Patients say they’ve been shocked at their doctors’ lack of knowledge, and offended by follow-up questions.
By
Ben Winsor

5 Sep 2016 - 12:11 PM  UPDATED 5 Sep 2016 - 1:36 PM

There are still doctors around Australia who have no knowledge of the HIV prevention pill, PrEP, and some who have no interest in learning about it.

The drug, approved by the Therapeutic Goods Administration in May this year, can prevent HIV infections if taken daily, but many GPs have never heard of it.

Patients say they’ve been shocked at their doctors’ lack of knowledge, and offended by follow-up questions.

Justin, 34, says he recently went to a GP in Queanbeyan, NSW, with the flu and a stomach ache. When he was asked what current medications he was on, he told the doctor he took PrEP.

“He asked what it was for,” Justin tells SBS. “I began to explain and before I could finish he had put a mask on and said that if I have HIV the stomach problem is a different issue.”

“I then had to explain I didn't actually have HIV and was shocked at his lack of knowledge,” he says.

The GP asked why he needed the drug. Justin said that he wanted to protect himself and that a previous partner had been HIV positive.

Justin says the doctor then asked him if he was "still gay", and wondered why he would need to be on PrEP if he "wasn't having a gay relationship".

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It appears Justin’s experience isn’t isolated.

Dante James, a 42-year-old Gold Coast man, asked a doctor for a PrEP prescription, explaining that he was in a relationship with a sex worker.

“He suggested that I use condoms or consider having a relationship with 'someone safer'” Dante says. “I asked if he'd be willing to see me again in two weeks once he had time to do some reading up. He said he didn't have time.”

“Is that what you say to a young woman who wants to go on the pill for the first time? Just use condoms?” Dante replied, “or just have sex with a man who has had a vasectomy?”

“He wasn't impressed and suggested that I might be best to 'go and see one of those inner city doctors' who might 'better understand my needs'” he says.

Avron Woolf, a 36-year-old from Melbourne, says he got a similar response when he recently told a doctor he was on PrEP during an appointment for an allergic reaction.

“He looked at me puzzled and said ‘why not stop the PrEP and just use condoms?’” Avron says.

“I was dumbstruck by the comment,” he says, “I think it made me feel like my choices were being restricted and questioned.”

Dante James says he felt the same way. “I worry about younger guys who may not have quite the same level of resilience as me,” he says.

“It's very similar to women trying to prevent falling pregnant,” he says. “The pill gives them control. The condom really relies on the man – in this case the top [the insertive partner] – except in this case the empowerment for personal safety is equal for both the top and bottom.”

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Ruth McNair, fellow at the Royal Australian College of General Practitioners (RACGP) and a member of the college’s sexual health special interest group, says these cases are concerning, but not surprising.

“There is a lack of knowledge about PrEP among GPs in Australia,” she says, “more and more LGBT people are coming out and being open and demanding appropriate care, and many GPs are realising their own inadequacies.”

“Sometimes they’re homophobic, but I think that a lot of the times it’s just ignorance,” Doctor McNair says.

It’s not just PrEP that some doctors lack knowledge about, McNair says other HIV medications such as PEP – which can prevent infection if taken within 72 hours of sexual contact – are also not properly understood.

“It can be difficult for some gay men to get PEP within the 72 hour window,” she says.

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Doctor McNair says it’s a GP’s own responsibility to educate on new drugs and best practice, but with a massive range of health issues to keep abreast of, LGBT+ issues can drop off the list. 

“I can see why it happens, but it’s no excuse,” she says.

Vincent Cornelisse, a GP and Registrar in Sexual Medicine at the Prahran Market Clinic, agrees with McNair.

“In the burbs and elsewhere outside of LGBTI hubs, most GPs don't see a lot of men who have sex with men and other people at risk of HIV,” he tells SBS. “This means that PrEP is probably not a major clinical priority for them, and hence they may not seek out education on PrEP.”

“The reality is that doctors tend to educate themselves on issues that affect the patients they see,” he says.

Sexual health networks and the RACGP sexual health group are educating GPs – Doctor McNair says – and while drug companies also have a role to play, they shouldn’t be relied on.

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The cost of PrEP in Australia is almost prohibitively expensive in Australia, at almost $30 per daily dose. The price has led many to rely on ordering generic versions online from overseas pharmacies.

“HIV medication has traditionally been over-priced in Western countries,” McNair says.

Development costs are high, she says, so companies pass on the costs to Western patients who are more likely to be able to afford it.

“But it doesn’t need to be that expensive – as we can see from overseas pharmacies,” she says. Some Australians order the drug from online pharmacies in Swaziland or India.

While the imported generics are licenced from the original producer, they're not covered by Australian regulatory standards.

“We’re supplying prescriptions for people to self-import because it’s a harm minimisation approach,” Doctor McNair tells SBS. “We can’t guarantee that it’s actually the drug that it says it is, but it’s better than nothing.”

Dr McNair is not aware of any cases where there have been issues with self-importation, “but how would we know? That’s the problem.”

More on PrEP:

See our guide on how to get PrEP in Australia

For more information  on PrEP, see the Australian Federation of AIDS Organisations and the Ending HIV factsheet.

If you're a GP and want to learn more about PrEP, the Australasian Society for HIV Medicine (ASHM) provides resources to practitioners online.

You can do your part to end HIV/AIDS in Australia by knowing your status, being honest with your partners, and practicing safe sex

Truvada: The End of HIV? (The Feed, 2015)