Pre-exposure prophylaxis and primary care

Des Crowley; Walter Cullen; Patrick O’Donnell

doi:10.3399/bjgp20X712097

INTRODUCTION

Despite the increasing evidence of the effectiveness of pre-exposure prophylaxis (PrEP) as a HIV prevention strategy, its usefulness is rarely reported in the general practice literature.¹

HIV infection remains a major public health concern worldwide and it is men who have sex with men (MSM) that carry a disproportionate amount of the disease burden.² Despite evidence that the rate of new HIV infections in the UK is falling, the rate among young MSM is a cause for concern.² The Republic of Ireland (ROI) has not seen a similar decline, with 523 new HIV cases diagnosed in Ireland in 2018.³ Similar to other European countries, the main risk for HIV transmission in Ireland is sex among men.²^,³

HEALTH DISPARITIES AND MINORITY STRESS

With the recent introduction of legislation allowing same sex marriage in both the UK and Ireland, there is increasing acceptance of LGBT people; however, many LGBT people continue to experience stigma and discrimination.⁴

It is recognised that LGBT people experience inequalities across a range of health issues when compared to heterosexuals; including higher levels of anxiety, depression, self-harm, suicide, and drug dependence.⁴ Minority stress may explain some of these identified disparities,⁵ and this theory has also been proposed as an explanation for the high levels of risk-taking behaviour seen in MSM populations.⁵ Marginalisation and stigma are certainly recognised as factors that contribute to people engaging in risky behaviour.⁵