Need help finding a doctor to talk about PrEP.

November 4, 2013 6:48 AM

I'm a 35-year-old, gay male (in Silicon Valley) who is looking to jump back into the dating pool after a long absence. A bit after reading this post on Truvada for pre-exposure prophylaxis (PrEP) I thought I might be a candidate for it. I talked to my primary care doctor and although he though it as worth looking into, he didn't have any experience with Truvada and referred me to an infectious disease specialist. Unfortunately my experience with the specialist wasn't great; I felt like he dismissed the idea of PrEP almost out of hand and without really discussing my concerns or possible HIV risk factors. ...

So, now I'm on the search for a doctor in the Silicon Valley area who would be more willing to discuss PrEP with me (and who would have experience with it); however, I'd like to stay with my current primary care doc for all the other things.

(Part of the reason I'm interested in PrEP is that I have OCD (obsession's about germs generally and STIs specifically) and wonder if it would help with some of the anxiety I feel before and after sex--during I'm usually "distracted" enough. For example, after a recent hook up, I started worrying about whether small injuries, such as the remnants of zits, cracked skin, small cuts on cuticles, etc. might have provided an avenue for infection (despite the other guy saying he was "DDF").)

Email for private or follow-up questions: [e-mail]

posted by anonymous to Health & Fitness (7 answers total)

I can't answer your question directly, I am not local, but you might want to consider addressing the OCD directly by treating that, possibly instead of the PrEP. I'm not saying that PrEP is a bad idea per se, but considering that you are already having intrusive thoughts about exposures that are essentially zero risk (i.e. remnants of zits), it suggests that the issue goes beyond just telling yourself that logically, you're very unlikely to get infected.

Also, since the PrEP is marketed to physicians as helping people who find it difficult to consistently use condoms, if you tell them that you always use condoms and that you just want the PrEP to help with obsessive thoughts about HIV infection, they may be reticent to prescribe you an expensive drug with potential serious side effects (albeit a fairly safe one).
posted by treehorn+bunny at 7:17 AM on November 4, 2013 [2 favorites]

You may have more luck finding a provider in San Francisco.
posted by judith at 8:14 AM on November 4, 2013

Seconding that you should deal with the OCD directly. The PrEP is a red herring: you are just feeding your obsession by trying to reassure yourself that it will help, but it sounds like your problem is the fear, not your actual HIV risk. You could go down this path at great effort and expense, yet be completely abstinent and still have that fear.
posted by epanalepsis at 8:21 AM on November 4, 2013

If you're worried, I think you should ask your partners more explicitly whether they're HIV negative (and been tested for other STDs) rather than relying on them saying they're "DDF" (which is presumably on a profile and not something they said out loud?)

But agreed the PrEP is probably a red herring -- if you're using condoms correctly every time, there is insignificant risk.
posted by lewedswiver at 8:31 AM on November 4, 2013

The San Francisco AIDS Foundation had a forum about PrEP last year, and they recently launched a website about it - prepfacts.org. If you don't get other suggestions, I'd try calling them or other contacts listed on the prepfacts website to see if they can recommend someone in the South Bay.
posted by needs more cowbell at 9:01 AM on November 4, 2013

Mod note: This is a followup from the asker.

I am already seeing a therapist for the OCD (for a while now, ~10 years) and am taking paroxetine (Paxil) for it. (I am thinking of changing therapists, but that would be another Ask.)

posted by cortex (staff) at 10:33 AM on November 4, 2013

OP: I just e-mailed you a referral to a great HIV doc at Stanford who would be happy to see you. E-mail includes his contact info. Best of luck.
posted by alms at 1:37 PM on November 4, 2013 [1 favorite]