My doctor shamed me for getting tested

[craigville beach]

Everyone needs to be more active in their health care. Picking the right doctor makes all the difference in the world, and it may save your life to live another day.

 

When I was working I would listen to my co-workers complain about: their doctor, their pharmacy, the local hospital, and the health insurance company.

 

I had the same health insurance company they did. Ask question, speak up, don't accept any answer as the only answer. But do it with respect and be polite. Good health care is out there.

 

Several years ago I was in the doctors office for some routine tests. The next thing I knew, it was 3 days later and I was in the Beth Israel Deaconess Hospital Cardiac ICU with 5 chest tubes coming out from within me and and a respirator down my throat. I had emergency open heart surgery. For those who haven't experienced this, it must be easier to die. The pain was incredible, and there wasn't anything I could say to those attending to me.

 

I later found out that my Doc was reprimanded for punching a male nurse (the doc knocked the nurse out) for not moving fast enough to take care of one of the Doc's patients. That patient was me. My Doctor is NOT a one of a kind. There are many who are dedicated to their patients.

 

Good health care is out there. Too many people turn over their health care to whomever is standing in front of them at the time. We tend to think of them as gods. They are not. But once in while one of them is an angel in disguise.

 

you need to find another doctor, he or she is out there.

[MikeyGMin]

As my new dr told me when I mentioned prep. He said " The official on the record response Is Safe sex is the only choice. Prep is not endorsed or should even be considered an option.. off the record, The studies do show Prep to be effective as long as you keep up with the regimen, its not a pop it in the night you decide to get lucky. Also it wont protect you from all the OTHER STDs.. and hope to god you don't encounter someone with a virus strain that is Truvada resistant. "

 

Yikes! Where are you guys finding these doctors?

 

A. Remember when we used to call it "safer" sex? When we acknowledged there was no such thing as 100% "safe" sex because of accidents? To say "safe sex is the only choice" is just one step above saying abstinence is the only choice.

 

B. Yes, you do have to take a pill every single day. Something women have been doing for birth control for generations. It's not a big hardship.

 

C. No, it won't protect you from other STDs, but that's only relevant if you are using it as your only means of protection. Would you skip the polio vaccine because it also doesn't immunize you from the mumps?

 

D. I have never seen a single thing about a Truvada resistant viral strain. Probably because the drug is so damn effective. But once again, if there's an accident or you make a mistake, wouldn't you rather have something in your corner that works against all the strains we do know about?

 

I know I live in a pretty liberal city. We have a very active PREP program that works diligently to get it into the hands of everyone who wants it. They started the program just because of the ignorance and slut shaming of doctors who claim there is an "official" position and people were finding it difficult to get prescriptions.

 

A year ago, the jury was still out. But now any doctor who says you should just play safe and not bother with PREP is as bad (and ill informed) as someone who denies climate change

[sincitymix]

Yikes! Where are you guys finding these doctors?

 

A. Remember when we used to call it "safer" sex? When we acknowledged there was no such thing as 100% "safe" sex because of accidents? To say "safe sex is the only choice" is just one step above saying abstinence is the only choice.

 

B. Yes, you do have to take a pill every single day. Something women have been doing for birth control for generations. It's not a big hardship.

 

C. No, it won't protect you from other STDs, but that's only relevant if you are using it as your only means of protection. Would you skip the polio vaccine because it also doesn't immunize you from the mumps?

 

D. I have never seen a single thing about a Truvada resistant viral strain. Probably because the drug is so damn effective. But once again, if there's an accident or you make a mistake, wouldn't you rather have something in your corner that works against all the strains we do know about?

 

I know I live in a pretty liberal city. We have a very active PREP program that works diligently to get it into the hands of everyone who wants it. They started the program just because of the ignorance and slut shaming of doctors who claim there is an "official" position and people were finding it difficult to get prescriptions.

 

A year ago, the jury was still out. But now any doctor who says you should just play safe and not bother with PREP is as bad (and ill informed) as someone who denies climate change

 

B. That's the point you have to take it everyday, and ensure you have enough of the active ingredient in your system. Depending on the medication, the longevity of the active ingredient can vary to a few days to 2 weeks. That is why some people think.. oh im just going to take this Truvada the night I go clubbing, that way I will be safe from hiv when I go home or have sketchy sex in the bathroom stall with that hottie!

