Ok so I started this thread back in April trying to find someone to prescribe PREP in Memphis. I wanted too update you on my lack of progress and get some feed back on my experience. I talked with a friend who suggested a doctor who is gay. I contacted his office and he was out on medical leave until September, so I continued my search. Talked to the local aids organization and they directed me to a planned parenthood type clinic. I contacted them in June and asked if they provided it. A lady said she would check and call me back. She called back and said yes they did provide it. I asked for the first available appointment and it was for a month away on July 22.
I went in today and I must say I was a little disappointed. The nurse practitioner came in and asked the reason for my visit. I told her I wanted to talk about PREP. She said sure. She continued to explain that PREP was mainly for use in sero-discordant relationships or situations where there was repeated exposure to HIV. She then asked me several questions about sexual practices. Two of the questions were number of partners more than 1 and unprotected sex in the last 6 months. Both of which I answered yes. She said based on my answers I did not meet the clinical criteria for being on PREP. She went on to discourage it because of on going side effects such as stomach and intestinal issues. It was clear she was against it. She said she would prescribe it once testing was done but that insurance would likely not cover it since I didn't meet the clinical criteria. I asked her why was the clinical criteria different from CDC recommendations. She said that was the CDC guidelines for prescribing. I told her those have been updated to include MSM. She said she would review it and get back to me. She suggested we move ahead with testing and meet back once results were in. I then asked what type of test she would be using to test for HIV she said a rapid test. I questioned her further about I thought an RNA test was required since I have been active in the last month. She said no reason to use it. She ordered the baseline test for blood panel,kidneys etc and a full STI panel to include a blood HIV test, but not RNA test. I consented to the testing, but left the clinic feeling I was better educated than the practitioner.
The nurse practitioner called me about 45 minutes later and said she had reviewed the updated guidelines and I would qualify. She also said the test she had ordered would be sufficient for testing before starting prep. I am concerned as to the adequacy of care. Although i had negative rapid test last month and I have no reason to believe I have been exposed to HIV is she doing the appropriate test? I don't have a lot of options here, what should I do?