I first learned about PrEP at a training day years ago. In my head it belonged to the specialist clinics and to gay men. I run contraception appointments. I didn’t think it was my conversation to have.
What I didn’t say
When doctors in France were allowed to start PrEP outside hospital, I told myself I would offer it. With men, I did. With women, I waited for them to bring it up. I worried about offending them, or seeming to judge their partners. Many of the women I see have just arrived, some without papers, and the paperwork felt like one more thing to put on them.
I wasn’t protecting them. I was protecting myself from an awkward minute.
Then a survey of family planning centres in our area was shared with our team. Most of the women asked had never heard of PrEP. Once it was explained, around two in three said they would consider it, and almost all would rather start it with us than be sent somewhere new. Most of the professionals asked had never raised it with a woman. I recognised myself.
The first time
A woman in her twenties came in for her pill. Her boyfriend didn’t like condoms and she couldn’t make him. I said: “There is also a medicine that stops HIV. Some women here take it. Would you like to hear about it?” She said yes before I finished. We did the tests that day, and I started the application for state medical aid with her.
What changed
Now I mention PrEP at every contraception review, in the same breath as the coil and the implant. Most women say no, and that is fine. Some say yes. A few come back and say a friend wants to talk to me.
If I could tell other professionals one thing: don’t decide for the patient. Offer it, and let her choose.