Author: Samira Prasad

Drs. Darrell Tan and Sean Rourke spoke with The Canadian Press about Canada’s updated HIV prevention guidelines released on World AIDS Day. The new clinical guideline published in the Canadian Medical Association Journal provides 31 recommendations and 10 good practices for prescribing antiretroviral medication before and after a potential HIV exposure to prevent infection.

Dr. Darrell Tan, MAP scientist and infectious diseases physician at St. Michael’s Hospital, is the lead author on the latest national guidelines for HIV Prevention Medication. The updated guidelines, published in the Canadian Medical Association Journal offers Canadian health care providers, community members and policy-makers the latest insights on prescribing HIV medications, in an effort to ensure the life-saving drugs are equitably prescribed and bring down rising infection rates.

The guidelines come at a critical time as research shows that HIV cases are spiking in Canada. The federal government reported 2,434 people newly diagnosed with HIV in Canada in 2023, which is a 35% increase over previous years. Marginalized communities face disproportionately higher cases, calling for more guidance and equitable prevention tools.

The Canadian Press wrote about the updates to HIV Prevention Guidelines. Read the story here

World AIDS Day, marked each year on December 1, is an opportunity to draw attention to the AIDS epidemic, and a reminder of the impact HIV and AIDS continues to have today.

We spoke with Dr. Tan about the need for the guidelines, why they’ve been released now and what populations will be affected the most.

Let’s start with your background. Can you describe your research in general at St. Michael’s?

I’m an infectious diseases physician and clinician-scientist, and my doctoral training is in clinical epidemiology. A major goal of my work is to expand the range of tools that we have available for treating and preventing sexually transmitted and blood borne infections, notably HIV – the virus that causes AIDS. My team and I do this through a number of methods like clinical trials, but we also work in the field to learn how to implement prevention tools in the real world.

My research team is called the Options Collaboratory in HIV and STI Treatment and Prevention Science (Options Lab). We work to maximize the range of medical options available to people seeking HIV and STI treatment and prevention care, because we know it’s not a one-size-fits-all solution. We’re a team with expertise in clinical science, social science, public health science, and most importantly community engagement.

Can you talk about the need for updated guidelines around Pre- and Postexposure Prophylaxis (PrEP and PEP) medications in Canada, and why these guidelines are released now?

There’s a story behind it, actually. The first clinical trials demonstrating that PrEP is a safe and effective strategy for preventing HIV infection were published in 2010. PrEP is a profound intervention, and was eventually approved by Health Canada in 2016. The hope was that we would see a rapid uptake in its use. But we were hearing from medical colleagues that they wanted guidelines for prescribing PrEP. In fact, some physicians would point to the absence of Canadian guidelines as the reason for not prescribing the medication. Prescribing PrEP was also controversial because of the stigma around HIV and AIDS, and the behaviours that lead to transmission, such as sexual activity and injection drug use.

Faced with this inaction, we took the initiative to put together Canada’s first and only national guidelines on PrEP and PEP, which were published in 2017, to show what is evidence-based, effective and standard practice for prescribing these medications. But even though those first guidelines got a lot of attention, and despite the fact that PrEP has now been around for over a decade, the incidence of HIV in Canada has worsened.

So, it was critically important to update the guidelines and focus on equity gaps in how PEP and PrEP are prescribed and accessed in Canada. This was a concern that came up with the original guidelines, and we’ve now emphasized that PEP and PrEP are tools that need to be equitably deployed to bring down HIV numbers in this country.

What populations will the new guidelines affect the most?

Efforts to contain epidemics benefit all of us, and the HIV numbers are too high in our country as a whole. PrEP in particular has been taken up the most among sexual minority men who have historically represented half of HIV infections in Canada since the dawn of the epidemic. But even in this group, the uptake hasn’t been equitable by race, urban and rural divide, or socio economic status.

We’re seeing HIV numbers rise among Indigenous people and cisgender women in Canada. Gender diverse and transgender people are also important populations who are often lumped together with sexual minority men, but each community has distinctive characteristics and we mustn’t conflate them. Another important group is people who inject drugs and use substances. This group has been under-represented in biomedical HIV prevention work.

Who was involved in creating the new guidelines?

We worked to include sex, ethno-racial, and geographic diversity within the panel of experts. Certainly there was disciplinary diversity, and we included community expertise as well. Many of the key populations that are disproportionately affected by HIV in Canada were represented in the panel, and people with lived experiences and professional experiences.

