Nature & Nurture: A whole health approach to PrEP
By Morgan Jade, PrEP Navigator

People are often surprised to find they can get PrEP (HIV Pre-Exposure Prophylaxis) from a Naturopathic Doctor (ND). NDs focus on prevention, treatment, and optimal wellness by combining modern science and medicine with a natural, whole-person approach to health care. J. Brooke Huffman is an ND at Portland’s 2BWell Clinic who provides primary care services including PrEP.

PrEP is a prevention option that can help individuals stay HIV-negative. Patients take a daily HIV medication called Truvada to help block the virus if it gets in the body. Being on PrEP requires a patient to visit their health care provider every couple of months for repeat HIV testing, STD testing, and medication refills. When taken every day, the medication provides over 90% protection against HIV1.

So why aren’t more people taking PrEP? Some medical providers are unaware of PrEP while others are unwilling to prescribe it, preferring to advocate for traditional prevention methods like condom use or abstinence. However, Dr. Huffman argues “it’s not realistic to ask people to stop doing behaviors they enjoy”. “With PrEP, people are informed; think consciously and intentionally about health….and are more apt to allow themselves to have fun”.

  J. Brooke Huffman, ND

Dr. Huffman’s interest in PrEP stems from her background in harm reduction and education through work with a street outreach program. She’s also a co-founder of People’s Health Clinic of Portland, which provides free health care one night per month at Sisters of the Road. Some of Dr. Huffman’s PrEP patients come to 2BWell Clinic asking about PrEP, while for others it may come up during the office visit. Routine testing and a conversation about sexual health sometimes result in getting PrEP. “I normalize testing with my clients by letting them know I recommend at least yearly testing for everyone,” Dr. Huffman says.

A patient’s first visit for PrEP is 60 minutes. Dr. Huffman takes a whole health history including current medications; current and past concerns; family history; lifestyle behaviors such as diet, sleep, and exercise; and completes a quick physical exam. Doctor and patient talk about the patient’s concerns which often include side effects, how the medication works in the body, and how much of a commitment is required to be on PrEP. An additional concern for some of her trans patients is whether Truvada interacts with hormones. The last step is getting the required labs drawn (HIV and STD tests, and kidney function), which patients can get at 2BWell Clinic or offsite.

So how does a patient know if PrEP is right for them? “Each patient needs to be informed well enough to make the decision,” Dr. Huffman says. “PrEP is not for everyone. The patient is the only one who knows [their risks]”, she says, adding the importance of trusting the patient when they think it’s a good option.

While PrEP is gaining momentum in Portland, and across the state, this work is far from complete. “Trans women and sex workers are still left out of the PrEP conversation. In addition, we need more public knowledge of Truvada, more public awareness of PrEP clinical services, and more providers bringing up PrEP with their patients” she says.

For more information about 2BWell Clinic or to schedule an appointment, call 503.841.6828, visit http://2bwell.net/tbw/p/services/ or stop by 2 NW 3rd Ave. in Portland.

For more information about PrEP:
• prepfacts.org
• Cascade AIDS Project’s PrEP Provider List: pivotpdx.org/preventiontools/prep

Sources:

1. Centers for Disease Control and Prevention (2014). Preexposure Prophylaxis for the Prevention of HIV Infection in the United States – 2014. Retrieved from https://www.cdc.gov/hiv/pdf/guidelines/PrEPguidelines2014.pdf