It was with interest that we read the letter by Javier Velasco et al. in reference to our article, “Experiencia de un programa de profilaxis preexposición en una unidad de virus de la inmunodeficiencia humana hospitalaria. Descripción del perfil basal del usuario e identificación de oportunidades de mejora” [Experience of a pre-exposure prophylaxis programme in a human immunodeficiency virus hospital unit. Description of the user’s baseline profile and identification of opportunities for improvement],1 and we would like to make the following clarifications:
The group of people referred from a hospital consultation consists of people seen in the accident and emergency department with symptoms consistent with a sexually transmitted infection (STI) or who requested post-exposure prophylaxis (PEP) assessment after risky sexual contact. These are individuals that we already identified as potential candidates to participate in the PrEP programme as soon as it was available at our centre. This fact justifies the high percentage of people initially included in our cohort with this history, almost half (45%), markedly higher than that reported in other series.
Both demand for PEP and STIs assessed in an accident and emergency department clearly identify people who are eligible for a rapid HIV diagnostic test, as has recently been demonstrated in our setting,2 and the possibility of offering participation in a PrEP programme in the event of a negative result. We are aware that due to the overburdened nature of these services, the lack of time to offer advice or lack of awareness due to the high staff turnover, patients are not informed about the existence of this preventive strategy and the healthcare pathway to access it.
There are other opportunities for referral from the accident and emergency department that we did not include in our paper, related to recommendations about PrEP for patients seen after intoxication by recreational substances, and when identifying the use of drugs in the sexual context or certain risky practices.
It is very important to stress the need to ask anyone who comes to a consultation about his or her sexual practices and risky behaviours for contracting STIs without judgement and with respect. In this regard, it is essential to continue working on training and acquisition of cultural skills for interviewing patients, educate on general preventive measures and not miss opportunities to make a connection to the health system for people who need it.
