Pre-Exposure Prophylaxis for HIV (PrEP) is recommended by the CDC for patients at risk of contracting HIV disease from sexual activity or IV drug use. PrEP involves taking a combination pill of antiretroviral medications daily. If the patient is compliant with the regimen, studies confirm a reduction of sexual activity related HIV by 99% and IV drug use by 74%. Many clinicians have pointed to this preventative regimen as a standard of care, and it is directly promoted to patients via direct marketing and media venues. Catholic clinicians will find themselves in a decisional pathway involving PrEP and confronted with the moral dilemma of cooperating with immoral sexual acts by providing prescriptions to their patients for antiretroviral medication.
Catholic Medical Association (CMA) affirms that disease prevention is a worthy goal of medicine and consistent with its moral tradition. More specifically, the prevention of sexually transmitted infections (STI) is not intrinsically evil. However, not all means to prevent disease are morally licit.
Catholic clinicians uphold the sanctity of natural marriage between one biological male and one biological female intended for life. Among HIV discordant married couples, PrEP may be utilized by the HIV negative spouse if the conjugal act is safely engaged in without the use of a condom. Even in such situations, continence is advised if the risk of infection to the spouse remains despite PrEP (such as the HIV positive spouse having a detectable viral load). Continence would be an act of charity between spouses to reduce the risk of viral transmission.
Sexual activity outside of marriage should not be endorsed by Catholic clinicians. PrEP should in principle not be prescribed in these situations to avoid endorsing immoral activity and creating scandal. Unresolved questions on the utilization of PrEP in cases of non-consensual sexual acts, for example in situations of human trafficking or in persons who lack legal and mental capacity, will require further clarification. Catholic clinicians should never formally cooperate with unchaste activity in any patient entrusted to their care. Of course, clinicians should educate their patients on the physical and psychological benefits of chastity in part of their routine care conversations. Similar arguments can be made concerning the use of PrEP in IV drug addiction, while finding ways to accompany patients who are struggling to maintain freedom from addiction. Again, Catholics should not cooperate with programs that endorse ongoing immoral activity, while partnering with patients to lead them to lives of good health and integrity of life.
Approved by the Board – October 6, 2021