A recipe for increasing racial and gender disparities in HIV infection: A critical analysis of the Canadian guideline on pre-exposure prophylaxis and non-occupational post-exposure prophylaxis' responsiveness to the HIV epidemics among women and Black communities

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  • Additional Information
    • Affiliation:
      Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
      Center for AIDS Research, School of Medicine & Dentistry, University of Rochester, Rochester, NY
      Correspondence concerning this article should be addressed to, Ph.D., Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, ON M5B 1W8, Canada.
      Department of Health Sciences, Faculty of Science, Wilfrid Laurier University, Waterloo, ON
      School of Nursing, University of Ottawa, Ottawa, ON
      Ontario HIV Treatment Network, Toronto, ON
      Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON
      Washington, DC
      Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON
      Ottawa Public Health, Ottawa, ON
      Women's Health in Women's Hands Community Health Centre, Toronto, ON
      Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
      Department of Psychology, Faculty of Sciences, Wilfrid Laurier University, Waterloo, ON
    • Subject Terms:
    • Subject Terms:
    • Abstract:
      Clinical guidelines have emerged as an important tool for improving healthcare quality and controlling healthcare costs. However, they also have the potential to limit access to treatment and services for those who could greatly benefit. In November 2017, a clinical guideline for prescribing HIV pre-exposure prophylaxis (PrEP) was published in the Canadian Medical Association Journal. After careful review, we determined the current Canadian PrEP guideline is not wholly inclusive and lacks sufficient sensitivity for detecting HIV seroconversion risk in African, Caribbean, and Canadian Black (Black) communities, as well as women. In this article, we present several scenarios to illustrate how the Canadian guideline for HIV PrEP compromises patient-centered HIV prevention for Black communities and women and may imperil efforts to reduce HIV incidence in these communities. As it stands, the current PrEP Canadian guideline omits the behavioural, clinical, and social factors known to contribute to HIV risk, which also disproportionately affect Black communities. We recommend that healthcare providers, who opt to consult the guideline, exercise clinical discretion, and consider relevant contextual information about the patient presenting for care. However, for a greater impact, the existing guideline should be revised or supplemented with additional recommendations to ensure equitable access for all individuals who would benefit from PrEP.
    • Journal Subset:
      Biomedical; Canada; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed
    • ISSN:
      1188-4517
    • MEDLINE Info:
      NLM UID: 9516982
    • Publication Date:
      20190412
    • Publication Date:
      20190418
    • Accession Number:
      http://dx.doi.org/10.3138/cjhs.2018-0043
    • Accession Number:
      135797935
  • Citations
    • ABNT:
      NELSON, L. E. et al. A recipe for increasing racial and gender disparities in HIV infection: A critical analysis of the Canadian guideline on pre-exposure prophylaxis and non-occupational post-exposure prophylaxis’ responsiveness to the HIV epidemics among women and Black communities. Canadian Journal of Human Sexuality, [s. l.], v. 28, n. 1, p. 1–4, 2019. DOI 10.3138/cjhs.2018-0043. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=ccm&AN=135797935&custid=s6224580. Acesso em: 8 dez. 2019.
    • AMA:
      Nelson LE, James Ll, Coleman T, et al. A recipe for increasing racial and gender disparities in HIV infection: A critical analysis of the Canadian guideline on pre-exposure prophylaxis and non-occupational post-exposure prophylaxis’ responsiveness to the HIV epidemics among women and Black communities. Canadian Journal of Human Sexuality. 2019;28(1):1-4. doi:10.3138/cjhs.2018-0043.
    • APA:
      Nelson, L. E., James, Ll., Coleman, T., Etowa, J., Husbands, W., Lofters, A., … Wilson, C. L. (2019). A recipe for increasing racial and gender disparities in HIV infection: A critical analysis of the Canadian guideline on pre-exposure prophylaxis and non-occupational post-exposure prophylaxis’ responsiveness to the HIV epidemics among women and Black communities. Canadian Journal of Human Sexuality, 28(1), 1–4. https://doi.org/10.3138/cjhs.2018-0043
    • Chicago/Turabian: Author-Date:
      Nelson, LaRon E., Llana James, Todd Coleman, Josephine Etowa, Winston Husbands, Aisha Lofters, Marlon O. Mitchell, et al. 2019. “A Recipe for Increasing Racial and Gender Disparities in HIV Infection: A Critical Analysis of the Canadian Guideline on Pre-Exposure Prophylaxis and Non-Occupational Post-Exposure Prophylaxis’ Responsiveness to the HIV Epidemics among Women and Black Communities.” Canadian Journal of Human Sexuality 28 (1): 1–4. doi:10.3138/cjhs.2018-0043.
    • Harvard:
      Nelson, L. E. et al. (2019) ‘A recipe for increasing racial and gender disparities in HIV infection: A critical analysis of the Canadian guideline on pre-exposure prophylaxis and non-occupational post-exposure prophylaxis’ responsiveness to the HIV epidemics among women and Black communities’, Canadian Journal of Human Sexuality, 28(1), pp. 1–4. doi: 10.3138/cjhs.2018-0043.
    • Harvard: Australian:
      Nelson, LE, James, Ll, Coleman, T, Etowa, J, Husbands, W, Lofters, A, Mitchell, MO, Nguemo, JD, Nnorom, O, Oraka, C, Rana, J, Siddiqi, A & Wilson, CL 2019, ‘A recipe for increasing racial and gender disparities in HIV infection: A critical analysis of the Canadian guideline on pre-exposure prophylaxis and non-occupational post-exposure prophylaxis’ responsiveness to the HIV epidemics among women and Black communities’, Canadian Journal of Human Sexuality, vol. 28, no. 1, pp. 1–4, viewed 8 December 2019, .
    • MLA:
      Nelson, LaRon E., et al. “A Recipe for Increasing Racial and Gender Disparities in HIV Infection: A Critical Analysis of the Canadian Guideline on Pre-Exposure Prophylaxis and Non-Occupational Post-Exposure Prophylaxis’ Responsiveness to the HIV Epidemics among Women and Black Communities.” Canadian Journal of Human Sexuality, vol. 28, no. 1, Apr. 2019, pp. 1–4. EBSCOhost, doi:10.3138/cjhs.2018-0043.
    • Chicago/Turabian: Humanities:
      Nelson, LaRon E., Llana James, Todd Coleman, Josephine Etowa, Winston Husbands, Aisha Lofters, Marlon O. Mitchell, et al. “A Recipe for Increasing Racial and Gender Disparities in HIV Infection: A Critical Analysis of the Canadian Guideline on Pre-Exposure Prophylaxis and Non-Occupational Post-Exposure Prophylaxis’ Responsiveness to the HIV Epidemics among Women and Black Communities.” Canadian Journal of Human Sexuality 28, no. 1 (April 2019): 1–4. doi:10.3138/cjhs.2018-0043.
    • Vancouver/ICMJE:
      Nelson LE, James Ll, Coleman T, Etowa J, Husbands W, Lofters A, et al. A recipe for increasing racial and gender disparities in HIV infection: A critical analysis of the Canadian guideline on pre-exposure prophylaxis and non-occupational post-exposure prophylaxis’ responsiveness to the HIV epidemics among women and Black communities. Canadian Journal of Human Sexuality [Internet]. 2019 Apr [cited 2019 Dec 8];28(1):1–4. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=ccm&AN=135797935&custid=s6224580