Doctors say any Canadian who asks for HIV prevention drugs should get them

According to the latest clinical guidelines, Canadians do not have to explain why they need them to access HIV prevention medications.

In fact, says Dr. Darrell Tan, a physician-scientist at St. Michael’s Hospital in Toronto and lead author of the new guidelines, doctors should feel completely comfortable prescribing the drug to any adult or teen who comes to their office and asks.

“We don’t need to ask the person detailed questions about aspects of their personal health,” Tan said. as it happens Host Nil Koksal.

guidance, Published Monday in the Canadian Medical Association JournalProvide recommendations and outline good practices for prescribing antiretroviral drugs used to prevent HIV infection. This is the first time since 2017 that these have been updated.

These new data show that Canada is far from its goal of eliminating HIV as a public health threat by 2030, with new infections rising in communities with less access to health care and health information.

Why are HIV cases still so high?

According to the Public Health Agency of Canada, there are 1,826 new HIV diagnoses in Canada in 2024. This does not include 476 new cases in Quebec, which does not provide data for the federal report.

While Canada saw a slight decrease of 2,434 new cases recorded across the country in 2022, doctors say it is not a statistically significant decline. Overall, new HIV diagnoses have Continuing to grow in Canada since 2021.

This, despite the emergence and development of a class of antiretroviral drugs Which are extremely effective in preventing HIV infection.

“Every single one of the HIV infections we saw last year is preventable and so I want this number to eventually go to zero,” Tan said.

“We have tools that are virtually 100 percent effective and safe if used properly.”

Pre-exposure prophylaxis (PrEP) is a preventive medication that significantly reduces a person’s risk of becoming infected with HIV, while postexposure prophylaxis (PrEP) is an emergency medication taken to prevent infection after exposure to HIV.

So what is the problem? The guidelines say PREP and PEP are not being prescribed widely enough.

According to the guidelines, this is due in part to oversight by doctors, who prescribe the drug only to patients who report engaging in high-risk behavior such as injecting drugs or having unprotected sex.

“There are many reasons why people may not disclose HIV-risk behaviors to health care providers, including shame, medical mistrust, and structural barriers associated with homophobia, transphobia, racism, colonial practices, HIV stigma, and other forms of discrimination,” the guideline states.

While Tan says doctors should prescribe PrEP regardless of whether someone wants to discuss their personal life, he says that doesn’t mean doctors shouldn’t have candid and open discussions about HIV risks.

In fact, the guidelines even encourage doctors AC ToActively seek opportunities to prescribe HIV prevention medications to anyone at risk.

The guidelines also call for better public health messaging about 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 this has been a huge pandemic,” Tan said.

“But we don’t see the same messaging around PrEP.”

At the moment, he says, the scope of PrEP campaigns has mostly been private pharmacies and drug companies, and they often target men who have sex with men.

This means that many people who need to know about these drugs are not getting the message, including drug users, low-income people and Indigenous communities.

“HIV, like many other health problems, goes hand in hand with and exploits some of the inequalities that exist in society,” Tan said.

“There are some communities that are quite aware of it and in which we have seen some good progress, but others where we are seeing consistent new infections are where we really need to see a lot more, I think, leadership in this area.”

Indigenous communities are particularly at risk

More than a third of new infections are in women, 38 percent are in gays, bisexuals and other men who have sex with men, and 25 percent are in people who inject drugs.

According to communities, coalitions and networks that address HIV issues in the Indigenous context, Indigenous people represented 19.6 percent of new HIV diagnoses in 2023, despite only being five percent of the population where race/ethnicity was reported.

Dr. Sean Rourke, a scientist at the MAP Center for Urban Health Solutions at St. Michael’s Hospital, says he would have liked the guidelinesmore deeply Find out how to reach Indigenous communities who face huge barriers to health care.

Rourke and a team of HIV advocates are partnering with Indigenous leaders to reach people in Canada’s most affected communities. More than 15,000 people have been tested in an HIV-testing program launched in March for underprivileged and remote communities in the Prairies.

“The people who are most vulnerable are being impacted by this, three or four times more than it otherwise would be, because other things have happened and the safety net isn’t there,” he said.

Tan says it’s disappointing to see how far Canada is from reaching its goal of eliminating HIV as a public health crisis within the next five years.

Still, he says, we must not give up.

“It’s a very laudable goal and it’s important for us to keep it in mind at this time when many people feel like HIV has disappeared from the headlines,” he said.

“I’m optimistic that if we keep our eyes on the goal and really use the tools we have, we can really make a difference.”