HIV Prevention Strategies Beyond PrEP, Catalyzing Clinic Improvement

Segment Description: Gregory Felzien, MD, AAHIVS, Medical Advisor, Division of Health Protection/IDI-HIV Georgia Department of Public Health, discusses prevention beyond PrEP and creating a safe environment for patients with HIV.

Interview transcript: (modified slightly for readability)

One of the things that we hear all the time in the media is prevention equals PrEP. And that's what the clients I serve are hearing. It's PrEP, PrEP, PrEP, and I'll have providers and clinics call me and say, “well, we want to start a PrEP clinic,”. So I listen to them. And what they really want is a sexual health or a wellness clinic that includes condoms, treatment as prevention, PrEP. So we know that that if you take a pill every day, as in PrEP, it works, but it's not for everybody.

And I'll have clients that come in we have the discussions and they just say, “you know that pill isn’t for me,” what else what else is available? We definitely want to talk about not just that individual in front of us, but is your partner positive? If they’re positive, are you going to their appointments? Are they taking medications? Because we know treatment is a form of prevention.

We really want to think about this as sexual health in general, because we also have a lot of misconceptions. Some think, “oh, I'm on this pill, I'm protected from everything.” But yet, we can see in some populations, higher rates of other sexually transmitted infections, we're seeing more syphilis, gonorrhea, chlamydia, etc. It’s really bringing to them education, and making sure that they're safe as possible. So all of a sudden, they're not going from an HIV negative status to an HIV positive status. We really want to think about it from that standpoint.

We also want to think about it from the standpoint that it's so easy to say: “your clinic should be doing this, your facility should be doing this.” And when you're thinking about expanding the services in any system, what one of the things we really get from pushback is “we have limited resources.” And that doesn't always mean finance. That means we have limited staff, we have limited time. And to add one more thing, whether that be prevention or the other types of care, can be very challenging.

One of the things that we want to do when we promote these type of services is finding that champion. So, we're going to find an individual in that system that says, “I want to do this, I want to take this on, I'm willing to do it without additional pay or, or without additional time, I'm willing to take on this challenge.” And that really helps promote some of these new programs.

The other part of this is getting away from the old system. And the old system is you want to start a wellness clinic, I show up. We might spend an hour to 3 hours having a discussion, and then best of luck and I leave and then you're left and then there's this feeling of isolation. So really educating folks on how to expand these services, really thinking through this process, and also making sure they don't feel isolated so they can contact somebody and then contact the individuals that spoke to them, their national help lines, to assist with this.

Their programs such what I have is the echo projects or moving knowledge, not people. We can have a safe environment where individuals can present cases and the community learns. I think there's a lot of different methods that can promote these processes. But then on the flip side, we have to think about the community we serve. So if I walk into your clinic, or let's say my mother brings me to the clinic because I don't have transportation and she walks in and in that clinic in the waiting room, all she sees are HIV posters, prevention posters, and I haven't disclosed to her, all of a sudden we're going to have a conversation on the ride home.

The individual wants to feel safe in that environment. A lot of times, their support system is that clinic, because they're not getting support from family because they haven't disclosed, they're not getting support from their faith-based organizations, from their work environment. It’s really making sure that we create these safe environments. So that when we do develop these programs, individuals feel welcomed and they're going to come and access that carry on.