And for Friend of Dorothy, it’s exactly why they’re building something different.
Gay men aren’t suddenly taking more risks – they’re just done pretending they don’t.
For Oliver James and Azamat Valiyev, that reality has been obvious for a long time.
It’s also the reason they started Friend of Dorothy.
“We didn’t start this as a product”, says Oliver. “We started it because the system didn’t reflect how gay men actually live.”
For decades, sexual health has been framed around control. Be careful. Be responsible. Reduce risk. But real life doesn’t follow guidelines.
And now, a new conversation – sparked by the rise of Doxy-PEP- is exposing the gap between what people are told to do, and what they actually do.
A mission built around reality
From the beginning, the goal at Friend of Dorothy wasn’t to tell people how to behave.
It was to build something that actually fits around them.
“People are going to have sex – that’s not going to change,” says Azamat. “What hasn’t changed is the system around it.”
That disconnect – between behaviour and healthcare – sits at the core of Friend of Dorothy’s mission.
Not to control behaviour. But to support it safely.
Doxy-PEP didn’t create this – it exposed it
The growing conversation around Doxy-PEP has brought that gap into the spotlight.
“This didn’t create anything new,” says Oliver. “It just exposed what was already happening – and how far behind the system is.”
At its simplest, Doxy-PEP represents a shift:
From reacting after the fact
To thinking about prevention differently
Speaking on the Friend of Dorothy podcast, Dr Tony Fordham explains:
“Doxycycline has traditionally been used to treat infections. More recently, it’s being used as a form of post-exposure prevention.”
“PrEP is taken before exposure. PEP is taken afterwards – typically within 72 hours – to reduce risk.”
Where the tension really sits
But this shift isn’t universally accepted.
“There is some controversy, particularly around antibiotic resistance,” says Dr Fordham. “This has to be approached carefully.”
And that’s where the real tension lies.
On one side: clinical caution and long-term implications.
On the other: real-world behaviour and harm reduction.
“People will make their own decisions about sex regardless,” he adds. “What matters is reducing risk in a realistic way”
The part no one wants to say out loud
For Friend of Dorothy, this isn’t really about Doxy-PEP.
It’s about something much bigger.
Access.
Because if sexual health was actually easy, discreet, and stigma-free, people wouldn’t avoid it.
But right now, too many still do. Outside London, the experience changes fast.
“You might know your pharmacist. Your doctor might know your family,” says Azamat. “That changes everything.”
Add in long wait times, limited services, and embarrassment – and suddenly “just go get tested” isn’t so simple.
So people adapt — and that’s the point
They find workarounds. They share information. They manage risk in their own way.
And that’s exactly what Doxy-PEP represents.
Not a shift in behaviour.
But a shift in how people navigate a system that doesn’t work for them.
Building around the problem — not ignoring it
This is where Friend of Dorothy positions itself differently.
Not as a reaction to one treatment. But as a response to a broken experience.
“We’re not building around one product,” says Oliver. “We’re building around access.”
The company is developing a digital clinic designed specifically for gay men – focused on removing friction entirely.
No awkward waiting rooms. No postcode limitations. No judgement.
“If you make something easier, more private, and built for people, they will use it, ” says Azamat.
From the UK to everywhere
While the clinic is launching in the UK, the ambition is global.
“The same problems exist everywhere,” says Oliver. “If anything, they’re even more complex in places like the US.”
Rather than solving for one market, the goal is to build something scalable – a platform that works across different systems.
“This isn’t a UK problem,” Azamat adds. “It’s a global one.”
A bigger shift in sexual health
For Dr Fordham, Doxy-PEP is just one part of a wider change.
“This is about harm reduction. Not eliminating risk – reducing it in a way that works for people.”
This is just the beginning
And maybe that’s the uncomfortable truth at the centre of it all:
The system isn’t failing because people are irresponsible.
It’s failing because it hasn’t evolved.
For Friend of Dorothy, that’s exactly the opportunity.
“We’re building the healthcare platform we wish existed,” says Oliver.
“And if we get it right – it changes everything.”
Friend of Dorothy Digital Clinic
Launching Spring 2026
Access: UK-wide (digital)
Private. Discreet. On your terms.
Early access available now
Download the Friend of Dorothy app
