In December 2023, the Public Health Agency of Canada (PHAC) made its report available regarding new cases of human immunodeficiency virus (HIV) in the Canadian population. For Quebec, this review revealed 4.9 new HIV diagnoses per 100,000 people in 2022. Still according to the PHAC, men who have sex with men (MSM) represent 51.1% of new cases recorded. .
A small handful of articles were published last February about this situation described as “alarming” in Quebec daily newspapers, each highlighting the opinion of experts according to which more should be done in terms of education, awareness and HIV prevention. Since then, however, nothing more… This important file seems, once again, to have quickly fallen into oblivion.
As a clinical nurse, I am challenged by these figures, but especially by the discourse surrounding this public health issue, and they encourage me to question myself differently. Some actors who have spoken out on the issue emphasize the lack of prevention campaigns regarding this chronic disease, while others maintain a moralizing discourse regarding the use of condoms, although it has been shown that this approach alone is not very effective in changing people’s behavior. On the other hand, the more encouraging discourse on HIV pre-exposure prophylaxis (PrEP) seems to occupy an increasingly predominant place in the political arena with regard to possible means of prevention.
However, although this treatment option is established, factors determining its accessibility and MSM’s willingness to use it must be considered.
PrEP has been around for a dozen years now and studies are categorical: it is an effective preventive method that significantly reduces the risk of HIV transmission when used correctly. According to the National Institute of Public Health of Quebec, studies show risk reduction rates of up to 92%.
Based on my observations and research carried out in clinical, academic and personal contexts, however, I have a growing concern with regard to the “community” stigma faced by MSM, which influences the extent to which they consider using or no to PrEP.
Whether through direct peer interactions or through dating apps such as Grindr, Scruff or Tinder, many MSM, both PrEP users and non-users, engage in hostile behaviors and stigmatize each other. . For example, some mistakenly believe that PrEP encourages behaviors deemed “irresponsible” and that this therapy should only be used by people involved in sex work.
Some men are actively discouraged, even ridiculed or blamed, from using PrEP. On the other hand, other interlocutors are tired of being refused a potential meeting on the pretext that they do not take this molecule and express the desire to take this treatment in order to increase their chances of meeting sexual partners.
At the same time, there is also stigma induced by healthcare professionals themselves, including doctors and nurses. Indeed, many MSM report facing barriers when trying to obtain PrEP. An American study published in Health Expectations in 2022 by Alt and colleagues also pointed out that it can be very complex for MSM to find health professionals (especially in rural areas) who have a deep, current and non-judgmental understanding of prevention of HIV-AIDS and available modern pharmacological options such as PrEP.
As a nurse and student researcher, I see the extent to which MSM find themselves caught in a set of complex community and systemic dynamics that have a determining impact on the acceptability and accessibility of PrEP. We must recognize the importance of these sociocultural aspects and their potentially stigmatizing effects if we want to maximize its effectiveness in HIV prevention.
Given the seriousness of the public health implications, we cannot afford to let the dust settle on the PHAC report and relegate this issue to the background of government priorities.
It is imperative to continue efforts to demystify and make treatment modalities like PrEP accessible. Likewise, we must continue efforts to raise awareness among the population and stakeholders in the health network with regard to the experiences of stigmatization experienced by MSM regarding the taking or not of this contemporary and effective preventive treatment.