A new study co-led by researchers from St. Michael’s hospital found that public health interventions are urgently needed to increase awareness and uptake for HIV prevention medication in Black and Indigenous communities in Canada.
Researchers analyzed data of nearly 4,300 male participants from “I’m Ready,” a national HIV self-testing research program first launched in 2021 and developed by Dr. Sean B. Rourke, director REACH Nexus at the MAP Centre for Urban Health Solutions at St. Michael’s hospital in Toronto.
The study, published March 19 in the Canadian Journal of Public Health, showed that Black males were 66 per cent less likely and Indigenous men were 43 per cent less likely than white men to be aware of pre-exposure prophylaxis, or PrEP – a life-saving HIV prevention medication.
For PrEP uptake, the study found Black male participants living in rural communities were roughly 60 per cent less likely to be on PrEP than white men.
“Our analysis is the first national study to identify and describe the racial differences in PrEP awareness and uptake,” said Dr. Wale Ajiboye, an implementation scientist with REACH Nexus at St. Michael’s Hospital (Unity Health Toronto). Dr. Ajiboye is also the recipient of a Research Excellence, Diversity, and Independence (REDI) Early Career Transition Award from the Canadian Institutes Of Health Research.
“We show that Black and Indigenous men are less likely to be aware of or receive PrEP than their white counterparts. This highlights the continuing inequalities in HIV medication awareness and use in communities most impacted by the HIV epidemic in Canada.”
HIV PrEP involves taking oral or injectable antiretroviral medications on an ongoing basis to prevent a new diagnosis and is vital especially among key populations and vulnerable communities for people who are at risk through sex or injection drugs.
Canada has identified PrEP as an effective biomedical intervention to achieve zero new cases by 2030. In Canada, new HIV diagnoses have soared, increasing by 35 per cent between 2022 and 2023, according to the Public Health Agency of Canada, with the Prairie provinces being hardest hit.
Yet, race-based data on PrEP awareness and uptake are currently not available at the provincial or national levels.
Study aims to fill critical dearth of information around PreP
Black people in Ontario represent 5.5 per cent of the population, yet they accounted for 25% of new cases in 2020, according to data from the Ontario HIV Surveillance Initiative. Indigenous populations represent 5 per cent of the population, but accounted for 18 per cent of new cases in 2020 according to national estimates from Public Health Agency of Canada.
Dr. Ajiboye and researchers from Women’s Health in Women’s Hands Community Health Centre and Women’s College Hospital in Toronto, Yale University, the University of Toronto and the Canadian Aboriginal AIDS Network among others, say the “mismatch” between new HIV diagnoses for Black and Indigenous people is concerning and requires a better understanding of PrEP awareness and uptake in these communities.
“Canada may not be able to reach the goal of zero new cases by year 2030 if the PrEP racial disparities for these communities are not urgently addressed,” said Dr. Ajiboye.
The study reviewed participant demographics of 4,294 people from the “I’m Ready” program, including age, gender, sexual orientation, race, sexual risk behaviour, and PrEP awareness and use. Participants were mostly 18-45 years old.
When comparing the PrEP among different racial identities, participants identifying as Black had the lowest percentages of those who were aware of PrEP (45 per cent), received PrEP (15 per cent).
REACH Nexus designed, launched and scaled the highly effective HIV testing initiatives and programs “I’m Ready” along with “Community Link.” These landmark programs reached close to 100,000 people to get tested to “know their status” – and the I’m Ready program identified an estimated 100+ people who were previously undiagnosed with HIV.
Dr. Rourke said the study shows an urgent need to “dramatically transform” the conversation in Canada at all levels of government on how to implement and scale up new policies, initiatives and programs to close these racial disparities.
“We know that PrEP is an incredibly effective medical intervention,” said Dr. Rourke. “By maintaining the status quo failing to expand PrEP awareness, we condemn marginalized communities to greater suffering, perpetuating Canada’s history of racism and discrimination within health care.”
Proposed solutions
To address the barriers faced by Black and Indigenous communities in accessing PrEP for HIV prevention, the study urged policy makers to adopt a decolonizing framework that prioritizes combatting anti-Black and anti-Indigenous racism.
Researchers said Canada should adopt a national PrEP strategy, with the federal government implementing an equity-focused approach, ensuring free access to PrEP for marginalized communities. Black and Indigenous peoples should be prioritized in resource allocation, the study said, as data shows increased PrEP use can significantly reduce HIV rates.
Collecting race-based data is also crucial for guiding HIV prevention research and policies. The data will enable more targeted interventions and efficient resource use, accelerating progress toward public health goals. The study highlights the need for disaggregated data on race, gender, sexual identity, and location to track progress and ensure equitable access to PrEP.
Researchers also said that more effective campaigns are essential to promote PrEP awareness and uptake, particularly within Black and Indigenous communities. These campaigns should be community-driven, culturally relevant, and incorporate input from community members, service providers, and leaders. Utilizing diverse media platforms like social media, dating apps, and TV will enhance outreach and increase demand for PrEP, the study said.
REACH Nexus Contact
Andrew Russell
Senior Communications Specialist
REACH Nexus – MAP Centre for Urban Health Solutions
andrew.russell@unityhealth.to
Phone: 416-268-7642
