HIV Health Spotlight: A conversation about PrEP with Dr. Lisa Sterman
This interview has been edited for length and clarity.
Dr. Lisa Sterman, M.D., MPH, is an expert in the field of HIV medicine who has been in private practice in San Francisco for over 20 years. After obtaining her Master’s in Public Health, she completed her training in medicine and HIV at UCSF. She’s been involved in clinical research for HIV medications and has worked in the community as an educator and advocate, including serving on the Board of Directors for the San Francisco AIDS Foundation, for many years.
Dr. Sterman kindly agreed to sit down and talk with us about pre-exposure prophylaxis (PrEP), an HIV prevention method that's available by prescription. The most important thing she wanted us to know? This conversation is for everyone.
Can you tell us a little about how you got started in your field?
It’s been a long road. I started working with HIV in the ’80s. I was at college in Berkeley, and I do a lot of rock climbing. My friend and rock climbing partner was a nurse at SF General, at their famous HIV ward. I knew I wanted to go into medicine and she said, “You should come volunteer on our ward.” It was the ‘80s, so it sounded totally controversial and dangerous and I was like, “I’m in.” That’s my personality, so that's how I got started. Really, it was the doctors and nurses there that inspired me to go into HIV. They were just incredible.
What’s something everyone should know about PrEP?
Everyone needs to know that there is a pill that prevents HIV. So many people haven’t even heard of the concept. Nearly everyone is eligible with a short screening set of labs, so talk to your provider and find out if you might want to consider PrEP.
A lot of people may think, “I’m not at risk” or, “that’s not my group of people.” The way I teach it is: if you’ve ever had sex, you’re at risk for HIV. If you’ve ever shared drug needles, you’re at risk for HIV. Everyone should know their status.
Editor’s Note: To learn more about PrEP and how it works, see our article, “All About PrEP for HIV Prevention.”
If you’re using condoms every time you have sex, would you still recommend PrEP?
Yes, condoms break or fall off, and then you can have exposure. They are not 100%. I would say we’ve come as far as we can with condoms, that piece of HIV prevention efforts is great, and this is the next step. Condoms may prevent or reduce the risk of other STIs, but they are not the only or appropriate way to protect yourself from HIV if you are at higher risk for HIV.
Some groups of people at risk for HIV can’t always ask their partner to use condoms. They may not have the power in the relationship or they may be under pressure because they’re exchanging sex for commodities like housing, money, food, shelter, or drugs. PrEP helps empower many people who are at risk and can be taken without a partner’s knowledge or consent. In this way, some groups of people have a better chance of protecting themselves against HIV.
How can you go about talking to a doctor about PrEP?
It would be nice if doctors asked every patient the right questions. I ask anybody who walks through my door, “Do you have risks for x, y, and z?” Part of that is taking a sexual history, but not every provider is going to do that. For a motivated patient who wants to go out and find a PrEP provider, there are great websites like pleaseprepme.org where you can find providers that do video calls, or for other folks, a trusted relationship with an in-person provider. There are more conservative areas in the US where you might perceive yourself to be at risk for HIV, but you can’t talk about who you are having sex with, who your partners are having sex with, or how you exchange all those things. If you worry about feeling stigmatized by your provider, there are other resources out there. It’s just that a lot of people don’t know about them.
Need help finding a PrEP provider? Try:
If you decide to use PrEP, what does the process look like?
We need to verify that you’re HIV-negative, but we’ll probably send you off with a prescription for PrEP at the initial appointment. If you’re at high risk, we want to get the medication into you before we even necessarily know the results of your HIV test. We’ve come to find that a rapid start to HIV prevention is important. We don’t want to miss the opportunity to protect someone during the week when their labs are being done. There is very little risk in taking a week’s worth of PrEP even if you are HIV positive.
So, you would start PrEP and then we’d follow up in a week to go over your labs. We’d treat any STIs, make sure your renal function is normal, and then we’d continue these tests on a regular basis while you’re on PrEP. The standard protocol is every three months. Some patients with
very high risk of STI exposures may need more frequent testing for other STIs.
How can we make PrEP more accessible?
I think the key is to make sure everyone knows it’s out there and for everyone to be able to have that conversation with a healthcare provider they feel comfortable with. People need to understand where they are at risk and where they are not. PrEP for HIV is not for everyone. We think about PrEP as having “seasons of risk.” A person’s need to use it may come and go depending on what their lifestyle is like. You need to be having an ongoing conversation about how your risk changes over time.
How do you think Alto can be helpful to people on PrEP?
Alto is a wonderful way for people to access their meds, especially during COVID. It’s convenient. It shows up when you need it. For PrEP and HIV meds I can have them provide all sorts of support for the patients. Everyone is knowledgeable—I’ve worked with some of Alto’s pharmacists in other capacities. I’ve had great experiences with Alto and I think my patients would say the same.
Is there anything else you’d like to tell our community?
Your relationship with your healthcare provider is so important. If you don’t feel like you can tell them everything that is going on, you need a new provider. If you’re feeling stigmatized and someone is not supportive of your lifestyle, then switch, if possible, to an online pharmacy or a community health center that works with the LGBTQ community and get your PrEP that way. Any online pharmacy that handles PrEP will have someone sensitive to these communities, lifestyles, and risk factors.
Even though I do everything I can to encourage an open dialogue, I don’t always get all the information out of people either. Sometimes people feel embarrassed, but we can’t support someone if we don’t know what they’re doing. The first step is to have a healthcare provider that you really trust. The second step is to be really honest with that person. Help them help you prevent HIV.
For more information about Dr. Lisa Sterman and her practice, you can view her profile here.