Starting the process

[drscorpio]

I had tried to talk to my doctor about going on PrEP before, but he told me I was worrying too much. Today I was in again for something unrelated, and I decided to give it another try.

After a few minutes back and forth, it became clear he didn't know shit about the topic. So I did some education. He went online while I was there to look up more information. He is going to refer me to the infectious diseases specialist he refers anyone who is positive to since he does not feel he knows enough about it to supervise me on PrEP. We went ahead and drew blood for an HIV test since that has to be done anyway.

I am excited to be getting the ball rolling. I will speak to my insurance company tomorrow. I suspect I will end up contacting Gilead as well.

[rawfuckr]

I've seen people complaining that their GP will refer them to infectious disease doctors, but I think this is the right approach if the doctor is not familiar with HIV stuff.

Good luck

[mplsgopherbottom]

I just started PrEP on Saturday. It's been about a 4 month process before first starting to talk to my doctor about it (thankfully a great gay doctor who is very up to speed on the latest research) and taking the first pill. I'd contact your insurance company first or getting on a free/reduced cost copay to avoid any surprises at the pharmacy. My first insurance plan didn't cover Truvada as PrEP so I had a $1500 copay... Needless to say I didn't pay for it, spent a few more weeks researching new health plans and then once I got a good plan, needed to do all the HIV tests over again. But, no side effects and am looking forward to no longer freaking out about random hookups. Good luck!

[Poz1956]

I'm seeing comments like this more an more. Why waste a specialist's time, on someone who doesn't have an infectious disease? If you end up seeing the ID doc, ask him to educate your GP on what blood tests to order, and what things to look for.

Sending everyone who want's PrEP to an ID doc is just a waste of resources, and an unneeded stress on the medical system.

[rawfuckr]

Sending everyone who want's PrEP to an ID doc is just a waste of resources, and an unneeded stress on the medical system.

Not sure I agree. There is plenty of medical protocol that needs to be observed with PrEP and seems reasonable at this moment to bump people to ID docs. Sure, maybe the GP is a bit lazy to research stuff and do it on their own but I'm sure in a year or two they'll get up with the program and do it themselves.

I'm getting PrEP with Kaiser and they have a whole team of docs here in SF doing PrEP alongside with HIV care and that's the way they want it, and this is from the quintessential HMO who is always looking at keeping costs down.

[backpackguy]

Met w/my doc 7 weeks ago and told her I believed I should go on PrEP as I had been having raw sex with guys for some time. I educated myself on the topic well in advance (CDC website, friends on PrEP, articles from Gay community publications, etc). She admitted she was not up to date on the subject but complimented me on my research and knowledge. She asked if it was ok for her to query the infectious disease/HIV specialist (I get my medical work done at Stanford University Medical Center). The specialist asked me to visit him for a one time consult. After a couple of Qs he agreed I was a good candidate for PrEP and prescribed it. (I had already gotten all the requisite blood tests: HIV, STDs, kidney panel, etc). I pay $35.00 for a month's supply of PrEP. I have Blue Cross/Blue Shield PPO.

I have been on PrEP for a month with no adverse affects. Provides peace of mind!

[rawfuckr]

I pay $35.00 for a month's supply of PrEP

Remember that Gilead will pay up to $200 a month of your copays and it's an easy thing to setup. The copay assistance program is available to everyone (because well, they are already getting $1300 a month from the insurance, so paying your copay costs them little).

[Poz1956]

I think the multi-million population bases are a special case. Most of them the Gay specific medical infrastructure. So PrEP is not a unique concept for them. In fact it's routine.

A GP can order blood tests and check the results. Your GP can discuss your sex life, and remind you to use condoms. Your GP can write a three month prescription, and make you book an appointment just before the three months is up. To the best of my knowledge, that's the whole protocol. None of it is beyond the capabilities of a GP.

The whole mindset of "Oh - I'ts about HIV. You must go to an infectious disease specialist," just creates another barrier for people wanting to go on PrEP. It also shows that the doctor doesn't really know much about PrEP. You don't have HIV, and that's the point of PrEP. Because you DON'T have a disease, you NEED to see an Infectious Disease specialist? Again, that's a waste of resources.

Imagine if we get 10% or more of the gay population on PrEP. Most of the ID specialist's time will be taken up writing PrEP prescriptions, for people who don't have any of the diseases he was trained to treat. Hell, it could lead to the Pozzies having more trouble getting in to see him/her, because it's all booked up with PrEP clients. That would be especially bad for newly diagnosed Poz guys, who should get on the meds ASAP. (I know a bit of hyperbole)

There must be an Introduction to PrEP pamphlet for doctors, that outlines what initial questions they should ask. There must be an info sheet on what blood tests to order, and what specific things to look for. Let's find that stuff, and have guys who want PrEP take it in to their doctor.

