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HIV PrEP Is Our Responsibility
Prevention Is the Best Medicine: HIV PrEP Is Our Responsibility

Released: March 10, 2026

Matthew M. Hamill
Matthew M. Hamill, MBChB, PhD
Activity Information

Activity

Key Takeaways
  • The importance of PrEP spans 3 main categories: the individual, public health, and healthcare resource utilization.
  • Most of the key barriers to PrEP provision can be overcome by training, experience, and preparation, such as providing patients with a sexual health questionnaire before their appointments.

Although the number of new HIV infections has decreased dramatically since the peak of the epidemic in the 1980s, the latest data show that more than 30,000 new HIV infections are still occurring per year in the United States. Those infections could be prevented. That is why it is so important for all healthcare professionals (HCPs) to take increased responsibility for prescribing pre-exposure prophylaxis (PrEP), no matter their specialty.

I think it is important on the individual patient level, for their healthcare and well-being, for their sexual partners, and for their children in terms of mother-to-child transmission. It is also important in terms of utilization of health resources. It is very expensive to provide lifelong antiretroviral treatment (ART) for people living with HIV.

PrEP Barriers
The primary barrier to PrEP provision is responsibility. For a long time, PrEP provision was thought to be the responsibility of infectious disease HCPs.

However, I would frame it this way: All HCPs—that is, everybody working in the healthcare system—have a responsibility to provide prevention. This can take many forms, whether that is prevention of lung cancer by encouraging smoking cessation, prevention of heart disease by offering statins to eligible people, or HIV prevention through PrEP. We all have a role in preventive healthcare.

Beyond knowing that PrEP is the responsibility of all of us, I think that there are several other key barriers: sex, time, and experience.

Let’s Talk About Sex
First, we may feel awkward about taking a sexual history, but it is essential in order to provide PrEP.

Talking about sex, sexual practices, and injection drug use can be intimidating, particularly if you have known a patient for decades. In long-term patient relationships, suddenly embarking on this conversation about intimate subjects can be difficult. I think sometimes we just do not know where to start.

However, most of that awkwardness or lack of preparation can be addressed by training. As I say to the HCPs with whom I work, you already tell people if they have an untreatable malignancy or if they have very limited life expectancy because of very severe heart disease. So, you already have the skills to have those challenging conversations. Now, you just have to shift your mindset so that you can apply those skills to a different aspect of healthcare.

What Time Is Love?
Another other important barrier is time. Primary care providers, in particular, have so many things to do. They have so many preventive actions to address with their patients: Are they up to date with their mammography or their colonoscopy? What is their blood pressure like? How is that A1C? There is a lot going on. So, sexual health and well-being often fall down the list of priorities because there are other urgent issues with which to contend.

Are You Experienced?
Finally, I think lack of experience can be a barrier. When one is not used to providing or writing a prescription for PrEP, it can feel a little bit intimidating because it is new. You might think, “What if I do this wrong? What if I am not following the guidelines correctly? What if a patient experiences severe adverse effects?”

Again, this barrier can be overcome with training and by using some of the many comprehensive online resources that are available.

PrEP Facilitators
I try to think of PrEP provision as an opportunity to connect with patients in a new way. Initiating discussions about sexual health and wellness may lead you to discover that a patient is also having sexual difficulties, erectile dysfunction, or pain with sex. These conditions may seem unrelated initially, but they become very related when you are talking about a sexual health paradigm.

Overall, my advice is to start slowly. First, try to open up a few conversations with patients, then expand from there so that you build your confidence, figure out your own approach, and methodically work through the guidelines to determine what agents to use and what tests and monitoring are necessary. Confidence grows in that way, with experience. Also, do not be afraid to ask for help. Excellent resources are available to help you provide PrEP.

We should be cognizant that patients might feel even more intimidated about bringing up their sexual health needs with us, more than we are about initiating the discussion. These talks are difficult for HCPs, so one can imagine how much more difficult it can be for some patients. I think having an appreciation of that and making it easy for patients to bring up their concerns is really the way forward.

You can make it easier for everyone by being prepared. For example, before your patient arrives in the clinic, you can send a basic sexual health questionnaire through an electronic medical record portal. I think that is a practical way for patients to provide information in advance that might be challenging for them to bring up independently. This also gives you time to think about how this information can segue into talking about prevention, including PrEP, hepatitis B vaccination, human papillomavirus vaccination, and contraception. It can provide an entryway into a broader conversation about preventive sexual health measures.

Finally, normalizing conversations about PrEP and sexual well-being in general is critical for reducing stigma and implementing preventive sexual health measures. With so many PrEP options now, there is something that suits everyone’s needs.

Your Thoughts
What are your biggest challenges with discussing PrEP? How have you tried to overcome those barriers? Leave a comment to join the discussion!