Cases/Sexual Health

Man Asking About Medication to Prevent Hiv — Free SCA Practice Case

Man asking about medication to prevent HIV

Station Timer

12:00

Golden Minute

Initial Introduction

•Introduce yourself

•Ask an open question — "How can I help you today?"

•Listen — don't interrupt

•Catch early cues

Data Gathering

History, ICE & Diagnosis

Clinical Management

Diagnosis, Plan & Decisions

Safety Net

Follow-up & Close

12:00

Golden Minute

Materials for Candidate

Please review before starting the consultation

Patient Profile

Full Name

Dominic Farrow

Age

31 years

Consultation Type

Telephone

Age

Situation

Telephone Consultation.

Reason for Encounter

"I've read there's a tablet you can take to stop you getting HIV. I want to know whether I should be on it."

Medical Records

●PMH: Nil significant.
●Medications: None.
●Allergies: NKDA.
●Recent notes: Nil. No HIV or STI testing recorded at this practice. Hepatitis A/B vaccination status not recorded.

Patient Script

For the friend playing the patient role

Character Overview: You are Dominic, a 31-year-old chef. You are gay and single, and over the past year you have had several casual partners; condoms are used most but not all of the time. A friend told you about PrEP — a tablet to prevent HIV — and you want to know whether you should be taking it and how to get it. Importantly: you had condomless anal sex a couple of days ago with a man whose HIV status you do not know. You will not volunteer the timing unless asked; if asked directly, it was about 40 hours ago. You have never been tested for HIV. You are anxious but matter-of-fact, and you will be put off immediately if you sense any judgement.

Opening Sentence: "Hi Doctor. A friend was telling me about PrEP — the tablet that stops you getting HIV. I wanted to ask whether I should be on it and how I'd go about getting it. I've had a few casual partners over the last year."

History if Asked (Data Gathering Phase)

●Why he's asking: "A friend takes PrEP and said I should look into it. I'd rather be protected than worrying."
●His partners: "I'm single. Several casual partners over the last year. We use condoms most of the time, but not always."
●The recent encounter (volunteers only that it happened): "There was one a couple of days ago where we didn't use anything."
●If asked exactly when: "About 40 hours ago, I suppose — Wednesday night." (Inside the 72-hour PEP window.)
●The partner's status: "I don't know his HIV status. We didn't discuss it."
●Testing history: "I've never had an HIV test. I know I should have."
●What he wants: "To get on PrEP, really — and to know if I need anything else."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores his perspective.

●Ideas: Dominic understands PrEP as a tablet that prevents HIV, and assumes it is something a GP prescribes. "I thought it was just a tablet you get from your GP."
●Concerns: His dominant concerns are whether he might already have been exposed — particularly by the recent encounter — and, if explored, a fear of being judged for how he asks about it. "I'm worried about the other night, if I'm honest. And I half expected to be judged for asking."
●Expectations: He expects to be prescribed PrEP or told how to get it. "I want to get on PrEP, or at least know how to."

If Asked — HIV Risk, PEP Window, and Sexual Health Screen

The patient answers these only when directly asked, and more openly if the clinician is clearly non-judgemental.

●If asked precisely when the condomless encounter occurred: "About 40 hours ago." (Critical — inside the 72-hour PEP window.)
●If asked about the type of sexual contact: "Anal sex, and I was the receptive partner." (Higher-risk exposure.)
●If asked about the partner's HIV status, whether he is on treatment, or whether his viral load is undetectable: "I've no idea. I don't know anything about his health."
●If asked about condom use generally: "Most of the time, but not always — that's why I want PrEP."
●If asked about number of partners in the past year: "Several — maybe six or seven casual partners."
●If asked about previous STIs and testing: "I've never been tested for anything, and I've never knowingly had an STI."
●If asked about symptoms (discharge, dysuria, ulcers, rash, sore throat, fever, lymphadenopathy): "No symptoms at all — no discharge, no sores, no rash, no fevers."
●If asked, sensitively, about recreational drug use in a sexual context or injecting drug use: "I don't inject anything. Occasionally I've used something recreational on a night out, but nothing regular."
●If asked about hepatitis A/B vaccination: "I don't think I've ever had those."
●If asked about medication, kidney problems, or other medical history: "Nothing at all — I'm well, no kidney problems that I know of."
●If asked about mental health and support: "I'm okay, just anxious about this."