 

D. Any hiv virus can become resistant if the person stops taking the meds, or takes it intermittently, or the virus mutates. That person then has sex with another person who gets infected. that person now has a virus that can be one or more drug multi resistant, especially if its a strain that has gone through many different carriers on many different medications.

[MikeyGMin]

That is why some people think.. oh im just going to take this Truvada the night I go clubbing, that way I will be safe from hiv when I go home or have sketchy sex in the bathroom stall with that hottie

 

I personally don't know anyone that stupid. If you do, you should lovingly slap them very firmly upside the head! :mad:

[gallahadesquire]

Please allow me to play Devil's Advocate [to all of the above, not just the OP]:

 

Most GP / Internists / Family Practitioners may have inadequate knowledge of HIV, PREP, and what truly consititues Safe Sex [above and beyond abstinence, of course].

I think my medical alma mater has gotten a better handle on Human Sexuality, but I also think this is a relatively new subject for them.

 

Rather than dumping the Practitioner wholesale, consider having a heart to heart with them about sexuality, your personal sexual interactions, and risks. They may merely be having a moment of il-lucidity.

 

I'm reminded of a cardiologist I saw. He said, "I'll tell Mr. Jones, 'You know, you really shouldn't have steak twice a week. It will increase your chances of dying early.'

'But there's no point to living if I can't have my steak.'

'I understand. It's a choice that you can make. I just have to tell you my professional opinion.'"

 

Personally, depending on your sexual activity, being tested for STD more than quarterly does seem to be a bit much. Then again, if you're having sex so frequently that bi-weekly is not inappropriate, I tip my hat off to you!

 

And, gentlemen, DO try to play safe!

[Zman]

Yah this kind of attitude is far too common in my experience. It's not just doctors. You can find this BS at clinics too.

[Juan Vancouver]

B. Yes, you do have to take a pill every single day.

 

B. That's the point you have to take it everyday, and ensure you have enough of the active ingredient in your system. Depending on the medication, the longevity of the active ingredient can vary to a few days to 2 weeks. That is why some people think.. oh im just going to take this Truvada the night I go clubbing, that way I will be safe from hiv when I go home or have sketchy sex in the bathroom stall with that hottie!.

 

In the spirit of keeping the information we share here correct and current, I think it is important to share the findings of IPERGAY's study in France.

 

Google it.

 

The gist of the study is simple. They prescribed Truvada on demand. This is with the purpose of making the expense smaller and also to avoid the possible kidney complications of daily long use of Truvada.

 

They recommended to take two pills of Truvada from2 to 24 hours before sexual contact, then one pill a day later and a last pill 48 hours after the contact.

 

The success rate was really high. 86% efficacy in preventing seroconversion.The two conversions that took place in the study are believed to have been caused by a lack of adherence to the program, rather than because the medication didn't work.

[MikeyGMin]

The success rate was really high. 86% efficacy in preventing seroconversion.The two conversions that took place in the study are believed to have been caused by a lack of adherence to the program, rather than because the medication didn't work.

 

Do you know if they went bare after that or the expectation was that they would still use protection? Our clinic is still telling people to take it daily and to not count on protection for two weeks into it.

 

They are going to get it fine-tuned I know it. Just like I know there will still be people slut shaming people who take it because of the actions of the boys that do go crazy and act like it's a get out of jail free card.

[Juan Vancouver]

Do you know if they went bare after that or the expectation was that they would still use protection? Our clinic is still telling people to take it daily and to not count on protection for two weeks into it.

 

I had exactly the same question. A pharmacist who had just attended a conference in which this study was brought up says the study was a study of treatment as prevention. This means condom use was discretionary. I pushed further and asked whether this meant people getting fucked bare but orgasming outside, but he said no, ejaculations inside the ass. Positive partners ejaculating inside negative partners.

 

Same applies to the 99% efficacy on studies taking it daily.

 

As for protection, I thought you had to take it for a month before they were certain it protected you. I am not sure, I would double check on that. At this point in time it is just theoretical information for me. Fucking fascinating! It blows my mind to see that we collectively have come the other side.

 

Of course, safer sex increases your protection against all other nasties, but it is such a relief to know the stop of HIV is now conceivable.

[+ purplekow]

Yikes! Where are you guys finding these doctors?

 

 

 

 

D. I have never seen a single thing about a Truvada resistant viral strain. Probably because the drug is so damn effective. But once again, if there's an accident or you make a mistake, wouldn't you rather have something in your corner that works against all the strains we do know about?

