Troubling the non-specialist prescription of HIV pre-exposure prophylaxis (PrEP): the views of Australian HIV experts

ABSTRACT

The broadening of access to HIV pre-exposure prophylaxis (PrEP) in Australia has rekindled debates about which types of clinicians are best suited to deliver HIV prevention innovations: specialist HIV services or primary care physicians and general practitioners (GPs). We conducted 21 semi-structured qualitative interviews in 2017 with Australian HIV sector experts working across policy, advocacy, clinical service provision, research, and health promotion. These interviews took place before a national policy commitment to subsidising access to PrEP was achieved. We explored how participants conceptualised PrEP, patients and GPs at this key turning point in the history of HIV prevention. Participants expressed varied views regarding GPs’ anticipated ability to successfully navigate the potential complexities associated with PrEP roll-out. While participants were supportive of greater patient access to PrEP, they expressed concerns about non-specialist GPs’ cultural competence and expertise regarding sexuality and clinical practice, and the potential for patients to experience discrimination and homophobia from non-expert GPs. This study has broad implications for thinking about experts and expertise, the implementation of previously specialised medicine into mainstream settings, and the anticipated challenges of LGBTIQ+ inclusive healthcare.

KEYWORDS:

• Pre-exposure prophylaxis (PrEP)
• general practice
• primary health care
• cultural competence
• gay and bisexual men
• qualitative

Acknowledgements

We thank all our colleagues and experts who took the time to participate in the study. Funding for this study was provided by a UNSW Arts and Social Sciences Collaborative Research Scheme grant and a Research Promotion Grant from the Centre for Social Research in Health. The Centre for Social Research in Health is supported by the Australian Government Department of Health.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Anthony K J Smith http://orcid.org/0000-0002-0005-9542

Martin Holt http://orcid.org/0000-0002-2586-8274

Shana D. Hughes http://orcid.org/0000-0002-1388-4103

Christy E. Newman http://orcid.org/0000-0002-5482-2822

Additional information

Funding

Funding for this study was provided by a UNSW Arts and Social Sciences Collaborative Research Scheme grant and a Research Promotion Grant from the Centre for Social Research in Health. The Centre for Social Research in Health is supported by the Australian Government Department of Health.