Responses to Management (The Negotiation Phase)

●If the Doctor identifies that PEP may be indicated for the recent exposure — the key safety point: "Hang on — there's something different I can take after an exposure? And there's a time limit? Nobody mentioned that." (The tested point is distinguishing PEP from PrEP and recognising PEP as time-critical.)
●If the Doctor arranges same-day sexual health/emergency assessment: "So I need to be seen today, not next week? I'll go straight there." (The tested point is arranging urgent same-day assessment rather than a routine referral.)
●If the Doctor explains PrEP and how it is accessed: "So PrEP comes through the sexual health clinic rather than from you? That's useful to know." (The tested point is knowing that PrEP is provided via sexual health services, and referring rather than attempting to prescribe.)
●If the Doctor counsels on PrEP requirements and monitoring: "I need to be HIV-negative first, and have regular tests and kidney checks? That makes sense." (The tested point is accurate PrEP counselling.)
●If the Doctor explains PrEP does not protect against other STIs: "So it won't stop me getting other infections — I'd still need condoms and regular screening?"
●If the Doctor offers vaccination and testing: "Hepatitis jabs too? And a full screen?"
●If the Doctor is non-judgemental throughout: "Thanks for not making me feel awkward about this."

Mark Scheme

Domain 1: Data Gathering and Diagnosis

0 / 18 indicators checked+0−0

Positive (0/9)

Negative (0/9)

Domain 2: Clinical Management and Medical Complexity

0 / 20 indicators checked+0−0

Positive (0/10)

Negative (0/10)

Domain 3: Relating to Others

0 / 12 indicators checked+0−0

Positive (0/6)

Negative (0/6)

Clinical Learning Points

Always Establish the Timing of Any Recent Exposure

●When a patient asks about HIV prevention, always ask whether there has been a recent exposure and exactly when. A patient asking about PrEP may in fact need PEP — and PEP is time-critical.

PEP — Post-Exposure Prophylaxis

●PEP is antiretroviral treatment taken after a potential exposure. It should be started as soon as possible and within 72 hours of exposure; the sooner the better. It is accessed via sexual health/GUM services or A&E out of hours, and requires urgent, same-day assessment — not a routine referral.

Assessing HIV Transmission Risk

●Risk depends on the type of exposure (receptive anal intercourse carries the highest sexual transmission risk), the partner's HIV status, and whether the partner is on effective treatment with an undetectable viral load (in which case sexual transmission risk is effectively eliminated). Assess practices and partner factors — not identity.

PrEP — Pre-Exposure Prophylaxis

●PrEP is highly effective at preventing HIV when taken correctly. It requires a confirmed negative HIV test before starting, regular HIV and STI testing, and renal-function monitoring; it may be taken daily or as event-based dosing depending on circumstances and clinical advice. In the UK it is commissioned and provided through sexual health services, so the GP's role is risk assessment and prompt referral/signposting.

PrEP Prevents HIV Only

●PrEP does not protect against other STIs — continue to advise condoms and regular STI screening. This must be stated explicitly to avoid a false sense of complete protection.

Testing, Vaccination, and Wider Prevention

●Arrange HIV and full STI testing, explain window periods and repeat testing after recent exposure, offer hepatitis A and B vaccination, and discuss risk-reduction measures. Screen for seroconversion illness (fever, rash, sore throat, lymphadenopathy).

Non-Judgemental Care Is Clinically Necessary

●A non-judgemental, inclusive approach is not merely courteous — it is what enables the patient to disclose the information (such as the timing of a recent exposure) on which safe management depends.

Common Candidate Mistakes in This Case

●Missing the PEP window: discussing PrEP only and failing to ask when the recent exposure occurred.
●Routine rather than same-day referral: losing a time-critical opportunity.
●Confusing PrEP and PEP: or wrongly attempting to prescribe PrEP in general practice, or saying it is unavailable.
●Judgemental questioning: inhibiting the disclosure on which the whole management depends.
●Omitting testing, vaccination, or the "HIV only" caveat: leaving him under-protected or falsely reassured.

Free MRCGP SCA practice case for GP registrars covering Man Asking About Medication to Prevent Hiv — Sexual Health. Includes candidate brief, patient script, marking scheme mapped to the RCGP SCA marking domains, and learning points. Built directly from the RCGP curriculum topic stations listed under "How this might be tested in the MRCGP SCA," part of a free library of 79 SCA practice cases for simulated consultation assessment preparation.

← Back to Free SCA Practice Cases