This section addresses PrEP suitability for heterosexuals. This section is relevant to the following populations: (i) people who were assigned female at birth (cis-female), identify as female and as heterosexual; (ii) people who were assigned male at birth (cis-male), identify as male and identify as heterosexual; (iii) people who were assigned male at birth (cis-male), identify as female (trans-female) and identify as heterosexual and (iv) people who were assigned female at birth (cis-female), identify as male (trans-male) and identify as heterosexual.
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Box 14.2 PrEP suitability criteria for heterosexuals |
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HIV risk in the previous 3 months and the future 3 months The clinician should prescribe PrEP if the patient describes a history of any of the following HIV acquisition risks in the previous 3 months and if the patient foresees that there are likely to be similar acquisition risks in the next 3 months. • At least one episode of condomless anal or vaginal intercourse (insertive or receptive) with a regular HIV-positive partner who is either not on treatment, or who is on treatment but has a detectable HIV viral load • At least one episode of receptive anal or vaginal condomless intercourse with any casual HIV-positive partner or a male bisexual partner of unknown status • Episodes of planned condomless insertive or receptive vaginal sex in an effort to conceive with an HIV-positive partner, regardless of the HIV-positive partner’s viral load. |
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HIV risk in the future 3 months The clinician should prescribe PrEP if the patient foresees that they will have HIV acquisition risk in the upcoming 3 months, despite not having had HIV acquisition risk in the previous 3 months: • Future episodes of planned condomless insertive or receptive vaginal sex in an effort to conceive with an HIV-positive partner, regardless of the HIV-positive partner’s viral load • When a person plans to travel to countries with high HIV prevalence during which time they anticipate having condomless sex with casual partners who are HIV positive or of unknown HIV serostatus • When a person plans to return home to an overseas country which has a high HIV prevalence during which time they anticipate that they will be having condomless sex with casual partners • When a person reports that they have recently left a monogamous relationship and will be having condomless sex with a casual HIV-positive partner, or a male or female partner of unknown HIV serostatus from a country with high HIV prevalence, or a male partner who is thought to have sex with men • When an individual reports that they will be entering, or leaving institutional or correctional facilities in the near future where they may have condomless sex with HIV+ or gay or bisexual male casual partners in the future • When a person presents with concerns of deteriorating mental health and a history of having had increased their HIV acquisition risk behaviour in this setting • When a person presents with a history of intermittent binge drinking of alcohol or recreational drug use and a history of having had increased their HIV acquisition risk behaviour in this setting. |
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The clinician should consider prescribing PrEP also in the following circumstances: • When an HIV serodiscordant couple experience undue suffering and anxiety about inter-couple HIV transmission despite the positive partner being virologically suppressed on treatment. |