This is a list of important topics to discuss with the client when explaining PrEP for the first time and deciding whether it might be right for him or her. It is not comprehensive. Please ensure you use your organisation’s available counselling tools for each of these topics.
What to discuss:
Assess the client’s risk profile
How to discuss it:
Develop a clear picture of the client’s risk profile and lifestyle; make sure they understand how their lifestyle impacts their risk profile. IMPORTANT: use your organisation’s risk assessment tools.
What to discuss:
Combination prevention
How to discuss it:
Taken daily, PrEP is an additional prevention option. It should be used in combination with other prevention tools, like condoms, PEP, healthy lifestyles, treatment for STIs, male medical circumcision, and ART for partners living with HIV. REMEMBER: counselling should highlight that ideally PrEP should be used with condoms.
What to discuss:
Condom negotiation
How to discuss it:
Some clients, may not be able to enforce condom use. Provide guidance on how to safely advocate for condom use by the partner. IMPORTANT: does your organisation have a tool that can help you?
What to discuss:
STIs
How to discuss it:
PrEP does not protect against STIs. Regular testing for STIs is encouraged, regardless of PrEP use. REMEMBER: STIs may increase the risk of HIV acquisition.
What to discuss:
Contraception / Fertility goals
How to discuss it:
PrEP is not a contraceptive. PrEP is safe to use with all contraceptive methods. Consult with a physician to provide guidance on how to proceed if the client becomes pregnant.
What to discuss:
Adherence (daily)*
How to discuss it:
For PrEP to be effective, the pill must be taken every day. Adherence counselling is critical for full HIV protection. *More detail is provided in the Adherence section that follows.
What to discuss:
Side effects
How to discuss it:
Some people get mild side effects when they start PrEP, but they generally go away after a few weeks. The most common side effects include: nausea, headache, tiredness, diarrhea, depression, abnormal dreams, vomiting, rash, problems sleeping, and changes in appetite.
What to discuss:
Intimate partner violence (IPV)
How to discuss it:
People who have abusive or controlling partners may find it more difficult to take care of their sexual health and to adhere to PrEP. Ask about the client’s relationships, and for clients experiencing abuse, provide counselling and referrals, when possible.
What to discuss:
Talking to your partner, family, friends, etc.
How to discuss it:
Deciding whether to tell anyone about your PrEP use is a completely personal decision. Some people find it helpful to tell friends or family for support and to provide reminders to take the pill daily. Discuss with the client whether and how they would like to discuss PrEP with loved ones and how to overcome any potential barriers to gaining their support.
What to discuss:
Visit schedule
How to discuss it:
Explain the visit schedule for PrEP use. The client must return for follow-up visits at the first month, and then every three months. They must also return to the clinic monthly to pick up their pills.