Key TakeawaysThe Centers for Disease Control and Prevention (CDC) is now recommending that physicians discuss prophylactic drugs that reduce the risk of HIV transmission (PrEP) with all of their patients who are sexually active.A brief discussion of a patient’s sexual history should be part of primary care and should guide physicians in discussing whether patients might need PrEP.Many physicians skip taking a sexual history of patients—either because of their own or their patients’ discomfort. As a result, patients who could benefit from PrEP miss out on key HIV prevention measures.

Key Takeaways

The Centers for Disease Control and Prevention (CDC) is now recommending that physicians discuss prophylactic drugs that reduce the risk of HIV transmission (PrEP) with all of their patients who are sexually active.A brief discussion of a patient’s sexual history should be part of primary care and should guide physicians in discussing whether patients might need PrEP.Many physicians skip taking a sexual history of patients—either because of their own or their patients’ discomfort. As a result, patients who could benefit from PrEP miss out on key HIV prevention measures.

Medications that can reduce thetransmission of HIV(human immunodeficiency virus) have been approved for several years and recommended for people who are at risk for contracting the virus.

This has historically included men who have sex with other men and people who use intravenous (IV) drugs like opioids. Now, the Centers for Disease Control and Prevention (CDC) is recommending that primary care physicians discuss the use ofmedicationsthat prevent HIV with all patients who are sexually active, including teenagers.

Preventing HIV is a key step, but treating the infection if it does occur is also important; untreated HIV infection can progress toacquired immunodeficiency syndrome(AIDS).

Ada Stewart, MD, FAAFP, a family physician and board chair and spokesperson for the American Academy of Family Physicians, told Verywell that when taken every day, preexposure prophylaxis (PrEP) is 99% effective at reducing the risk of the sexual transmission of HIV. For people who use IV drugs, Stewart said that the medication is “over 70% effective” at preventingHIV.

Considering that the medications are safe and effective, why aren’t more people taking them?

Global Statistics About HIV

How Doctors Can Help

PrEP Medications

A third option, Apretude (cabotegravir), is an injection that is administered every two months. It recently receivedFDA approval.

Stewart commended the CDC on its recommendation because it gives providers a “greater stand as we talk with our patients about PrEP. We have over one million individuals who are living with HIV and many of those don’t know that they have HIV.”

Michelle Collins-Ogle, MD, FAAP, a pediatric infectious disease specialist, assistant professor of pediatrics at Einstein College of Medicine, and a spokesperson for The Infectious Disease Society of America (IDSA), told Verywell that the organization “has supported and has been supporting the use of PrEP in all populations that are sexually active.”

There are also a number of health disparities that affect who takes PrEP—often among the people who are most at risk for HIV.According to the CDC, there are persistentracial, ethnic, and socioeconomic disparitiesthat mean that many people who could benefit from PrEP are not able to access it.

HIV in Black Men: Increased Risk, Facts, Testing, Resources

If primary care physicians only think that gay men, transgender people, and IV drug users are the patientswho need PrEP, Stewart cautioned that they would be missing many patients who are at risk for HIV and would benefit from prevention.

Ada Stewart, MD, FAAFPThere’s so much stigma around HIV that it’s important that we recognize we have to address that issue.

Ada Stewart, MD, FAAFP

There’s so much stigma around HIV that it’s important that we recognize we have to address that issue.

“As family physicians on the frontlines of all of this, we have recognized that many times we’ve missed the boat for individuals who are candidates for PrEP," said Stewart. “We miss a huge group of individuals who potentially could have benefited from PrEP and therefore miss that opportunity.”

Stewart said that asking all patients about their sexual history and habits should be part of primary care practice, as asking about smoking or alcohol use is. Stewart takes a sexual history on each patient at least once a year and asks them if anything (such as relationship status) has changed.

“There’s so much stigma around HIV that it’s important that we recognize we have to address that issue,” said Stewart. “One way to address it is to talk to all our patients—all our patients, no matter what—about their risk.”

How Is HIV Treated?

Never Assume HIV Risk

Stewart stressed that physicians should never make assumptions about which patients are most likely to contract HIV. For example, a patient might be monogamousin their relationship, but their partner might not be. A patient could also be in a relationship with a person who uses IV drugs.

“It is not just for men right now. It’s for women—especially African American women,” said Stewart, adding that they care for an 87-year-old female patient who was recently foundto be HIV positive.

HIV Risk Factors

According to Collins-Ogle, many physicians do not consider women in their 30s for 40s as being at risk for HIV. Therefore, they’re not having these important conversations about sex with them.

“I’ve had many women who have been denied PrEP because the clinician does not perceive that person as being at risk,” said Collins-Ogle. “The primary care clinician is in a great place; [it’s] a great point of entry to receiving prevention services and appropriate sexual health counseling.”

Stewart added that counseling sexually active adolescents about whether PrEP could be right for them is also crucial. Stewart asks the patient’s parents or caregivers to step out of the room, which gives them the opportunity to ask teenagers questions about their sexuality privately.

“You have to establish trust with that young person, and you have to let them know that what you tell me is between you and me and I don’t share my information with anyone else,” added Collins-Ogle, who sees primarily adolescents and young adults in their practice—many of whom are HIV-positive.

What This Means For YouThe CDC’s updated recommendation about discussing HIV prevention with all sexually active patients might mean that your doctor is more willing to have the conversation with you.If you are not sure if you are at risk for HIV, or you do not know about your options for preventative treatment, you can also bring the topic up with your doctor.

What This Means For You

The CDC’s updated recommendation about discussing HIV prevention with all sexually active patients might mean that your doctor is more willing to have the conversation with you.If you are not sure if you are at risk for HIV, or you do not know about your options for preventative treatment, you can also bring the topic up with your doctor.

The CDC’s updated recommendation about discussing HIV prevention with all sexually active patients might mean that your doctor is more willing to have the conversation with you.

If you are not sure if you are at risk for HIV, or you do not know about your options for preventative treatment, you can also bring the topic up with your doctor.

Health Disparities and HIV

4 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

National Institutes of Health.Pre-Exposure Prophylaxis (PrEP). Updated August 10, 2021.

Centers for Disease Control and Prevention (CDC).What Is PrEP?. Updated October 18, 2021.

Centers for Disease Control and Prevention (CDC).PrEP for HIV Prevention in the U.S.Updated November 23, 2021.

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