We Need Better HIV Prevention to End the Epidemic
Despite biomedical innovations to address HIV and other sexually transmitted infections (STIs), Canada’s health services, policies, and funding still have considerable ways to go in ensuring optimal health outcomes for gay and bisexual men.
“There’s still too much stigma surrounding HIV, other STIs, and sexual orientation,” says Dr. Mark Gilbert, Medical Director of Clinical Prevention Services at the British Columbia Centre for Disease Control. “This stigma, and expectations of negative interactions with doctors or nurses, can prevent gay men from coming forward for testing.” While homophobia in health care needs to be addressed, supportive policies and funding for HIV and STI testing and treatment options are also urgently required.
“Since the dawn of the [HIV] epidemic, gay and bisexual men have been disproportionately affected."
– Dr. Darrell Tan, St. Michael’s Hospital
According to the Public Health Agency of Canada, the rate of new HIV infection remains 131 times higher among gay and bisexual men than in the general population. “The epidemiology is strikingly clear,” says Dr. Darrell Tan, Clinician-Scientist, Division of Infectious Diseases at St. Michael’s Hospital. “Since the dawn of the epidemic, gay and bisexual men have been disproportionately affected. We must redirect resources to address this.”
Barrier-free access to treatment
Community leaders and health advocates believe that ending the HIV epidemic in Canada is within reach. This will require the scaling up of a variety of testing options, pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP) — medicines that can be taken by HIV-negative individuals to reduce their chances of getting infected — and culturally appropriate mental health and harm reduction services.
Recent research has confirmed that effective HIV treatment can suppress HIV in the body to undetectable levels, eliminating the possibility of transmitting the virus to sexual partners, so prompt treatment is vital.
“The onus is on the health care system to create a culturally safe space for gay and bisexual men.”
– Dr. Mark Gilbert, British Columbia Centre for Disease Control
“The most important thing is for gay and bisexual men to regularly test for HIV,” emphasizes Dr. LaRon E. Nelson, Ontario HIV Treatment Network Research Chair in Implementation Science with Black Communities at St. Michael’s Hospital. “If they have HIV, they can be linked to treatment and achieve viral suppression. If they don’t, then it’s an opportunity to discuss ways to remain HIV-negative, including the use of PrEP.”
Ending homophobia is essential
We must remove the barriers that keep gay and bisexual men from accessing the highest standard of care. “Health care providers have not been held accountable for how they’ve prevented gay and bisexual men from accessing PrEP and PEP,” says Dr. Nelson. “Racism, homophobia, transphobia, and HIV stigma must be addressed in our health care system.”
Regular testing, preventative medicine, and HIV treatment and care must be made readily available in stigma-free environments throughout Canada. “The onus is on the health care system to create a culturally safe space for gay and bisexual men,” says Dr. Gilbert.
The GMSH is an alliance of organizations in Ontario championing the sexual health of Two Spirit, gay, bisexual, queer and other transgender and cisgender men who have sex with men in Ontario.