Box 4.3 PrEP suitability criteria for heterosexuals

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 homosexual or 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

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 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.

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.