HIV Treatment and Management

HIV Testing and Prevention

PrEP suitability criteria for heterosexuals

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 man who has sex with men 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.

HIV Treatment and Management

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