Express talks to four sexual health experts about the importance of being open about your sexuality and sexual practices with your doctor.
PrEP (a pill that if taken as prescribed, prevents HIV contraction) was funded in March last year, with research estimating that 5847 New Zealanders would be eligible for it, based on current PHARMAC criteria. By the end of June this year 2423 New Zealanders had tried it and 1238 has picked up a prescription in the previous 90 days.
The list of potential barriers that are stopped more New Zealanders from trying PrEP is a long one with lots of variants at play, but all our experts agree the relationship between patient and doctor is key.
New Zealand AIDS Foundation Chief Executive Dr Jason Myers points out that “a recent NZAF survey of gay, bisexual and other men who have sex with men in NZ found that 17% reported using PrEP in the previous 6-months and over 80% knew what PrEP was, so we know that more people understand the role of PrEP now. One of the biggest barriers reported to us is that people are worried about needing to talk to their doctors about sex, this is an especially tricky barrier when we consider only around 50% of gay men are out to their GPs.”
“Your GP can’t offer you the best care if they don’t know about your sexuality,”
Says Dr Peter Saxton, Director of the Gay Men’s Sexual Health (GMSH) research group. “It’s not just HIV testing and PrEP, but regular sexual health checks, vaccinations for HPV (that causes warts and cancers), hepatitis A and B, and help with mental health, harm reduction about drug use and addictions.”
“PrEP is an HIV treatment that’s been in use since 2004 so it has been well studied. But all medications come with the potential for interactions with other drugs or food,” explains Body Positive Executive Director Mark Fisher. “It’s important for your doctor to be aware of everything happening with your health so that they can provide you with the best care. They can check for any possible interactions or side effects and provide the support you need. Doctors are bound by confidentiality so you should feel confident to have an open discussion about what is happening in your life. This include and recreational drugs, as well as these, may have an impact. For example, you should never mix poppers with Viagra.”
Dr Garsing Wong is a General Practitioners at Auckland Central Medical, who is regarded for his extensive knowledge around prescribing PrEP. He reiterates that a patient’s openness and honesty are necessary keys for them to receive optimal care.
“I like to remind patients that if at any time they find they don’t feel comfortable telling me anything, then it is time to change doctors.”
New Zealand’s GPs need to be fostering an environment that encourages this important honesty from patients and ensure more than 50% of gay men are out to their doctors.
Dr Jason Myers says it’s important that Dr’s avoid making assumptions around gender or sexuality based on physical appearance alone. “Using gender-neutral language when asking about sexual partners and the nature of sexual activity is just one example of how to build trust and connection,” he says.
Dr Peter Saxton says Doctors can also be more proactive in asking patients about sexual health. “Normalise the topic of sexuality by routinely asking all patients about sexual orientation at the first consult,” he advises, adding this can be backed up by, “ reassuring patients about confidentiality and displaying queer-friendly material in waiting and consultation rooms.”
Saxton concludes: “Quick PrEP uptake in the community gives us the best chance at bringing the HIV epidemic to a screeching halt. This is because if all gay and bisexual men are using condoms, taking PrEP, or have an undetectable viral load then it leaves the virus with nowhere to go.”
For more info on PrEP visit endinghiv.org.nz and bodypositive.org.nz