Before starting the college
health rotation with Drexel student health, my knowledge about PrEP (HIV
Pre-exposure Prophylaxis) was fairly limited. I knew that it was marketed to
populations at higher risk of HIV infection and that was about it. I could have
never guessed how frequently I would have come across its prevalence in Student
Health at Drexel University and needless to say, I was relatively unprepared. I
knew working in college health, addressing sexual health would be well within
my responsibilities. I was ready to comfortably
ask questions about sexual health: are you sexually active? Do you prefer men,
women or both? How many partners do you have/is this an exclusive or casual
relationship? Do you engage in oral, vaginal, anal sex? Do you use toys? Do you
use condoms? Are you on birth control if so, which one? I even got to the point
where I knew it was better to ask if someone was top, bottom or verse as
opposed to anal-receptive, penetrative or both (terminology I felt to be a
little too sterile, especially with this younger population). These questions
helped steer the conversation during the visit. I was ready to discuss safe
sexual practice, nudge an STI check, and engage in one size does not fit all
conversation (both figuratively and literally). But I missed the mark when it
came to discussing PrEP. By my fourth
year of medical school, I had a solid understanding about interventions if a
patient were to become infected, but I was missing a key component of infection
prevention. As I was fairly ignorant of its uses and contraindications, I found
that I could not properly engage in the conversation.
As I have seen first-hand, HIV
Pre-exposure Prophylaxis has gained an increasing presence in college health. This
is largely due to the American College Health Association (ACHA) and their push
to address college sexual health and improve its practices. The ACHA is a large supporter of broad access to PrEP
in college and university health services. This makes sense when considering
the ages of newly diagnosed patients and the average aged college individual. According
to the CDC, “young adults ages 13–24 accounted for 21% of new HIV infections in
the United States in 2016”. This incidence is not lost on the ACHA. They make
the point that “college health is uniquely positioned to make a significant
impact in the health of young adults in the U.S. by offering PrEP as a standard
health care service.” PrEP can reduce the risk of HIV infection by 90% when
taken as prescribed and used in conjunction with condoms and other prevention
strategies.
It is imperative that as a healthcare
provider, we should be proactive about addressing the benefits of PreP to whom
it is recommended. Whether in college health or not, chances are that our paths
will cross with individuals who could benefit from being on PrEP. A 90% reduction of infection is nothing to
sneeze at and so, arming ourselves with knowledge about this drug is absolutely
required.
Brittney Bruno DUCOM 2020
