More pushing PrEP to teens?
“Operation Warp Speed v. 2.0” anyone?
Forgive me if it’s starting to feel a little like Groundhog Day here, but the news about the creepy push for PrEP has become so pervasive that I will continue to report on it, since no other writer seems interested, and this ugly chapter of medical history must not be forgotten. Today’s piece is about guidelines for prescribing PrEP to minors, which seems to be the latest market to exploit. I can’t speak for other parents, but I would not be happy at all if my child’s physician attempted to put them on PrEP.
Is it just me, or does the push for getting everyone on PrEP appear to be rapidly approaching warp speed? Consider this article in Nature online, Knowledge, sex, and region associated with primary care providers prescribing adolescents HIV pre-exposure prophylaxis (emphasis mine).
Although HIV pre-exposure prophylaxis (PrEP) effectively and safely prevents HIV among adolescents, uptake of PrEP is low. [Ed: thank the Lord for that.] Adolescents must have primary care providers (PCPs) prescribe them PrEP, making PCPs critical actors in PrEP delivery. However, research has primarily investigated determinants of PCPs’ intention to prescribe adolescents PrEP rather than the determinants of performing the behavior itself. We examined the demographic, clinical practice, and implementation determinants of PCPs previously prescribing PrEP to adolescents. PCPs were recruited from a national Qualtrics panel of licensed medical providers in the United States from July 15-August 19, 2022. The Theoretical Domains Framework informed the implementation determinants measured. A multivariable logistic regression was used. PCPs who were more knowledgeable of the CDC guidelines (aOR 2.97, 95% CI 2.16–4.10), who were assigned male at birth (aOR 1.64, 95% CI 1.03–2.59), and who practiced in the Western region (aOR 1.85, 95% CI 1.04–3.30) had greater odds of prior prescribing adolescents PrEP. Provider-based educational interventions should be designed, implemented, and tested to encourage PCPs to prescribe PrEP to eligible adolescents.
I think when they say “assigned male at birth,” that refers to the prescribing physician and not the patient.
Here’s more. This is just so bizarre. There’s something almost cultish about the language—does anyone else notice this?
Participants were asked how much they agree or disagree with the Theoretical Domains Framework determinants (1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agree). All the determinants consisted of a single item to reduce participant burden, participant time, and survey costs. Items were adapted from the Determinants of Implementation Behavior Questionnaire22. The 11 items were knowledge (I am aware of how to prescribe sexually active adolescents HIV PrEP following the CDC guidelines), skills (I have the skills to prescribe sexually active adolescents HIV PrEP), professional role (Prescribing sexually active adolescents HIV PrEP is consistent with my professional role), belief capacity (I am confident that I can prescribe sexually active adolescents HIV PrEP), optimism (I am optimistic when prescribing sexually active adolescents HIV PrEP), belief consequence (If I prescribe sexually active adolescents HIV PrEP, it will benefit public health), attention (When I need to concentrate to prescribe sexually active adolescents HIV PrEP, I have no trouble focusing my attention), environmental resource (In my clinic, all necessary resources are available to prescribe sexually active adolescents HIV PrEP), social influence (Most professional in my organization think that I should prescribe sexually active adolescents HIV PrEP), emotion (I would enjoy prescribing sexually active adolescents HIV PrEP), and intention (I intend to prescribe sexually active adolescents HIV PrEP).
Is it just me, or is the phrase “I would enjoy prescribing sexually active adolescents HIV PrEP” unbelievably creepy? And how much does this remind you of behavior control? It’s so, so creepy and weird and dare I say it, almost dystopian. This could be in a YA novel about the future.
In the article, they say “Although adolescents and young adults are at risk of contracting HIV, adolescents and young adults have the greatest unmet need for PrEP among all other age groups. Adolescents accounted for 1.5% of all PrEP users in the US in 2012–2017.”
“The greatest unmet need” for PrEP? Is there some sort of explosion of HIV positivity among teenagers? How have they determined that adolescents are at high need for PrEP? There are a lot of blanket statements being made without much evidence to back them up. Are they just making stuff up at this point? This all smacks of trying to sell your product to as many consumers as humanly possible.
This article seems to be an attempt to elucidate what demographic characteristics might make a primary care provider or a pediatrician more likely to prescribe PrEP to teenagers, which might make someone wonder what the point even is, but I think that’s a red herring. The crazy thing, what is not being discussed, is that just two and a half months ago, I reported on how there might be a push to prescribe PrEP to minors, from the perspective that this was still far out of the mainstream, and it appears that I was right. How is this happening so quickly?
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The danger of prophylactic and screening guidelines is they get built into electronic medical records systems. These systems can be used to monitor and control physicians to enforce an artificial and harmful "standard of care." If a computer's dark AI algorithm looks at the computerized medical records and suddenly says "Patient is at-risk for HIV" and "PrEP should be recommended" and the doctor does not advise the patient to use PrEP (perhaps because s/he's been reading Rebecca's columns), or to take an HIV test, the doctor can be disciplined. Similarly, if the doctor practices informed consent and receives a decline from the patient by telling the Patient PrEP might be harmful or unnecessary but the computer says otherwise, the doctor can be disciplined. The result is a sort of thoughtless robo-care.
What's interesting to me is that people ages about 18 to 30 are generally considered to be at highest risk of getting an STI. And yet we've never seen this explosion of HIV in the general population, not in 40 years since this all started. So why the push to start young people entering into the sexual phase of their life onto this drug, except for the old profit motive? It's weird.
I've been interested recently in another iatrogenic mess, the damage caused by benzodiazepines. There's something similar going on, a medical system in denial of the damage a class of drugs is doing, and doctors prescribing drugs that are seriously damaging people. Holy cow, the interviews I've listened to of people who lost a husband or wife to these drugs and the sheer hell they went through.
Prep is one chapter of a larger story going on. The covid shots are another. I've been reading about women's reproductive health being damaged by them in crazy ways and the CDC just continues to push them. And now this, pushing Prep on teenagers.