Sonal Gupta
Local Journalism Initiative Reporter
Canada’s National Observer
Trevor Stratton recalls the day he wandered out of a pharmacy without paying last summer. The pharmacist chased him down and scolded him — only to later confirm there had been no charge at all. Stratton, who was recovering from a seizure and unclear on his medication coverage, describes the experience as “disrespectful,” but also painfully familiar.
A member of the Mississaugas of the New Credit First Nation, Stratton is an HIV activist diagnosed with the virus in 1990. He serves as a board member for the Canadian Foundation for AIDS Research and as the Indigenous leadership policy manager for Communities, Alliances and Networks.
Experiences such as his, he said, are common for Indigenous people who face increased scrutiny in pharmacies and clinics. Many are shadowed in the aisles, treated with suspicion or ordered to leave before they can even speak with a pharmacist. Some are barred altogether because they were once confused, unwell or simply didn’t “look right” to staff. Over time, people stop seeking care — a pattern that he says lies at the heart of why Canada’s new national HIV-prevention guidelines fail to reflect the realities of Indigenous communities.
The new guidelines released on Dec. 1, 2025 in the Canadian Medical Association Journal urge providers to offer pre-exposure medication, known as prophylaxis or PrEP, to any adult or teen who requests it, and to assess HIV risk during routine health visits. But those assumptions — that people can get to clinics, understand what PrEP is or even regularly see a doctor — do not hold true in many Indigenous communities, Stratton said.
Indigenous people made up 19.6 per cent of new HIV diagnoses in 2023 where race was recorded, despite representing just five per cent of the population.
Infection rates in some Indigenous communities in Manitoba and Saskatchewan have risen to three or four times the national average, said Sean Rourke, a scientist with the MAP Centre for Urban Health Solutions at St. Michael’s Hospital and a professor at University of Toronto.
He said while the guidelines clearly advise against gatekeeping PrEP, they could have gone further to spell out steps for improving accessibility. He added the crisis is deeply baked into long-standing structural issues — poverty, housing insecurity, mental health issues and systemic racism — that keep Indigenous people from clinics — even when prevention tools are technically available, Rourke added.
Indigenous women, who account for nearly half of all cases in their communities, remain largely unfamiliar with prevention tools. “If you ask Indigenous women, ‘What is PrEP?’ They have no idea,” said Stratton.“That information isn’t getting to our people because it’s packaged in a way that’s perfect for gay white men to take up.”
He pointed out that the transmission patterns in Indigenous communities differ from those cited in the guidelines. Data from community organizations that show that, in Indigenous communities, HIV is most often transmitted through injection drug use, followed by heterosexual contact. Cases involving same-sex relationships among men come third — a pattern that differs from national trends, which estimate that the majority of transmissions occur among gay, bisexual and other men who have sex with men, followed by people who inject drugs.
Stratton said language itself remains a major barrier to HIV prevention in Indigenous communities, specifically when they speak English as a second language. He said terms like “pre‑exposure prophylaxis” or “PrEP” mean nothing in many Indigenous languages and even in English sound overly clinical.
Advocates and experts say that beyond mainstream messaging, that’s where community-led efforts are needed.
Rourke said in areas with limited medical access, expanding digital options and engaging Elders and knowledge keepers who can share HIV-prevention tools will be key to reaching those most at risk.
Indigenous‑led programs and peer‑led networks are some of the most effective ways to reduce risk and support people who use drugs, Stratton said. These initiatives rely on relationships built through community credibility, using lived experience to normalize safer drug use, encourage testing and reduce stigma around HIV.
He pointed to an example of “Chuckie,” an Indigenous man from Thunder Bay, Ontario, who distributed sterile injection supplies in his building. Chuckie, he said, helped make needle sharing unacceptable among residents and reduced the risk of new HIV infections in his community — until his death from toxic drugs during the COVID pandemic. “We need money for that. We need to pay the Chuckies of this world, the ones that they will trust,” he said.
But programs like these remain chronically underfunded, Stratton said.
Some other successful initiatives have already disappeared. Canada’s national HIV self-testing program, I’m Ready, which reached more than 100,000 people (many of them first-time testers in high-risk communities), shut down in March 2024 after federal funding ended. “We had real-time data showing its impact,” Rourke said. “And then, it just stopped because of funding cuts.”
He said broader change will require sustained national advocacy and political will. Ongoing disputes between provincial and federal governments over cost-sharing continues to stall progress. “It’s a cop-out when governments pass the buck,” he said. “Both federal and provincial leaders need to step up — especially when we know these programs save lives and money.”
Sonal Gupta / Local Journalism Initiative / Canada’s National Observer.