 

 

A year ago, the jury was still out. But now any doctor who says you should just play safe and not bother with PREP is as bad (and ill informed) as someone who denies climate change

 

Now you have. Tricky thing with resistence is it starts slowly and then speeds along.

 

http://www.aidsmeds.com/articles/PrEP_drug_resistance_1667_26703.shtml

 

Paraphrasing Juan, there is an end in sight but be careful, someone is going to get the last case. Try and make the day that last case happens come sooner and try to make sure it is not you getting it.

[Guest]

Seems like malpractice.

 

Oh, for God's sake, get a grip. So the doctor was rude. That's not malpractice. Such melodrama. Getting tested every 3 months is pretty unusual, and should spurn any competent and caring health care provider to discuss ways in which to make sexual behavior more healthful. The challenge in medical practice, of course, is to frame the discussion in a way which makes the patient feel empowered to improve his health behaviors, rather than in shaming the patient. What would probably constitute more negligent care (though probably not exactly malpractice), would be to simply order the test and give results like some kind of automaton without discussing what's behind the request for such frequent testing. Of course, a lot of doctors probably do just that, most often because they get burnt out by patients who never seem to listen to advice, or, worse, feel slighted by such advice. These are the lousy doctors. This does not, of course, imply that the discussion should take place in an authoritative or demeaning manner. I will agree with most of the responders here that if your doctor makes you feel ashamed rather than empowered, he's probably not a good match for you.

On Wednesday, I saw a patient some 4 or 5 days after he was discharged from a hospital near my office (but not the hospital where I'm on staff). This 51 year-old was admitted due to shortness of breath, and found to be in heart failure, with his heart only pumping out 21% of the blood volume coming in (normal is about 55% to 70%). His drug screen (at the hospital) was positive for methamphetamines, and his blood tests showed evidence of significant alcohol use as the causes of his dilated, floppy heart. After welcoming him to our office and asking him how he had been doing since leaving the hospital, I asked him what they told him at the hospital, and what his understanding of his illness was. His answer was "They told me my heart was real bad." This man had seen a number of physicians and RN's, including his attending/hospitalist and a cardiologist or two, and no one told him that his heart failure was caused by his amphetamine and alcohol use, nor that he was going to die shortly if he continued.

Rather than shaming the patient, I put a positive spin on it. I told him that while his heart at this time was, indeed, very weak, that he in fact had the best kind of heart failure to have. I told him that I've taken care of lots of people in almost exactly his situation. When they stop the amphetamines and alcohol, their hearts usually go back to normal within a matter of months. I told him that if he stops the drugs and alcohol, I wouldn't be surprised to repeat the echocardiogram in 6 to 9 months, and find it to be completely normal, and to be able to take him off of all of his heart medicine. I told him that I've also had the experience of patients come back a few weeks later with drugs still in their systems, and then some weeks or months later, I get a call from the Medical Records Department: "Can you fill out the death certificate for Speedy O'Hara? The funeral home needs it to release the body." I then offered him some phone numbers for resources in helping him stay away from drugs and/or alcohol. His face brightened up, and he said "No thanks. Now that you've explained it to me, I don't think I'll have any trouble keeping clean."

By the way, on further questioning, he told me that he had resumed doing amphetamines and alcohol after leaving the hospital, because no one had told him they were killing him!

[Guest]

As for protection, I thought you had to take it for a month before they were certain it protected you. I am not sure, I would double check on that. At this point in time it is just theoretical information for me. Fucking fascinating! It blows my mind to see that we collectively have come the other side.

 

At the risk of promoting aberrant behaviors, I will enlighten our group with a study which was published in the New England Journal of Medicine just last week. It showed that one can get pretty good protection (if an 86% reduction is pretty good) even if one takes the pills "on demand." Please note, however, that 18% of those who took the medication had adverse kidney events, and 15% had adverse intestinal events. I'll stick with condoms, thank you.

http://www.nejm.org/doi/full/10.1056/NEJMoa1506273

[Wolfer]

"I shouldn't be doing preventative screenings, that I just should be having safe sex."

 

That's an illogical thing to say though since it's not an either or situation. Almost seems that there's something missing from this. You sure he wasn't just joking around and you missed it?

Yeah, that's what left me so confused about what exactly he was trying to say to me. I think we had a major communication mishap.

