DIVERSITY IN SCIENCE
PrEP-ing for HIV
By Rehnuma Islam
A
pproximately 62 000 Canadians are living with the Human Immunodeficiency Virus (HIV).1 In fact, roughly two thousand Canadians are diagnosed with HIV every year, and around 13% are unaware of their HIV positive status.1 HIV diagnosis involves testing for antibodies against the virus and viral components (e.g., antigens or nucleic acid) in blood samples. More recently self-testing was approved for use within Canada.2 HIV is contracted following exposure to vaginal fluid, semen, blood or breast milk and often manifests flu-like symptoms.2 As the disease progress into a chronic HIV infection, it can be asymptomatic.2 Left untreated, HIV enters a phase where the immune system is severely damaged, ultimately favouring opportunistic infections.2 This phase of the disease is termed Acquired Immunodeficiency Syndrome (AIDS) and the viral load is high. Without treatment, the estimated survival within this phase is around three years.2
University of Toronto; “We have this relatively underutilized but really […] blockbuster intervention which is PreExposure Prophylaxis (PrEP). So, a lot of my research program involves working on PrEP, which is a hugely effective and safe intervention that we don’t utilize well enough in Canada, unfortunately.”
There are numerous preventative measures one can take to avoid contracting HIV. Some of which include frequent status testing, discussing one’s status among partners, practicing safe sex, and not sharing needles. According to Dr. Darrell Tan, a clinician-scientist at St. Michael’s Hospital and associate professor at the
PrEP is given to individuals that are HIV negative to reduce the risk of contracting HIV. Previous research has highlighted the efficacy and safety of PrEP. However, even after a decade, individuals at risk of contracting HIV are seldom prescribed PrEP due to a lack of education and conversation surrounding its use.
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Dr. Tan was elected as a governing council member of the International AIDS Society and is a Canadian Research Chair in HIV prevention and STI Research. While completing his BSc at McGill University in Microbiology and Immunology and International Development Study, Dr. Tan was interested in the biological and societal impacts of HIV, particularly its devastating effects within the LGBTQ2+ community. Dr. Tan’s passion to continue studying HIV led him to complete his MD and residency training in infectious disease, and PhD in clinical epidemiology at the University of Toronto, where he continues his mentorship and research.
Currently, Dr. Tan’s research investigates the implementation of PrEP as an intervention against HIV. Past projects with PrEP implementation have helped clinicians learn about and prescribe PrEP.3 Other projects have helped link different parts of the health care system to identify individuals that could benefit from PrEP services when visiting a clinic.4 There is currently a study aimed at identifying barriers and facilitators in an individual’s choice to use or not use PrEP.5 These vital questions surrounding the efficacy and usefulness of PrEP will improve sexual health and wellbeing within the gay and lesbian communities, while efforts are being made to reach racial minorities, genderqueer individuals, and various other subjugated groups. Dr. Tan acknowledges that there remain many hurdles to improve the public discourse around PrEP use and emphasizes the problem stems from the top down; “It’s a failure of our public health and health system that everybody does not know about it because, obviously knowledge is power and is the first step to getting people access to something that is extremely effective and safe. Frontline clinicians do not always know about the product. I speak to clinicians all the time including primary care providers who could be potentially prescribing this to patients in Graphic design by Amy Assabgui
