As It Happens7:34New guidelines aim to reduce barriers to drugs that prevent HIV infections
Canadians shouldn’t have to explain why they need HIV prevention medications in order to access them, according to the latest clinical guidelines.
In fact, doctors should feel perfectly comfortable prescribing them to any adult or adolescent who walks into their office and asks, says Dr. Darrell Tan, a physician-scientist at St. Michael’s Hospital in Toronto and lead author of the new guidelines.
“We don’t need to necessarily grill that person with detailed questions about aspects of their personal health,” Tan told As It Happens host Nil Köksal.
The guidelines, published Monday in the Canadian Medical Association Journal, provide recommendations and outline good practices for prescribing antiretroviral medications used to prevent HIV infection. This is the first time they have been updated since 2017.
They come as new data shows Canada is far off track from its goal of eliminating HIV public health threat by 2030, with new infections soaring in communities with less access to health care and health information.
Why are HIV cases still so high?
There were 1,826 new HIV diagnoses in Canada 2024, according to the Public Health Agency of Canada. That doesn’t include the 476 new cases in Quebec, which did not provide data for the federal report.
While Canada saw a slight decrease from the 2,434 new cases recorded nationwide in 2022, doctors say it’s not a statistically significant drop. Overall, new diagnoses of HIV have been steadily rising in Canada since 2021.
This, despite the emergence and growth of a class of antiretroviral medications that are extremely effective at preventing HIV infection.
“Every single one of the HIV infections that we observed in the last year … is preventable and so I’d like to see that number go right down ultimately to zero,” Tan said.
“We do have tools that are virtually 100 per cent effective and safe if they’re used properly.”
Pre-exposure prophylaxis (PrEP) is a preventative drug that significantly lowers a person’s risk of contracting HIV, while postexposure prophylaxis (PEP) is an emergency medication taken to prevent infection after HIV exposure.
So what’s the problem? The guidelines say PrEP and PEP are simply not being prescribed widely enough.
That’s, in part, the guidelines say, because of gatekeeping by doctors who only prescribe to patients who report engaging in high-risk behaviours, like injecting drugs or having unprotected sex.
“There are many reasons people may not disclose HIV-risk behaviours to health-care providers, including shame, medical mistrust, and structural barriers linked to homophobia, transphobia, racism, colonial practices, HIV stigma, and other forms of discrimination,” the guidelines note.
While Tan says doctors should prescribe PrEP regardless of whether someone wants to discuss their personal lives, he says that doesn’t mean doctors shouldn’t have frank and open discussions about HIV risks.
In fact, the guidelines also encourage doctors to actively seek opportunities to prescribe HIV prevention drugs to anyone at risk.
The guidelines also also call for better public health messaging around these drugs.
“We see public health posters talking about getting your flu shot because it’s flu season in Canada, getting a COVID shot because we know that that has been a huge pandemic,” Tan said.
“But we don’t see the same messaging around PrEP.”
HIV advocates are concerned people newly infected with HIV will not get the care they need because federal funding for self-testing kits runs out at the end of March.
Right now, he says, PrEP campaigns have mostly been the purview of private pharmacies and drug companies, and they often target men who have sex with men.
That means a lot of people who need to know about these drugs simply aren’t getting the message, including drug users, low-income people and Indigenous communities.
“HIV, like so many other health problems, kind of travels along and exploits some of the inequities that exist in society,” Tan said.
“There are some communities that are quite aware of this and in whom we have seen some good uptake, but others where we continue to see new infections, where we really need to be seeing a lot more, I think, leadership in this area.”
Indigenous communities particularly at risk
More than one-third of new infections are in women, 38 per cent are in gay, bisexual, and other men having sex with men, and 25 per cent are in people who inject drugs.
Indigenous people represented 19.6 per cent of new HIV diagnoses in 2023, where race/ethnicity was reported, despite making up just five per cent of the population, according to Communities, Alliances and Networks, which addresses HIV issues within an Indigenous context.
Dr. Sean Rourke, a scientist with the MAP Centre for Urban Health Solutions at St. Michael’s Hospital, says he would have liked the guidelines to more thoroughly address how to reach Indigenous communities that face huge barriers to health care.
Rourke and a team of HIV advocates have been partnering with Indigenous leaders to reach people in Canada’s hardest hit communities. An HIV-testing program they launched in March for underserved and remote communities in the Prairies has tested more than 15,000 people.
“Those that are the most vulnerable. It’s impacting them, three or four times more than it would have otherwise because other things have happened and the safety net is not there,” he said.
Tan says it’s disappointing to see how far Canada is from reaching its goal to end HIV as a public health crisis within the next five years.
Still, he says, we shouldn’t give up.
“It’s a very laudable goal and it’s an important one for us to keep in mind at this time when a lot of folks have kind of felt like HIV has faded from the spotlight,” he said.
“I remain optimistic that if we keep our eye on the goal and really harness the tools that we’ve got, we really could make a difference.”