Ad verbatim:

GP: "Getting preventative screenings, it's the wrong kind of attitude, though."

Me: "Yeah, I always practice safe sex. It's for my own peace of mind."

GP: "That may well be, but still, I'm just saying. You know, it needs to be said."

And then uncomfortable silence while he input my info into the computer.

 

 

Personally, depending on your sexual activity, being tested for STD more than quarterly does seem to be a bit much. Then again, if you're having sex so frequently that bi-weekly is not inappropriate, I tip my hat off to you!

 

Oh, for God's sake, get a grip. So the doctor was rude. That's not malpractice. Such melodrama. Getting tested every 3 months is pretty unusual, and should spurn any competent and caring health care provider to discuss ways in which to make sexual behavior more healthful.

Unicorn, I think I would like to be your patient! But I live in Belgium, so that's gonna be difficult.

But this is what bothers me, there are no clear guidelines on what the cut-off point is for getting tested either every three or six months. When I started getting sexually active, I couldn't even find any clear resources that gave me a clear cut overview of risks, STI's and whatnot. Is having safe® sex with different partners every day unhealthy behaviour? (Just a rhetorical question to show that I'm bothered that everything is so up for interpretation, my type A personality does not like that . I don't have sex every day, though, I've had sex 14 times in the last six months.)

The most often recommendation I see is to get tested every six months when you don't have symptoms, practice safer sex and have a "normal" or "healthy" (hate those words) sex life. Many now here have posted that I might be getting tested too often, so the message is trickling through...

[+ quoththeraven]

From a risk-management standpoint (not a medical one; I'm not a doctor) every six months seems like the most frequent testing interval necessary given how often you have sex and use of safe sex practices (which from context I assume means condoms, not PrEP).

[sincitymix]

From a risk-management standpoint (not a medical one; I'm not a doctor) every six months seems like the most frequent testing interval necessary given how often you have sex and use of safe sex practices (which from context I assume means condoms, not PrEP).

Also be careful on the number of tests your doctor orders in a span of time. He kept scheduling my appointments every 3 months, Lab test after lab test for the same thing every time. My insurance finally called me and asked why the dr was testing me for the same tests every 3 months. (some sort of concierge Nurse type thing that the company pays extra for) Not that they were concerned about what they were paying, but rather what i was paying since my plan had a deductible. I had no explanation, went to the dr and he just shrugged and said it was routine. I put a stop to those unnecessary testing right away.

[Guest]

GP: "Getting preventative screenings, it's the wrong kind of attitude, though." ...

But this is what bothers me, there are no clear guidelines on what the cut-off point is for getting tested either every three or six months.

 

Well, your GP was essentially right, even if he put it awkwardly. After the initial infection, HIV almost always goes through a years-long silent period before the immune system goes to pot, so I can't see much sense in testing every 3 to 6 months even if your behavior is risky, which you say it isn't. There are actually are some good suggestions from guideline agencies out there. All pregnant women should be screened, of course, because of the chance to transmit to the baby. Leaving that aside, this is what the USPSTF (United States Preventative Services Task Force) has to say about testing frequency:

One reasonable approach would be one-time screening of adolescent and adult patients to identify persons who are already HIV-positive, with repeated screening of those who are known to be at risk for HIV infection, those who are actively engaged in risky behaviors, and those who live or receive medical care in a high-prevalence setting. According to the CDC, a high-prevalence setting is a geographic location or community with an HIV seroprevalence of at least 1%. These settings include sexually transmitted disease (STD) clinics, correctional facilities, homeless shelters, tuberculosis clinics, clinics serving men who have sex with men, and adolescent health clinics with a high prevalence of STDs. Patient populations that would more likely benefit from more frequent testing include those who are known to be at higher risk for HIV infection, those who are actively engaged in risky behaviors, and those who live in a high-prevalence setting. Given the paucity of available evidence for specific screening intervals, a reasonable approach may be to rescreen groups at very high risk (see Assessment of Risk) for new HIV infection at least annually and individuals at increased risk at somewhat longer intervals (for example, 3 to 5 years). Routine rescreening may not be necessary for individuals who have not been at increased risk since they were found to be HIV-negative.

