Mr. K. has a long history of using recreational drugs. He identifies as a gay man who enjoys clubbing and denies being in a stable relationship. He has partners that he sees regularly, but he also meets new partners at clubs, in chat rooms, and at bars. His condom use is not consistent. In the past year he was diagnosed with syphilis, but could not identify the source. He has been counseled many times by his health care provider about safe sex, but he prefers to keep his sexual activities “more spontaneous.” He admits that he may have had sex with partners who have HIV, but he hopes that “they would be truthful about it up front.” He was tested for HIV six months ago and the test was negative.

Today Mr. K asks his provider about PrEP. He has heard about it in the news, from friends, and looked into it on the internet. His provider informs him that PrEP should be considered as only one component of HIV prevention. Mr. K is tested and his results are negative. The correct medication dosing schedule is explained, the rationale for HIV testing every three months and possible adverse side effects for the medication. His provider stresses that PrEP is not an absolute guarantee that he will not get infected with HIV or other STDs and strongly encourages him to consistently use condoms.

By using the Harm Reduction Model the healthcare provider decreases Mr. K’s risk of HIV infection by providing PrEP. Mr. K will also have more frequent follow up visits with his provider for HIV testing and these visits can be used to reinforce HIV prevention education and risk reduction strategies. Hopefully over time, Mr. K. will begin to use condoms more consistently and become more careful when choosing sexual partners.

Mrs. R. is a healthy 56 year old woman. She has been married to her current spouse for twelve years. Both she and her spouse were divorced when they were introduced by a mutual friend, and were married several months later. They both have grown children from a previous marriage. She works full time in the cafeteria of a local school, and her husband is a construction worker. They both drink a few beers at night after work, at times more than they should, and smoke cigarettes.

At her recent primary care visit her provider suggested an HIV test explaining that it is now a recommended part of routine health care. She had been tested once before after her divorce and was negative.  At first she was offended at the suggestion, but her heath care provider assured her that she was offering the test to every one of her patients. She asked why she would not know if she has HIV since she has routine labs yearly. The provider explained that only a test specifically for HIV will yield those results.  She finally agreed, had the test along with other lab work and went home, not thinking about it again.

Several weeks later she was contacted by her primary care provider requesting that she make a follow up appointment to review lab results. At the appointment Mrs. R was informed that her HIV test results were positive. She was understandably upset and confronted her spouse that night after work. He finally admitted that despite the fact that he identifies as a heterosexual he occasionally has sex with men.  He also tested positive for HIV and both were started on ART and referred for counseling. Because HIV infection was detected early both Mrs. R. and her husband began treatment before they had severe immune suppression and their prognosis is very good.