Lisa is a 23 year old female

Lisa is a 23 year old female who is seeing you today for HIV and STI testing. She has a complex social history which includes sex work from ages 17-21, substance use disorder (heroin), intermittent homelessness, unemployment, and an arrest for prostitution for which she is currently on probation. Last active use of heroin was 2 months ago and she has been in treatment for 2 years, maintained on suboxone. Her current male partner also has a history of substance use disorder (heroin) and fluctuates between relapse and recovery. Lisa’s last relapse was related to drug use with her partner. Information obtained today: BP 92/60, O2 saturation 95%, HR 88, RR 22, BMI 18.5. LMP 6 weeks ago (irregular). Drug use: as above, tobacco: 1PPD, alcohol: rare. Condom use: infrequent. Contraception: condoms or withdrawal Urine pregnancy test and rapid HIV in office are negative. Gonorrhea, chlamydia and syphilis are pending. You initiate a conversation regarding HIV. 1. What are Lisa’s most significant risk factors for acquisition of HIV? 2. Is she someone you would consider having a conversation with regarding PrEP – why or why not? 3. What information and teaching should you review when starting/maintaining PrEP? 4. What are some realistic strategies you can review with Lisa to decrease her risk of HIV?

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