While cost remains the biggest barrier to accessing PrEP for gay and bisexual men in Canada, they also felt pressure to take PrEP and have sex without condoms, with younger men tending to feel less anxious about HIV transmission. This reflects shifting social and sexual norms in the era of PrEP and U=U, according to recent qualitative research.
While pre-exposure prophylaxis for HIV (PrEP) has been approved in Canada since 2016, implementation has been impeded by cost challenges. Certain provincial health insurance plans, including British Columbia’s, fully cover PrEP for gay and bisexual men who meet the guidelines. However, this is not the case in other provinces, such as Ontario, where PrEP is fully covered until the age of 25, over the age of 65, and for those receiving disability grants and social assistance. Across Canada, eligible Indigenous people, members of the armed forces and military veterans can access PrEP.
The study
Dr Mark Gaspar from the University of Toronto aimed to better understand PrEP-decision making among HIV-negative gay, bisexual and queer men. Drawing on the PrEP Cascade, which considers readiness for PrEP, seeking PrEP out and discussing it with a healthcare provider, he and colleagues conducted 45 in-depth one-on-one interviews between March and October 2020 (all but one were over Zoom) with men in Ontario and British Columbia.