NEWS

CDC: All Sexually Active Patients Should Know About HIV Prevention Drugs

A female-presenting mixed-race doctor talking to a young female-presenting white patient in an office.

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Key Takeaways

  • The Centers for Disease Control and Prevention (CDC) is now recommending that physicians discuss prophylactic drugs that reduce the risk of HIV transmission (PrEP) with all of their patients who are sexually active.   
  • A brief discussion of a patient’s sexual history should be part of primary care and should guide physicians in discussing whether patients might need PrEP. 
  • Many physicians skip taking a sexual history of patients—either because of their own or their patients’ discomfort. As a result, patients who could benefit from PrEP miss out on key HIV prevention measures.

Medications that can reduce the transmission of HIV (human immunodeficiency virus) have been approved for several years and recommended for people who are at risk for contracting the virus.

This has historically included men who have sex with other men and people who use intravenous (IV) drugs like opioids. Now, the Centers for Disease Control and Prevention (CDC) is recommending that primary care physicians discuss the use of medications that prevent HIV with all patients who are sexually active, including teenagers. 

Preventing HIV is a key step, but treating the infection if it does occur is also important; untreated HIV infection can progress to acquired immunodeficiency syndrome (AIDS).

Ada Stewart, MD, FAAFP, a family physician and board chair and spokesperson for the American Academy of Family Physicians, told Verywell that when taken every day, preexposure prophylaxis (PrEP) is 99% effective at reducing the risk of the sexual transmission of HIV. For people who use IV drugs, Stewart said that the medication is "over 70% effective" at preventing HIV.

Considering that the medications are safe and effective, why aren't more people taking them?

How Doctors Can Help

One reason why there are many people who are not using PrEP (but could be) is that they have never been offered it by their doctors. They might not even know it's an option if it's never come up in a conversation that they've had with their healthcare providers.

PrEP Medications

Currently, two oral medications have been approved by the Food and Drug Administration (FDA) for use as PrEP: Truvada (a combination of tenofovir disoproxil and emtricitabine) and Descovy (tenofovir alafenamide and emtricitabine).

A third option, Apretude (cabotegravir), is an injection that is administered every two months. It recently received FDA approval.

Stewart commended the CDC on its recommendation because it gives providers a "greater stand as we talk with our patients about PrEP. We have over one million individuals who are living with HIV and many of those don't know that they have HIV.”

Michelle Collins-Ogle, MD, FAAP, a pediatric infectious disease specialist, assistant professor of pediatrics at Einstein College of Medicine, and a spokesperson for The Infectious Disease Society of America (IDSA), told Verywell that the organization “has supported and has been supporting the use of PrEP in all populations that are sexually active."

There are also a number of health disparities that affect who takes PrEP—often among the people who are most at risk for HIV. According to the CDC, there are persistent racial, ethnic, and socioeconomic disparities that mean that many people who could benefit from PrEP are not able to access it.

If primary care physicians only think that gay men, transgender people, and IV drug users are the patients who need PrEP, Stewart cautioned that they would be missing many patients who are at risk for HIV and would benefit from prevention.

Ada Stewart, MD, FAAFP

There's so much stigma around HIV that it's important that we recognize we have to address that issue.

— Ada Stewart, MD, FAAFP

“As family physicians on the frontlines of all of this, we have recognized that many times we've missed the boat for individuals who are candidates for PrEP," said Stewart. "We miss a huge group of individuals who potentially could have benefited from PrEP and therefore miss that opportunity.”

Stewart said that asking all patients about their sexual history and habits should be part of primary care practice, as asking about smoking or alcohol use is. Stewart takes a sexual history on each patient at least once a year and asks them if anything (such as relationship status) has changed. 

“There's so much stigma around HIV that it's important that we recognize we have to address that issue," said Stewart. "One way to address it is to talk to all our patients—all our patients, no matter what—about their risk."

Never Assume HIV Risk

Stewart stressed that physicians should never make assumptions about which patients are most likely to contract HIV. For example, a patient might be monogamous in their relationship, but their partner might not be. A patient could also be in a relationship with a person who uses IV drugs.

“It is not just for men right now. It's for women—especially African American women,” said Stewart, adding that they care for an 87-year-old female patient who was recently found to be HIV positive

According to Collins-Ogle, many physicians do not consider women in their 30s for 40s as being at risk for HIV. Therefore, they're not having these important conversations about sex with them.

“I've had many women who have been denied PrEP because the clinician does not perceive that person as being at risk,” said Collins-Ogle. “The primary care clinician is in a great place; [it's] a great point of entry to receiving prevention services and appropriate sexual health counseling.”

Stewart added that counseling sexually active adolescents about whether PrEP could be right for them is also crucial. Stewart asks the patient's parents or caregivers to step out of the room, which gives them the opportunity to ask teenagers questions about their sexuality privately.

“You have to establish trust with that young person, and you have to let them know that what you tell me is between you and me and I don't share my information with anyone else,” added Collins-Ogle, who sees primarily adolescents and young adults in their practice—many of whom are HIV-positive.

What This Means For You

The CDC's updated recommendation about discussing HIV prevention with all sexually active patients might mean that your doctor is more willing to have the conversation with you.

If you are not sure if you are at risk for HIV, or you do not know about your options for preventative treatment, you can also bring the topic up with your doctor.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Institutes of Health. Pre-Exposure Prophylaxis (PrEP). Updated August 10, 2021.

  2. Centers for Disease Control and Prevention (CDC). What Is PrEP?. Updated October 18, 2021.

  3. Smith DK, Van Handel M, Grey J. Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction, transmission risk group, and race/ethnicity, United States, 2015Ann Epidemiol. 2018;28(12):850-857.e9. doi:10.1016/j.annepidem.2018.05.003

  4. Centers for Disease Control and Prevention (CDC). PrEP for HIV Prevention in the U.S. Updated November 23, 2021.