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AIDS Patient Care STDS. 2017 Apr;31(4):196-204. doi: 10.1089/apc.2017.0002.

"Support Your Client at the Space That They're in": HIV Pre-Exposure Prophylaxis (PrEP) Prescribers' Perspectives on PrEP-Related Risk Compensation.

Author information

1 Department of Psychology, George Washington University , Washington, District of Columbia.
2 Department of Chronic Disease Epidemiology, Yale School of Public Health , New Haven, Connecticut.
3 Center for Interdisciplinary Research on AIDS, Yale University , New Haven, Connecticut.
4 Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University , Washington, District of Columbia.
5 The Fenway Institute , Fenway Health, Boston, Massachusetts.
6 Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, Massachusetts.
7 Columbia School of Nursing , New York, New York.
8 University of Michigan Medical School , Ann Arbor, Michigan.
9 Yale Law School , New Haven, Connecticut.
10 Columbia Law School , New York, New York.
11 Department of Health Promotion and Behavior, College of Public Health, University of Georgia , Athens, Georgia .
12 Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts.
13 Department of Psychology, Yale University , New Haven, Connecticut.


Despite the demonstrated effectiveness of HIV pre-exposure prophylaxis (PrEP) and evidence that most PrEP users do not engage in risk compensation (i.e., increased risk behavior due to a perceived decrease in HIV susceptibility), some healthcare providers report patient risk compensation to be a deterrent to prescribing PrEP. Overcoming this barrier is essential to supporting PrEP access and uptake among people at risk for HIV. To inform such efforts, this qualitative study explored PrEP-related risk compensation attitudes among providers with firsthand experience prescribing PrEP. US-based PrEP providers (nā€‰=ā€‰18), most of whom were HIV specialists, were recruited through direct outreach and referral from colleagues and other participants. Individual 90-min semistructured interviews were conducted by phone or in person from September 2014 through February 2015, transcribed, and thematically analyzed. Three attitudinal themes emerged: (1) providers' role is to support patients in making informed decisions, (2) risk behavior while taking PrEP does not fully offset PrEP's protective benefit (i.e., PrEP confers net protection, even with added behavioral risk), and (3) PrEP-related risk compensation is unduly stigmatized within and beyond the healthcare community. Participants were critical of other healthcare providers' negative judgment of patients and reluctance to prescribe PrEP due to anticipated risk compensation. Several providers also acknowledged an evolution in their thinking from initial ambivalence toward greater acceptance of PrEP and PrEP-related behavior change. PrEP providers' insights about risk compensation may help to address unsubstantiated concerns about PrEP-related risk compensation and challenge the acceptability of withholding PrEP on these grounds.


HIV; behavioral disinhibition; condom attitudes; healthcare providers; pre-exposure prophylaxis; risk compensation

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