Rawfuckr: Kaiser is really up on this stuff. I've been watching presentations at various conferences. If there's a Q&A at the end, there always seems to be a Kaiser rep asking a question.

[Guest JizzDumpWI]

Interestingly, here in WI we seem to be sending new PrEP to ID docs. While I agree there is no reason my GP could not, at the moment ID doc it is. He isn't spending vast amounts of time with me, a good amount being done via his nurse. As the ID clinic is part of Medical College of WI - I suspect this is a good opportunity to incorporate this into training of new doctors. And as the goal of ID docs is to address spread of infectious diseases I see nothing inappropriate using ID resources.

Given that Wisconsin is a leader in successful HIV treatment in US; (measured as percentage of UD patients, and access to treatment) I am taking the position that if med community here is using ID specialists for this, they probably know what they're doing.

[wood]

A GP can order blood tests and check the results. Your GP can discuss your sex life, and remind you to use condoms. Your GP can write a three month prescription, and make you book an appointment just before the three months is up. To the best of my knowledge, that's the whole protocol. None of it is beyond the capabilities of a GP.

The whole mindset of "Oh - I'ts about HIV. You must go to an infectious disease specialist," just creates another barrier for people wanting to go on PrEP. It also shows that the doctor doesn't really know much about PrEP. You don't have HIV, and that's the point of PrEP. Because you DON'T have a disease, you NEED to see an Infectious Disease specialist? Again, that's a waste of resources.

Imagine if we get 10% or more of the gay population on PrEP. Most of the ID specialist's time will be taken up writing PrEP prescriptions, for people who don't have any of the diseases he was trained to treat. Hell, it could lead to the Pozzies having more trouble getting in to see him/her, because it's all booked up with PrEP clients. That would be especially bad for newly diagnosed Poz guys, who should get on the meds ASAP. (I know a bit of hyperbole)

There must be an Introduction to PrEP pamphlet for doctors, that outlines what initial questions they should ask. There must be an info sheet on what blood tests to order, and what specific things to look for. Let's find that stuff, and have guys who want PrEP take it in to their doctor.

I agree, but PrEP is not widely discussed and in some areas unless they are reading medical journals everyday (which I would venture most GP's are not) they probably wont know about it, and will also assume the worst. IE the medication is extremely toxic (its not) or that the person may have all sorts of other health risks.

Because of this they refer to ID docs because they dont want to get sued. One of the main reasons many doctors are leaving the field of GP is that they have sky high insurance costs, and they payoff isnt there anymore. They also dont want to be acused of making a mistake so they refer more often to specialists.

I agree it would be nice to have an intro to PrEP handbook, and IMO it would be a good start, but frankly there are much bigger health concerns all throughout north america. Diabetes, heart disease, cancer, etc. I know as gay men we see PrEP as a pet cause, but frankly I am much more concerned about diabetes for the country. Hell someone quoted on here, a doctor who said if he had to choose between HIV and diabetes he would be hard pressed to pick diabetes because its much harder to deal with.

[drscorpio]

I did not realize how long it has been since I updated. My GP never got the referral to the ID doctor accomplished.

Today I had my annual urology check up. I decided to ask him what he knew about PrEP. He also seemed clueless about it, but he pulled out his phone and started texting his buddy who is an ID specialist. I should have an appointment with this ID doctor set up in the next couple of days.

[drscorpio]

So today I finally heard from the office of the ID doctor. I have an appointment on February 10. 

[rawfuckr]

So today I finally heard from the office of the ID doctor. I have an appointment on February 10. 

 

that took a while

[drscorpio]

Yeah, the nurse who was supposed to set up the appointment with the ID doctor spaced it. She called to apologize right before Christmas. Then it took 3 more weeks to here from the ID doctor.

[tallbtm]

Good for  you for being persistent!

 

It shouldn't be so difficult to get on PrEP but it seems from reading other guys' accounts here and elsewhere it's not always as easy as it should be. For goodness sake, you're trying to do something smart for your health. You'd think doctors in general would applaud and support that wholeheartedly.

 

My experience starting PrEP was a lot easier an more straightforward. But then I go to a clinic that primarily serves the gay community and the doctors there all know about PrEP.