 

So you might probably be in the 3 to 5 year category. Now, if you have symptoms of acute HIV infection 2 to 4 weeks after some risky sexual activity, then you can be tested for acute infection, but this would be a viral load test, not an antibody test, since the antibody test becomes positive only after the acute infection. The symptoms of acute HIV infection include a fever of over 101F or 38.3C, muscle pain, sore throat (especially if there are sores), and swollen glands. As your physician inelegantly pointed out, though, testing doesn't prevent infection. Prevention is better than treatment, which is a lifelong endeavor with drugs that can have bad effects on many organ systems. So you can probably cool it on the frequent testing, and stay more focused on prevention.

[Guest]

Oh, I forgot to mention that acute HIV also often gives a rash. I don't know if any forum members with HIV remember having such a rash...

http://www.patienthelp.org/wp-content/uploads/2013/07/Acute-HIV-Rash-on-Chest.jpg

 

http://www.patienthelp.org/wp-content/uploads/2013/07/HIV-Rash.jpg

 

http://www.rashresource.com/wp-content/gallery/hiv-rash/hiv-rash-pictures-07.jpg

[Wolfer]

Well, your GP was essentially right, even if he put it awkwardly. After the initial infection, HIV almost always goes through a years-long silent period before the immune system goes to pot, so I can't see much sense in testing every 3 to 6 months even if your behavior is risky, which you say it isn't. There are actually are some good suggestions from guideline agencies out there. All pregnant women should be screened, of course, because of the chance to transmit to the baby. Leaving that aside, this is what the USPSTF (United States Preventative Services Task Force) has to say about testing frequency:

One reasonable approach would be one-time screening of adolescent and adult patients to identify persons who are already HIV-positive, with repeated screening of those who are known to be at risk for HIV infection, those who are actively engaged in risky behaviors, and those who live or receive medical care in a high-prevalence setting. According to the CDC, a high-prevalence setting is a geographic location or community with an HIV seroprevalence of at least 1%. These settings include sexually transmitted disease (STD) clinics, correctional facilities, homeless shelters, tuberculosis clinics, clinics serving men who have sex with men, and adolescent health clinics with a high prevalence of STDs. Patient populations that would more likely benefit from more frequent testing include those who are known to be at higher risk for HIV infection, those who are actively engaged in risky behaviors, and those who live in a high-prevalence setting. Given the paucity of available evidence for specific screening intervals, a reasonable approach may be to rescreen groups at very high risk (see Assessment of Risk) for new HIV infection at least annually and individuals at increased risk at somewhat longer intervals (for example, 3 to 5 years). Routine rescreening may not be necessary for individuals who have not been at increased risk since they were found to be HIV-negative.

 

So you might probably be in the 3 to 5 year category. Now, if you have symptoms of acute HIV infection 2 to 4 weeks after some risky sexual activity, then you can be tested for acute infection, but this would be a viral load test, not an antibody test, since the antibody test becomes positive only after the acute infection. The symptoms of acute HIV infection include a fever of over 101F or 38.3C, muscle pain, sore throat (especially if there are sores), and swollen glands. As your physician inelegantly pointed out, though, testing doesn't prevent infection. Prevention is better than treatment, which is a lifelong endeavor with drugs that can have bad effects on many organ systems. So you can probably cool it on the frequent testing, and stay more focused on prevention.

Thanks for the info. And what about testing frequency for other STI's like Chlamydia, Ghonorrea, Syfilis, Herpes? (I imagine hep C testing would be less frequent, like HIV, since it's a lot more difficult to transmit).

I'm already super careful on the prevention side, the only other step I can take is abstinance

[+ Funguy]

Make sure you get the HPV vaccine (series of 3) and Hep B vaccine (also series of 3).

[Guest]

Thanks for the info. And what about testing frequency for other STI's like Chlamydia, Ghonorrea, Syfilis, Herpes? (I imagine hep C testing would be less frequent, like HIV, since it's a lot more difficult to transmit).

