Trevor Stratton still remembers being chased out of a pharmacy last summer after unknowingly leaving without paying for his medication — only to learn later there had been no charge. Recovering from a seizure and confused about his coverage, Stratton called the encounter “disrespectful,” but familiar.
A member of the Mississaugas of the New Credit First Nation, Stratton has lived with HIV since 1990 and now works as an HIV activist and Indigenous health policy leader. He says Indigenous people are routinely scrutinized in pharmacies and clinics — followed, treated with suspicion, or turned away before they can access care. Over time, many stop seeking services altogether.
That reality, Stratton argues, is missing from Canada’s new national HIV-prevention guidelines, released Dec. 1, 2025, which urge providers to offer pre-exposure prophylaxis (PrEP) to anyone who requests it and to assess HIV risk during routine visits. Those assumptions — that people can easily reach clinics, understand PrEP, or regularly see a doctor — often don’t hold in Indigenous communities.
Indigenous people accounted for 19.6 per cent of new HIV diagnoses in 2023, despite making up about five per cent of the population. In parts of Manitoba and Saskatchewan, infection rates are three to four times the national average, said Sean Rourke of St. Michael’s Hospital and the University of Toronto.
While the guidelines warn against gatekeeping PrEP, Rourke said they stop short of outlining how to make it truly accessible amid entrenched barriers such as poverty, housing insecurity, mental health challenges and systemic racism.
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