A coalition of doctors across Canada is releasing new guidance on prescribing medications that can prevent HIV infection, with a focus on increasing advocacy and awareness of an expanding class of drugs.
The clinical guidelines, published Monday in the Journal of the Canadian Medical Association, make 31 recommendations and 10 best practices for prescribing antiretroviral drugs before and after potential HIV exposure to prevent infection.
Lead author Dr Darrell Tan said that over the past three years, 19 doctors have volunteered their time to review the latest research and write new guidelines as the range of available pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) options has expanded since the last guidelines were issued in 2017.
The recommendations are aimed at reducing the increase in HIV incidence in Canada over the past few years to achieve the country's goal of eliminating sexually transmitted infections as a public health threat by 2030.
“We are nowhere near achieving this ambitious goal,” said Tan, a physician-scientist at St. Michael's Hospital.
The Public Health Agency of Canada said HIV diagnosis rates increased steadily from 2021 to 2023, according to the most recent data available.
From 2022 to 2023, the number of new HIV cases increased by 35 percent, with 2,434 diagnoses. There were 1,800 new diagnoses recorded in 2022, and more than 1,450 in 2021.
The Canadian Institutes of Health Research said data for 2024 will be released Monday.
Tan said the rise is rooted in “deep historical and structural inequalities” that have put certain populations at a disadvantage when it comes to accessing PrEP and PEP.
More than a third of new infections are among women, 38 percent among gay, bisexual and other men who have sex with men, and 25 percent among people who inject drugs.
Infections have severely affected some First Nations communities, with Saskatchewan and Manitoba having more cases than the national average.
Tan said he is “disappointed” that national, provincial, regional and territorial governments are not promoting more public health information about PrEP and PEP to counteract the stigma that may surround these medications.
“Almost everyone in Canada knows unequivocally that public health authorities believe that influenza vaccination is something they will support,” Tan said.
“It is the failure of public health and authorities to communicate this information in a positive way.”
The Public Health Agency of Canada says it is providing national leadership in the prevention and control of sexually and blood-borne infections through its guidance on the issue for health-care workers.
In it, the federal agency cited recommendations for PrEP for HIV developed by the Canadian HIV Trials Network at the Canadian Institutes of Health Research.
Management
The new guidance says health care providers should prescribe PrEP to those who seek it, even if they don't disclose their HIV risk factors, rather than “control” doctors' access.
“There are many reasons why people may not report their 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 guidance states.
Dr Amita Singh, a member of the steering committee, said this aims to reduce the barrier to access PrEP.
Physicians in all specialties, such as primary care and reproductive health, should also proactively offer medications if they identify risks, such as sex without condoms, previous sexually transmitted bacterial infection, more partners, and injection drug use.
The expanding range of PrEP options available is also reviewed, and the recommendations describe appropriate scenarios in which they should be offered. In addition to daily and on-demand tablets, Health Canada has approved long-acting injectables in 2024.
This long-acting option is taken every two months, which Singh said is a particularly useful option for people who inject drugs and have unstable housing conditions, since taking a pill every day would be difficult.
“This is where injectable drugs have enormous potential,” said Singh, a clinical professor in the department of infectious diseases at the University of Alberta.
She said the next step is for policymakers to make implementation of the guidance a priority.
Action
Dr. Sean Rourke, a scientist at the MAP Center for Urban Health Solutions at St. Michael's Hospital, said he would like to see the guidance go into more detail about how to reach communities with the highest rates of HIV infection, especially Indigenous populations on the Prairies.
According to Communities, Alliances and Networks, an organization that focuses on HIV in Indigenous contexts, in 2023, Indigenous people accounted for 19.6 per cent of new HIV diagnoses (where race/ethnicity was reported) but only five per cent of the population.
“The paper doesn't say anything about how to contact these people,” he said.
Rourke and a team of HIV advocates are working with Indigenous leaders to reach people in Canada's hardest-hit communities. The HIV testing program they launched in March for low-income and remote communities on the Prairies has tested more than 15,000 people.
“Those who are the most vulnerable. It affects them three or four times more than it would have otherwise because other events have happened and there is no safety net,” he said.
Rourke said solutions like this testing program already exist to address long-standing health inequities.
However, he said: “It doesn't happen on its own. And that's the problem.”
This report by The Canadian Press was first published Dec. 1, 2025.
The Canadian Press' health coverage is supported through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
