All Populations
PrEP Access: Barriers and Opportunities
The following are PrEP access barriers and opportunities which emerged as common experiences across a number of priority populations consulted with through EMHC’s PrEP Alberta consultation series. While these do not capture all PrEP access barriers and opportunities experienced by Albertans they do provide an important starting point for healthcare of service providers when supporting clients or communities in seeking PrEP. We encourage you to read the remaining sections of this report to learn about the unique barriers, opportunities, and accessibility considerations experienced by specific priority populations disproportionately impacted by HIV in Alberta.
Barriers
This section focuses on PrEP access barriers. By barriers, we mean things that might make PrEP access more challenging.
Disconnected Systems
Health systems are seen as disconnected, with limited communication (and sometimes distrust) between different parts (CBOs, healthcare providers, policymakers). This results in a system which lacks the integration and collaboration necessary to facilitate access to PrEP for many who need it most.
Adherence Challenges
PrEP is not a “one-and-done” deal. People taking publicly funded PrEP are expected to adhere to consistent follow-up (i.e. for HIV/STI screening). Concerns about medication and treatment adherence emerged from many consultations - though the unique factors impacting adherence differed from population to population.
Provider Knowledge & Availability
There is a broad lack of PrEP knowledge amongst healthcare providers, as well as a lack of designated PrEP prescribers outside of the Edmonton and Calgary areas. In addition to this, many providers lack the cultural competency to provide safe, inclusive, and effective care to many of the populations who would benefit most from PrEP.
Sexual Health as Specialization
Sexual health is seen by many healthcare providers as being a specialized area of care as opposed to simply being one component of a person’s overall health. Therefore, a person’s sexual health is often not addressed by healthcare providers unless they seek out specialize services, resulting in lost opportunities to educate on, assess eligibility for, and facilitate access to PrEP.
Confidentiality
Confidentiality is a barrier for many, particularly those who live in rural areas, amongst close-knit communities, and/or who have close familial ties (often rooted in cultural identity). There are concerns of medical records and personal information being shared outside of the patient-provider relationship.
Limited Reach
There is little targeted PrEP education or services for priority populations other than gbMSM. Because of this, most PrEP resources and services fail to address key barriers experienced by other priority populations, including insurance coverage for immigrants and newcomers, and adherence and medication storage challenges for people who use drugs and/or are street involved.
Opportunities
This section focuses on opportunities to enhance PrEP education and access. By opportunities, we mean things that would make access to PrEP and information about it easier or more accessible.
Make it Accessible
Whenever possible, PrEP information should be delivered in a manner that is streamlined, practical, and easy to understand. This includes using more accessible language and using visuals to present information where appropriate (i.e. flowcharts). To reach all populations in need of PrEP, resources should be shared using a mixed approach, including both in-person and online resources that are delivered through a variety of networks, platforms, and spaces.
Enhance Knowledge
Increased education for healthcare and service providers on PrEP, sexual health, and cultural competency is needed to ensure that populations most in need of PrEP are able to access it. This includes nurses, community-based support workers, and other support staff, not just physicians/prescribers, as this broader set of providers represents an untapped resource for PrEP access facilitation.
Dig Deeper
While accessibility is important, people seeking PrEP should have access to enough information to understand whether it is right for them, what the full access timeline and process looks like, as well as access to other sexual health and harm reduction information, so they can decide if pursuing PrEP is something they want to do.
Expand Representation
As PrEP is a beneficial prevention option for a diverse range of Albertans, it is important that PrEP resources and services reflect a diverse range of identities and experiences, particularly those who have historically been least represented in PrEP resources and services. This includes both visual and cultural representation.
Read the remaining sections of this report to learn more about the unique barriers, opportunities, and accessibility considerations experienced by specific priority populations disproportionately impacted by HIV in Alberta.