Realizing PrEP’s full potential: It’s time to broaden awareness and access
PrEP is a highly effective tool for preventing HIV, but remains underused by many populations who could benefit. In order to realize PrEP’s full potential to dramatically reduce the number of HIV transmissions in Canada, there’s an urgent need to scale up its use and broaden its reach.
Promisingly, PrEP has played a role in reducing the number of HIV transmissions among gay, bisexual and other men who have sex with men (gbMSM), who make up the vast majority of people currently using PrEP in Canada. For example, studies have shown that PrEP contributed to declines in HIV transmissions among gbMSM in British Columbia and in Ottawa. However, in Canada overall, progress has been slow and uptake still needs to be improved.
Other groups that are disproportionately affected by HIV, such as Indigenous people, African, Caribbean and Black individuals, trans women and people who use drugs, have received comparatively less education about PrEP and there is important work to be done to expand PrEP awareness and access among these communities.
Casting a wide net: PrEP education for all who could benefit
We know PrEP awareness is high among gbMSM, but much lower among other groups disproportionately affected by HIV, as well as the general public. Many people who could benefit from PrEP don’t even know it exists. However, once they’re informed, a significant number of people are interested in taking it.
Educating more people is a crucial first step to improving uptake and we all have a role to play in increasing awareness – from peers and social service workers to potential PrEP prescribers and pharmacists. It’s best to cast a wide net with PrEP education and not make assumptions about whether a person may be at risk for HIV. Periodically having open and judgment-free conversations about risk behaviours can open the door to educating all clients about PrEP, as well as other HIV prevention strategies.
It’s important to recognize that some people at risk for HIV may not be comfortable disclosing their risk behaviours for various reasons, including stigma related to sex and drug use, homophobia and mistrust of the medical system. To effectively educate clients, service providers should understand the specific PrEP-related issues relevant to the populations they serve, enabling them to address questions and concerns with sensitivity. For example, there are specific considerations about PrEP for cis and trans women, and for people who use drugs.
Facilitating PrEP access and supporting people to stay on it
Many people experience barriers that can make it difficult to access PrEP or adhere to a PrEP regimen. These barriers can include various forms of discrimination, as well as factors like living far from PrEP services or lack of healthcare provider knowledge. Some people may also be dealing with competing priorities, such as work or childcare, which make it difficult to attend regular medical appointments or take a medication consistently.
A great way to support people who may be at risk for HIV is to integrate routine PrEP education and access into healthcare services they already use, such as population-specific health clinics or harm reduction services. This can make getting PrEP more convenient, offering a comfortable environment with trusted providers who specialize in the type of care they need, such as harm reduction approaches for people who use drugs, gender-affirming care for trans people, or culturally sensitive care for Indigenous people or people from African, Caribbean and Black communities.
Once a person starts taking PrEP, they may need support with adherence or attending regular medical appointments. For example, some people who are not stably housed have reported challenges safeguarding pills and maintaining a pill-taking schedule. For some people who use drugs, it may be helpful for PrEP to be dispensed along with other daily medications such as opiate agonist therapies or medications given through a safer supply program. PrEP is not one-size fits all. Different communities may need different types of support and may experience different barriers. Service providers can work with each person to overcome any challenges that make it difficult to follow a PrEP regimen.
We now have more PrEP options than ever
The range of PrEP options has significantly expanded in recent years. Oral PrEP is available in pill form and can be taken daily by anyone who may be at risk for HIV through anal or vaginal sex, or through sharing drug use equipment, and gbMSM can consider an on-demand dosing schedule. Also, a long-acting injectable form of PrEP was recently approved as an option for preventing HIV through vaginal or anal sex. This means that people may have several options to choose from and can select the one that works best for them.
Despite these highly effective innovations, we have not seen dramatic declines in the number of new HIV diagnoses in Canada overall and this points to an urgent need to inform a broader spectrum of people at risk for HIV about PrEP. With the increasing availability of PrEP options, the time is now to realize PrEP’s full potential to reduce HIV transmissions among all groups of people by expanding awareness, access and supports.
Mallory Harrigan is CATIE’s knowledge specialist in HIV prevention and testing. She has a master’s degree in community psychology from Wilfrid Laurier University.