Ep 171 – Rethinking HIV: prevention and pre-exposure prophylaxis

What if one of the most misunderstood diagnoses of the past is now one of the most manageable chronic conditions? How can GPs play a pivotal role in tackling stigma, increasing testing and improving outcomes for people living with HIV?

Dr James Waldron is joined by Dr Grace Bottoni (HIV and Hepatitis C GP Champion, Lewisham) for a series of podcasts about HIV. Together, they explore a range of topics with experts in the field. In this third episode, they talk with Dr Emily Mabonga (Consultant in HIV Medicine, London) about pre-exposure prophylaxis (PrEP): who it is for, how to start the conversation and practicalities around access and dosing.

Key take-home points

• Normalising conversations about sex and risk empowers patients and tackles stigma.
• Primary care plays a key role in HIV prevention, not just for testing and treatment but also in making space for safe, proactive discussions.
• The UK HIV Action Plan aims to end new transmissions by 2030; HIV opt-out testing and primary-care engagement are central to this.
• Undetectable is untransmissible (“U=U”) is a cornerstone of modern HIV care: treatment prevents transmission.
• What is PrEP? A daily or event-based tablet that stops HIV infection. Think of it like contraception, and think of post-exposure prophylaxis (PEP) like emergency contraception (within 72 hours).
• Who is PrEP for? Anyone at risk, including those with new partners, inconsistent condom use or sexually transmitted infections. Just asking for it is a valid reason to signpost.
• PrEP and PEP are HIV-prevention tools that every GP should know about; they are safe, effective and free.
• Start the conversation:
  • “Have you considered protecting your sexual health? It’s free and could stop you getting HIV.”
  • Patients often want to talk but wait for the clinician to initiate the conversation.
  • Acknowledge discomfort: this is new for many healthcare professionals too.
• Practicalities:
  • No identification or NHS number is needed to access PrEP.
  • It is confidential and accessed via level 3 sexual health clinics.
  • Leaflets and posters in your waiting room can help normalise it.
• Different PrEP dosing options:
  • Daily for regular risk.
  • Event-based for occasional risk (two tablets 2–24 hours before exposure).
• Effectiveness:
  • The PROUD study showed an 86% reduction in transmission with PrEP as compared with treatment deferred for 1 year.
  • U=U is backed by over 58,000 data points – no linked transmissions with viral suppression.
• Addressing stigma:
  • It is a major barrier for patients and healthcare professionals alike.
  • We must talk openly to challenge it: silence does harm.
• Primary care’s opportunity:
  • Sexual health conversations belong in general practice.
  • Testing and prevention together help "close the loop".
  • The period after a negative HIV test represents a great moment to discuss PrEP.

Related references and resources

1. HIV Drug Interactions. https://www.hiv-druginteractions.org/checker.
2. Prevention Access Campaign. https://preventionaccess.com/.
3. NHS. 2024. https://www.nhs.uk/nhs-services/sexual-health-services/find-a-sexual-health-clinic/.
4. McCormack S, Et al. Lancet. 2016;387(10013):53-60. doi: 10.1016/S0140-6736(15)00056-2.
5. NHS. https://www.nhs.uk/medicines/pre-exposure-prophylaxis-prep/.
6. i-Base. 2025. https://i-base.info/prep/.
7. YouTube. 2023. https://youtu.be/8WnBAJrPpzg.
8. Women and PrEP. https://www.womenandprep.org.uk/.
9. IwantPrEPnow. 2025. https://www.iwantprepnow.co.uk/.
10. South East London Integrated Care System. 2025. https://www.selondonics.org/lewisham-prep-clinic-in-general-practice/.