I'm already super careful on the prevention side, the only other step I can take is abstinance

 

This is an interesting set of questions, and there is some controversy regarding the answers. Chlamydia can live in the penis (urethra) or rectum. It can cause pain with urination when in the urethra in men sometimes, but not when it's in the rectum. The main problem with chlamydia is that it can damage the Fallopian tubes in women, leading to infertility and pregnancy in places other than the womb. Gonorrhea can live in the urethra, throat, or rectum. It usually causes pain when in the urethra, sometimes causes pain in the throat, and usually no symptoms when in the rectum. Syphilis causes a sore (skin ulcer) which doesn't hurt on the penis in men during the initial infection. The disease then usually becomes dormant for years, and then can come back, attacking just about any organ from the skin (rash) to the heart, brain, liver, or whatever. Herpes presents with painful sores which can keep coming back at any kind of interval, from as frequently as monthly to never. Chlamydia is checked with a pee test and rectal swab. Gonorrhea with the same, plus a throat swab. Syphilis is generally checked with an antibody test after the initial infection, but is very difficult to detect in the initial sore (it has to be put on special media and the bacteria themselves quickly examined with a special microscopic technique called darkfield microscopy; there are other newer methods but they're not readily available in most medical settings). Herpes is best checked from sores, preferably recent, themselves. One can do a blood test to check for prior exposure, but that won't tell you if a sore is from herpes; it just tells you whether the person has ever had herpes exposure. Hepatitis C is rarely transmitted sexually (unlike Hepatitis B, which one should be vaccinated for), and is not generally classified as an STD.

The USPSTF, which is the most evidence-based recommending body, states that there's insufficient evidence to make any recommendation one way or the other for gonorrhea or chlamydia. It recommends against screening for syphilis and herpes, and recommends hepatitis C screening once for baby boomers (born 1945-1965), and then repeatedly for those at risk for hepatitis C--which does not include gay men. This is how the USPSTF discusses who's at risk for Hepatitis C:

The most important risk factor for HCV infection is past or current injection drug use. Another established risk factor for HCV infection is receipt of a blood transfusion before 1992. Because of the implementation of screening programs for donated blood, blood transfusions are no longer an important source of HCV infection. In contrast, 60% of new HCV infections occur in persons who report injection drug use within the past 6 months1.

Additional risk factors include long-term hemodialysis, being born to an HCV-infected mother, incarceration, intranasal drug use, getting an unregulated tattoo, and other percutaneous exposures (such as in health care workers or from having surgery before the implementation of universal precautions). Evidence on tattoos and other percutaneous exposures as risk factors for HCV infection is limited. The relative importance of these additional risk factors may differ on the basis of geographic location and other factors1.

Large population-based studies report an independent association between high-risk sexual behaviors (multiple sex partners, unprotected sex, or sex with an HCV-infected person or injection drug user) and HCV infection. However, HCV seems to be inefficiently transmitted through sexual contact, and observed associations may have been confounded by other high-risk behaviors.

 

Here's a summary of their recommendations:

http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/chlamydia-and-gonorrhea-screening

http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/syphilis-infection-screening

http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/genital-herpes-screening

http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/hepatitis-c-screening

 

I should point out, however, that the CDC's recommendations are quite different. They recommend annual screening for all STD's in gay men (Hepatitis C is NOT included in this, since it's not considered an STD). The reason for the difference is that the CDC focuses on the public health aspect of these illnesses, rather than on the evidence of benefit to any particular patient. I can't see any benefit whatsoever in doing a blood test for herpes in someone who never comes up with sores. There's no point in having the information if the information has no possible beneficial purpose (you're not going to do anything about it), and serves only to cause unnecessary anxiety (herpes can't be cured). From a public health perspective, if one found gonorrhea or chlamydia, these can be treated for cure. But if you have no symptoms, the reason to treat it is that if you don't treat it, you might pass it on to some bisexual man who could pass it on to a woman, and she might have a problem. The infection itself would probably go away in yourself eventually. I don't see a major harm in checking for syphilis periodically. In fact, since syphilis can cause almost any symptom, from a rash to a heart murmur to behavioral problems, I find myself ordering it pretty frequently. Here's what the CDC says about STD screening:

http://www.cdc.gov/std/tg2015/screening-recommendations.htm

[+ nycman]

I just looked up my insurance company's policy for covering PreP with Truvada.

 

They require a documented negative HIV screen every 3 months.

 

What a pain in the ass!

 

Seems to me that they're just trying to deter people from PreP so they don't have to pay for it.

[Guest]

I just looked up my insurance company's policy for covering PreP with Truvada.

 

They require a documented negative HIV screen every 3 months.

 

What a pain in the ass!

 

Seems to me that they're just trying to deter people from PreP so they don't have to pay for it.

According to http://men.prepfacts.org/the-questions/

 

PrEP is not cheap. Without insurance, out-of-pocket costs can be as high as $13,000 per year.

