For Teachers & Professionals

Communication Strategies for Discussing PrEP

HIV continues to be a serious risk for men who have sex with men (MSM), with rising numbers also in Europe according to the latest data from the European Centre for Disease Prevention. The prevalence is three times higher for men than women and the MSM is the main transmission modality in western Europe while drug use and heterosexual intercourses are the main cause of transmission in eastern Europe.

A new means of HIV prevention, called pre-exposure prophylaxis (PrEP) reduces the risk of contracting HIV by over 90%, but its adoption has been slower than expected. There are more reasons and barriers that prevent PrEP adoption. For example, limits in social media and information strategies, like the fact that much of the information currently available via social channels focus on awareness of PrEP and how it works, but not on the complexities of insurance coverage and differences in young people’s ability to independently access care. But one of the main reasons is that healthcare providers may have difficulty communicating with their MSM patients and may lack cultural competence.

Here are revealed five strategies that healthcare providers successfully employed to discuss PrEP and sexual health with their patients.

1. Disclosure of identity and personal information 

Many patients feel most comfortable in interactions with their healthcare provider if their provider discloses that they are LGBT. This helps create a connection and leads to perceiving that the provider is better able to understand the patient. Although this strategy is clearly unique to LGBT-identified providers, both LGBT and heterosexual providers can utilize the remaining four strategies described here.

2. Knowledge of information that may be relevant to MSM patients

Being knowledgeable about cultural and health information that may be relevant to MSM. For example the knowledge about gay pride events: “Well, you can be honest with me. Did you do things that gay men usually do at a Pride Weekend? I’m your doctor, you can tell me about this.”. Or talking about MSM specific health concerns, like doing anal paps. Patients respond favourably when their providers appear motivated to learn about the information that they perceive to be relevant to them or their communities. This helps in building trust and rapport.

3. Positivity

Patients explain that they feel most supported by their healthcare providers when messages about sexual health and PrEP are framed in positive terms. For example, smiling while delivering information and answering questions can be perceived as warm and welcoming. Patients say that they appreciate when their providers acknowledge the steps they are taking to be healthier and view PrEP adoption as a responsible, health-fortifying decision. Patients also express that they value when providers use a realistic approach, the idea that no one makes the healthiest decisions all the time, with no shame and judgment between the lines.

4. Relationships inquiries

Patients report that it is validating for them when their healthcare providers ask about their relationships and their partners. For example, asking after a break-up “How are things going with that?”. Being professional, but also just pretty casual and asking you about the patient and his relationships like “Are you single? Do you have a partner?”. Patients note that when doctors ask them about their relationships, it makes them feel more comfortable discussing health-related topics. 

5. Remaining calm

Patients describe feeling anxious and uncertain about topics such as PrEP adoption, HIV testing, and other STI testing. Discussing these topics with a healthcare provider tends to be stressful. Patients report that they are most comfortable when their healthcare providers maintain their composure. Calmly outlining preventative measures or a course of treatment is a strategy that is enthusiastically endorsed by participants. 

These strategies help providers to establish a positive rapport with their patients and lay the foundation for a trusting relationship.

REFERENCES

Birnholtz J., Kraus A., Schnuer S., Tran L., Macapagal K. & Moskowitz D. A. (2021). ‘Oh, I don’t really want to bother with that:’ gay and bisexual young men's perceptions of barriers to PrEP information and uptake, Culture, Health & Sexuality. DOI: 10.1080/13691058.2021.1975825 

HIV/AIDS surveillance in Europe 2021 (2020 data). (2021, November 30). ECDC. Retrieved September 16, 2022, from https://www.ecdc.europa.eu/en/publications-data/hiv-aids-surveillance-europe-2021-2020-data

Schwartz J., Grimm J. (2022). Communication Strategies for Discussing PrEP with Men Who Have Sex with Men, Journal of Homosexuality, 69:1, 61-74. DOI: 10.1080/00918369.2020.1813509.