Maggie McKay (Host): Not everybody feels comfortable talking about sexual health and HIV prevention. So today, we'll take the awkwardness out of it with John Marrin, advanced practice provider, and find out the information we might normally be too embarrassed to ask.

Welcome to Together We Rise, a podcast from International Community Health Services. ICHS advocates for health as a human right and welcomes all in need of care, regardless of health, immigration status, or ability to pay. I'm your host, Maggie McKay. Thank you so much for joining us today, John.

John Marrin, DNP: Thank you so much, Maggie. I'm very happy to be here.

Host: Happy to have you. First of all, tell us what you do as an advanced practice provider.

John Marrin, DNP: Advanced practice providers at ICHS are family nurse practitioners or physician assistants. we see patients for all range of primary care concerns, including preventative or wellness visits. We help treating acute conditions like a sore throat or an earache. And then, we see patients for chronic disease management, things like diabetes care, blood pressure, and then of course, sexual health.

Host: And what is HIV PrEP and who is it for?

John Marrin, DNP: HIV PrEP stands for pre exposure prophylaxis. This is a pill or injection that protects people before they're exposed to HIV if they're HIV negative. So, this is a tool that can be used before exposure that prevents HIV from taking hold in the body if someone is exposed. It's extremely safe and effective, and if taken as directed, it reduces the risk of HIV by about 99% from sexual activity, and about 75% from injection drug use.

And Maggie, I'm so glad you asked the question about who is it for. New guidelines really reaffirm that PrEP is for anybody who would like PrEP as an additional tool, so that they can feel in control of their sexual health and HIV prevention. I think many people may have an assumption that PrEP is something that is for gay men, but that's not accurate. Both nationally and in Washington, we are seeing ongoing new cases of HIV, particularly among women and among heterosexual people. And so, we really want everyone to know that PrEP can be a tool that can be right for them, and hope that they'll talk to their provider about it.

Host: And why is it important for primary care providers to talk to patients about their sexual health and HIV prevention?

John Marrin, DNP: Sexual health is such a huge part of both our lives and our general health. We understand that this can be an uncomfortable topic for people to bring up, and we really want them to feel like their primary care provider's office at ICHS is a safe, welcoming space where they can come with questions, where they can get accurate information in a way that is welcoming and non-judgmental.

We know that for many people, it can be difficult for them to start this conversation, depending on their baseline comfort level, talking about sex or issues like intimacy. So, we are really hoping to create a space where providers are proactively asking patients about their sexual health, and how we can help in a way that feels welcoming.

I think particularly for people who may, not identify as straight or cisgender, we also really want them to feel like ICHS is a welcoming space for them too. We understand that these folks may have faced discrimination or prejudice in other healthcare settings. And we really want them to feel like the team at ICHS is here to make them feel welcome and to address any and all healthcare needs that they might have.

Host: That's so important, I would think, because when people have already had a bad experience somewhere else, they may not want to take a chance anywhere else, you know, trying to get help. So, how can patients access PrEP at ICHS?

John Marrin, DNP: There's a couple different ways that people can access PrEP. Of course, the first way is to talk with their primary care provider. That can either be at something like their annual wellness visit or just simply a visit to talk about PrEP itself. We offer in person, virtual, and telephone visits where patients can talk with their provider about that.

Existing patients at ICHS also have the option to talk with a pharmacist at our international district, Holly Park, or Shoreline locations, and they can provide more information about PrEP, do kind of the initial lab testing before starting the medication. And the pharmacist can actually prescribe the medication for appropriate patients that same-day. Patients who visit our Bellevue Clinic have the option to see a nurse for the same thing.

We want our patients to know that there are many, many different ways to access PrEP. And we have a whole team of individuals here at the clinic who are dedicated to making PrEP accessible and to answer any questions people have and provide support. That includes providers all across the organization, as well as a team of health educators that are located at each site who have received special training and have knowledge about PrEP that they're eager to share with people who have questions or just want to learn more.

Host: That's amazing. It sounds like you have all the bases covered.

John, what are some other ways people can prevent sexually transmitted infections?

John Marrin, DNP: It's a great question. I think one of the most key things is really open, honest, and safe communication with partners. That can be things like sharing, "Safe sex and protecting my sexual health is important to me, and I also want you to be safe. And so, I've taken the proactive step to get tested for sexually transmitted infections. How about you?" Or perhaps encouraging patients to go together with their partner to get tested for STIs.

