients from accessing PrEP. She said eradication
of HIV is possible, though; the goal of APAP is to see no new infections in
Austin by 2020. While PrEP has been successful in gay white communities, she said
her clinic has trouble reaching into the communities it would like to reach,
such as Hispanic, African-American, and underserved communities.
“We must do something to stop
this continual infection rate,” she said.
TMA is the largest state medical society in the nation,
representing more than 49,000 physician and medical student members. It is
located in Austin and has 110 component county medical societies around the
state. TMA’s key objective since 1853 is to improve the health of all Texans.
Contact: Brent Annear (512) 370-1381; cell: (512) 656-7320; email: email@example.com
Marcus Cooper (512)
370-1382; cell: (512) 650-5336; email: firstname.lastname@example.org
Connect with TMA on Twitter, Facebook, and Instagram.
Check out MeAndMyDoctor.com for interesting
and timely news on health care issues and policy.