 We also met with regional organizations representing different communities in Canada, like women’s groups, minority groups, and Indigenous groups to share their recommendations for the updated guidelines. I believe we made meaningful changes to the content of the guideline based on this input.

What does it mean to you that the updated guidelines are released on World AIDS Day?

This day reminds the whole world how important HIV and AIDS continues to be today. Many people have the impression that HIV is a problem of the past, but it continues to be a major public health issue all over the world, including in Canada. Paradoxically, we have worsening HIV incidence in Canada even though we have so many safe and effective tools to control the epidemic, including but not limited to PrEP and PEP. It represents an urgent need to re-double our focus and efforts.

We have excellent treatments for HIV and AIDS, and we can care for our patients living with HIV very well, but it is still an incurable condition and we must prioritize prevention.

By Christine Davidson, Unity Health Toronto

Photos by Kevin Van Paassen, Unity Health Toronto

In this article featured on the front page of the Toronto Star, Dr. Archna Gupta spoke about a recent study published in CMAJ that found that 13 per cent of Ontarians attached to a family doctor live more than 30 kilometres away from their physician. The study also found that these patients were more likely to use the emergency department for non-urgent reasons and to have fewer family doctor visits, and were less likely to have preventive screening for cancer.

“When we talk about the primary care crisis, we often focus on patients who don’t have a family doctor,” said said Dr. Gupta.

A new CMAJ report is highlighting the inadequate efforts to address opioid use among adolescents in Canada, stating that existing services need to be tailored to better meet the needs of young people.

A second CMAJ report co-authored by Dr. Tara Gomes gives insight into recent opioid-prescribing trends, showing that dispensing of opioids has decreased. Dr. Gomes shared with The Globe and Mail that while this is a positive trend, the recent also showed the concerning element of some practitioners outright refusing to prescribe opioids all together.

“Opioids have a place in clinical practice, but it’s really about making sure that when they are accessed, it’s required that people have tried other alternatives, and that they’re prescribed as low dose and short a time period as possible,” Dr. Gomes said.

Dr. Sean Rourke spoke with The Lethbridge Herald about the latest Healthbox launch in the Piikani Nation in Alberta. The free vending machines contain HIV self-tests, drug testing strips, pregnancy tests and socks and mittens.

“This offers an opportunity for people to come and have a low barrier way of getting things they need to take care of themselves, when it’s best for them and also to get it without judgement and stigma,” said Dr. Rourke.

This is Alberta’s second Healthbox, with the other one located in Siksika.

In contrast to the haste and investment the federal government has put behind mining projects, universal pharmacare has been approached cautiously and progressed slowly. MAP scientist and Canada Research Chair in Health Justice Dr. Nav Persaud spoke with the Toronto Star about the benefits universal pharmacare stands to provide, including economical development.

MAP scientist Dr. Sean Rourke spoke with the Canadian Press about the AIDS Committee of Toronto’s decision to close after 42 years amid soaring cases of HIV in Canada.

“Everybody should have a door that they can open for their care and support and treatment,” he said.

Dr. Rourke has spearheaded projects to change the way people across Canada access HIV testing.

MAP’s Navigator program pairs hospital patients who are homeless with an outreach counsellor—a “Navigator.” The Navigator gets to know the patient and connects them with the health and social support they need to break cycles of homelessness and poor health, and to move forward in securing housing that works for them.

Navigators April Aleman and Fred Ellerington, along with project lead Dr. Stephen Hwang, spoke with the Canadian Press about how the program came to be and what their day-to-day can look like.

The program started at St. Michael’s Hospital in Toronto, and thanks to the Even the Odds partnership with Staples Canada, has expanded to St. Paul’s Hospital in Vancouver, increasing the program’s reach to over 1000 patients served to date. The program will be launching at the University of Montreal Hospital Centre later this year.

Donovan Vincent, Public Editor for the Toronto Star spoke with MAP scientist Dr. Dan Werb as part of this op-ed on following the opioid toxicity crisis in Toronto. The article also explains the role of MAP’s Drug Checking Service, led by Karen McDonald, and the role it plays in monitoring the makeup of street drugs in the city.

Dr. Dan Werb spoke with CBC News about the reasons that could be behind the recent 17 per cent decrease in opioid overdose deaths in Canada. He notes that despite the decline, opioid toxicity still killed over 7000 people in the past year, highlighting the need for a regulated drug supply.