HIV prevention drug: 'Stigma is a thing that's still out there'

There's no room for stigma when it comes to GPs prescribing a safe sex drug commonly used by gay men, a leading doctor says.

Pre-exposure prophylaxis (PrEP) is up to 99 percent effective in preventing HIV, and this week Pharmac announced it was overhauling the criteria for funded prescriptions of the drug.

However, safe sex advocates said doctors needed to be more confident about prescribing it, some patients faced stigma from doctors when trying to get a prescription, and they wanted to see LGBQTIA+ healthcare improve.

From 1 July this year, some previous criteria for a funded prescription has been removed, including a strongly criticised stipulation that the patient had had unprotected receptive anal sex with a casual partner in the previous three months.

Instead, it now required that the patient be at risk of, but tested negative for HIV, and that their doctor believed it was "clinically appropriate" for them.

HIV peer support organisation Body Positive executive director Mark Fisher said a lot of work had been done to raise awareness of the drug, but more was needed.

"PrEP stigma is a thing that's still out there," he said.

"We need to normalise it, so it needs to become like viagra or the contraceptive pill."

He said clients of his organisation had been unable to get prescriptions because their GP did not "feel comfortable" prescribing it.

Similar experiences were highlighted by sexual health researcher Peter Saxton (who was leading the Sex and Prevention of Transmission Study), in his submission to Pharmac about the criteria change.

He used unpublished data from the study, which included comments about a nurse saying "how all gay and bisexual men should stop being promiscuous" when someone mentioned wanting to be on PrEP, a GP telling another person "it was disgusting" and they "should just use a condom", and others feeling judged.

Royal College of GPs medical director Bryan Betty said such experiences "would be a very unusual situation", and should not happen.

"Basically, general practitioners who are professionally trained and vocationally registered are trained to take a non-judgemental approach to patients - and that would be the expectation of the College."

He said there was "freely available" training online for medical professionals to upskill and educate themselves around PrEP.

Betty said Pharmac's changes would help more medical professionals become aware of the drug as more patients get prescriptions.