Why aren’t Indigenous Peoples who could benefit from PrEP getting it?

Jaris Swidrovich, an assistant professor and Indigenous Engagement Lead at the University of Toronto’s Leslie Dan Faculty of Pharmacy, has received a CIHR Catalyst Grant of nearly $100,000 to research the barriers urban Indigenous Peoples face to PrEP, as well as how to improve its uptake and the knowledge around it.“We want to ensure that any folks who prescribe, suggest, dispense, monitor, or follow patients on PrEP know why they’re not seeing Indigenous folks, or why they are seeing the ones who they are seeing,” Swidrovich said in a story on the university’s website. “Hopefully, we can provide some strategies for better knowledge, awareness, and uptake of PrEP.”HIV is far more common in Indigenous Peoples, with a rate of 15.2 new infections per 100,000 people, versus the overall national rate in Canada of 4.3 new infections per 100,000 people. Read: What integrating traditional Indigenous care into medical practice really meansIn addition to having higher HIV rates, Indigenous Peoples also face more barriers to getting pre-exposure prophylaxis (PrEP) than others in Canada. Swidrovich said that he heard from HIV pharmacists and Indigenous community members in Toronto that they felt few Indigenous Peoples knew about PrEP or how to access it. Research also suggests PrEP use among Indigenous Peoples is low. Swidrovich’s research can help fill that gap. “There is some literature about PrEP uptake, but it’s not specific to Indigenous Peoples, and the factors that influence uptake in other groups may not apply to Indigenous Peoples,” says Swidrovich. “We don’t know the reasons for the lack of uptake in urban Indigenous Peoples.”He will host Talking Circles with Indigenous Peoples who have a higher risk of acquiring HIV with the 2-Spirited Peoples of the 1st Nations and Toronto Indigenous Harm Reduction. “In addition to helping us understand current barriers that exist around PrEP use, access and adherence, the study is also an opportunity for Indigenous Peoples to be a part of health care change,” says Timothy Lim, a pharmacist and master’s student at the Leslie Dan Faculty of Pharmacy who is working with Swidrovich. “Hopefully, the Talking Circles will unravel unique opportunities for pharmacists to improve PrEP access and also help drive policy change that not only improves patient care but also expands pharmacist scope of practice, for example, to prescribe PrEP or order lab values.”Read: Pharmacy offers PrEP to IV drug users to protect against HIV infectionsLim and Swidrovich will also host information sessions on health topics and offer medication reviews for members of the community organizations. That’s a way to make sure the relationship is reciprocal, a crucial part of Indigenous methodology and approach. Indigenous Peoples have poorer health outcomes in general than non-Indigenous Canadians, which is a result of historical and ongoing colonialism, including racism, intergenerational trauma, and government policies that disadvantage them. Pharmacists can help improve access to PrEP right now, Swidrovich says, by learning more about it, posting information about it in their pharmacies, and counselling patients who would benefit from it. They can also ensure they understand the Non-Insured Health Benefits program, which covers First Nations Peoples and Inuit.Read: Long-acting injectable PrEP is a big step forward in HIV prevention

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