 

If getting tested is such a "pain in the ass," why don't you offer to pay 20%? Or maybe you could just use condoms. That way you don't have to be bothered with this pain in the ass testing.

[+ nycman]

According to http://men.prepfacts.org/the-questions/

 

PrEP is not cheap. Without insurance, out-of-pocket costs can be as high as $13,000 per year.

 

If getting tested is such a "pain in the ass," why don't you offer to pay 20%? Or maybe you could just use condoms. That way you don't have to be bothered with this pain in the ass testing.

 

I would have not have any problem paying 20%. Frankly, I'd be happy paying 100% if I had to....I'm not sure what that has to do with it.

 

My point was that, although many medications have "guidelines" associated with them, I don't remember any other medications

where an insurance company got to dictate what testing was required with the added threat that they would stop paying for the

medication if you failed to comply with the frequency of testing that they demand.

 

I think medical decision making should be shared with the patient and the physician. Insurance companies are notorious

for trying to get involved in those decisions in order to cut their costs...often at the expense of patient autonomy and health.

 

While I agree it's the CDC recommendation, I don't think that's the insurance company's motive. I think profit is the motive.

And by "profit" I mean creating additional barriers to obtaining an expensive life saving medication so they don't have to pay for it.

 

And for the record...I do use condoms...and I only top...but surely you realize that adding PreP to that is a good thing?

It's not an either/or thing. In my opinion, if you have sex with men you should be on PreP. Maybe you should read your

own link...start with the section "Aren't Condoms Enough"

 

But my favorite part of your link was "Ultimately, the decision about how frequently you will be seen is between you and your provider."

 

Guess again!....Your insurance company may be deciding that for you and your provider!

[sincitymix]

I would have not have any problem paying 20%. Frankly, I'd be happy paying 100% if I had to....I'm not sure what that has to do with it.

 

My point was that, although many medications have "guidelines" associated with them, I don't remember any other medications

where an insurance company got to dictate what testing was required with the added threat that they would stop paying for the

medication if you failed to comply with the frequency of testing that they demand.

 

I think medical decision making should be shared with the patient and the physician. Insurance companies are notorious

for trying to get involved in those decisions in order to cut their costs...often at the expense of patient autonomy and health.

 

While I agree it's the CDC recommendation, I don't think that's the insurance company's motive. I think profit is the motive.

And by "profit" I mean creating additional barriers to obtaining an expensive life saving medication so they don't have to pay for it.

 

And for the record...I do use condoms...and I only top...but surely you realize that adding PreP to that is a good thing?

It's not an either/or thing. In my opinion, if you have sex with men you should be on PreP. Maybe you should read your

own link...start with the section "Aren't Condoms Enough"

 

But my favorite part of your link was "Ultimately, the decision about how frequently you will be seen is between you and your provider."

 

Guess again!....Your insurance company may be deciding that for you and your provider!

 

They do that all the time with medications. This medication requiresd a Prior Authorization. Please have your dr call ## to get the form or instructions. The dr is sent a form that typically depending on the medication, requires the dr to PROVE medical necessity. At times its simple as the dr just writing a diagnosis.. other times the dr has to provide lab work, clinical evidence, reports on xyz, diagnosis codes. If the dr doesn't do it just right.. sorry pa denied. you used code a instead of c. heres what you can do to appeal it. a decision on your appeal can take 24-72 hours.. or 3 months depending on how your insurance is set up to deal with the appeal... if your lucky to have an appeals process.. some insurances don't allow an appeal.

[Juan Vancouver]

I just looked up my insurance company's policy for covering PreP with Truvada.

 

They require a documented negative HIV screen every 3 months.

 

What a pain in the ass!

 

Seems to me that they're just trying to deter people from PreP so they don't have to pay for it.

 

I was explained to me by two different people that this is not to deter anyone, it has very simple clinical reasons. It is a fact that some people don't adhere to the dosage religiously. If you skip many doses and get exposed it is possible you might seroconvert. Truvada alone is not enough treatment for someone who is seropositive. They believe that if a person with a recent infection is on a Truvada only regime this could potentially create a virus that is more resistant to treatment.

 

You are required to test every three months because if you seroconvert you will have to start full treatment.

 

Testing every three months is not only important for you, to make sure you are remaining negative, but for everyone else, to make sure you are not incubating a super bug.

 

Personally, I would be more than happy to adhere to a three month testing schedule. Being that I am highly active, I already do.