To make it easier for patients to get tested, we also recently started a program where existing patients can either walk in or schedule a same-day appointment with one of our nurses for testing for sexually transmitted infections. So, we really want people to understand that we want this to be as easy and as convenient for people as possible.

In addition to open communication with partners, we, of course, recommend to consider using things like condoms, what's called a traditional male condom, internal condom, Also, using water or silicone-based can also decrease friction that can increase risk for sexually transmitted infections and also make sex kind of more pleasurable, more comfortable experience for people. There are other tools like getting tested regularly for sexually transmitted infections. We often encourage people, if you have more than one partner or your partner has more than one partner and you can't always use protection, consider getting tested for sexually transmitted infections about every three to six months or each time you see your provider.

And finally, there are other couple of tools in addition to the HIV pre-exposure prophylaxis or PrEP that we talked about. Doxy-PEP, or doxycycline post exposure prophylaxis, is another medication that can be used in some cases to prevent bacterial sexually transmitted infections, like chlamydia, gonorrhea, and syphilis. And if patients are interested in that and think it may be a good tool for them, we encourage them to talk to their primary care provider about that. And we're happy to give more information.

Host: And what would you say to people who might feel uncomfortable seeking out help or information about sexual health matters? How would you give them the confidence, say, to take that step in utilizing ICHS resources?

John Marrin, DNP: I think perhaps the most important thing is to know that their providers and the team at ICHS, we're very eager to talk with them about these issues. Our providers and staff have received special training over the last couple years, including provider meetings to learn about sexually transmitted infections, trainings for our staff to learn about how to talk with patients about their sexual health in a way that is open and affirming and welcoming and not judgmental, training for staff to learn about, sexual orientation and gender identity. Really, we want our patients to understand that we really deeply desire for this to be a welcoming space for them, whatever questions or concerns that they might have.

Secondly, I would say there's no right way ask the question. It's just to ask the question. And so, as I mentioned, we're hoping that providers and patients will have a chance to talk about sexual health, certainly every time they come for their annual wellness visit or physical checkup, but even outside of that visit. If patients have questions they'd like to ask their provider during the visit, they can. We also have a wonderful team of nurses and, as I mentioned, health educators who have also received training on sexual health and talking with patients about sexual health. That team is here for you. And so, we're hoping that if for some reason, we haven't started the conversation that patients feel welcome to also help us to start that conversation with them about their questions and concerns.

Host: John, can you explain the difference between HIV and AIDS?

John Marrin, DNP: Absolutely. So, HIV is a viral infection that primarily targets part of the body's immune system. HIV is the name for the virus that causes the infection. AIDS is what is described as a later advanced stage of HIV infection. At which point, patients may be at increased risk for problems with their immune system or may be more vulnerable for infections or other complications.

I'm glad that you brought up that question, Maggie, because I think people can tend to conflate the two or think of HIV and AIDS as one and the same. Whereas these days, really, we want people to understand that thanks to amazing advances in medications and other treatments for HIV, really these days, we can view HIV as a chronic lifelong disease that can be treated very effectively with medications that are safe easy to use, well tolerated, and that people with HIV infection these days are living long, healthy lives, are having children, are getting pregnant, doing all the things that they want to do, and working with the team that includes their HIV provider and their HIV care management team. These patients do great and we see it as the same as managing another chronic condition like diabetes, high blood pressure, things like that.

We also, of course, want patients to know that, we do have a wonderful HIV provider at ICHS, Dr. Hieu Pham, who sees patients at the International District location, and is providing HIV care to a group of patients at ICHS. For patients with HIV who want to make ICHS their medical home, we also have a HIV case manager named Omar, who is available to help patients with care coordination, including things like finding a specialist, finding a case manager, dealing with pharmacy. So, WE really want these patients to feel like we have a whole team here that's ready to support them and help them with their disease management so they stay healthy for many years to come.

Host: Well, that is all so encouraging, and I'm sure very reassuring to people wondering how to bring up the topic, where to get help. So, thank you so much for sharing your expertise today. We really appreciate it.

John Marrin, DNP: Thank you so much for having me on, Maggie.

Host: Again, that's John Marrin. If you'd like to find out more, please check out our website at ichs.com. That's ichs.com. And if you found this podcast helpful, please share it on your social channels and check out our full library of podcasts for topics of interest to you. I'm Maggie McKay. Thanks for listening to Together We Rise from International Community Health Services.