HIV Pre-Exposure Prophylaxis (PrEP) Online Course at Coursera Review. Day 19 of 42.

Today we continue reviewing the PrEParing course on pre-exposure prophylaxis of HIV in men who have sex with men, abbreviated as MSM. The lecture was introduced by Jordan White, Desmond Tutu Fellow of Public Health in Human Rights at the Johns Hopkins Bloomberg School of Public Health.

Working with MSM requires a PrEP counselor to know about current approaches of working with MSM and a certain level of competence. There are available training, specialized literature, online courses that will allow the doctor to be aware of the psychological, ethical and cultural grounds for adequate assistance to MSM.

In this lecture, Dr. White examined the main features of an attentive, polite and courteous approach to counseling MSM. For those who want to get more skills in working with MSM, the instructor recommends to study the question yourself, and we at Life4me+ suggest asking questions in our groups on the social networks Facebook and VK.

Men who have sex with men, MSM, are faced with social barriers in understanding and communication, even in democratic countries. In countries where human rights are not always taken into account, such men experience much more pressure, sometimes a sense of social exclusion. In a conversation with a doctor, such men are often accustomed to telling fictional stories that will hide their orientation.

So, a client from the MSM group often comes to a consultation with a mistrust that may be caused by previous negative experiences. Even in the US, says Dr. White, many reproductive health professionals may have a prejudice regarding patients from certain groups, such as MSM for example. Prejudice can become a barrier in accessing PrEP.

So it is essential to a client to understand before starting PrEP what kind of prevention method it is, which risks of HIV transmission he has and how PrEP can help him. It may take some time for the client to begin to understand all the possibilities of PrEP, that is, before the appointment of PrEP it is worthwhile to know whether the patient admits such a method of prevention into his life, or not.

It is also worth paying attention to the stigma, the external environment of the patient. An open, benevolent and sincere dialogue will help to establish intimate contact with MSM client. Conversely, neglecting such an initial stage of consultation can negate the efforts to achieve adherence to PrEP for this patient in the future.

When we work with our clients, says Dr. White, especially MSM, we must leave open the questions we ask. The client should be able to identify himself independently; he should not feel that he is prejudiced. So consultant should be affirming and nonjudgemental.

Such skills require practice, but they will help a counselor to achieve high adherence to the PrEP among MSM clients and probably leads to a reduction in new HIV cases in a local community.

In Discussing Sexual Health and Risk, a counselor should be comfortable talking about sexual health and sexual behavior with clients. He also should acknowledge what he doesn’t understand, ask a client for clarification being willing to engage in conversations about anal health and key vaccinations.

The client will often be interested in learning about the risks of getting HIV in various situations — anal sex, oral sex in different positions. It is important to convey information about the lack of risk of HIV transmission in the case of undetectable viral load in an HIV-positive partner; this will help reduce the overall level of stigma and mistrust in the local community.

After that, it’s worth turning to the questions about the use of condoms, the history of bacterial genital infections, such as chlamydia, syphilis, gonorrhea, and others. Does patient have any eruptions on his genitals, perineum or anal area? Such rashes can be caused by viral agents, such as the herpes virus.

PrEP today is a daily dose of one tablet. Many MSM clients are concerned about the toxicity. The counselor may need to talk with the patient about an attitude to his health — if he is engaged in sports, follows a diet or dietary restrictions. These questions should be asked to interest a client to share his attitude to health, nutrition, a way of life.

Awareness about PrEP is one of the key elements of restricting the growth of the HIV epidemic in local communities. So, the way a counselor discusses with MSM client potentially affects lowering HIV spread in a local community. The best evaluation of such a consultation — whether the client was interested, learned all the details about PrEP and will he share this information with his community members, friends, etc. Such network models of involvement have shown good results in epidemiological studies in several countries.

The review is completed for today, if the information you read in the article seems to be important — please, share it on a social network or send it to friends by email or via Whatsapp, Viber, Telegram or another messenger.

If you have not already signed up for the PrEParing course on the Coursera platform, it’s never too late to do it, just follow the link https://www.coursera.org/learn/prep

Stay with us and stay healthy!