The morning sun filters through the venetian blinds at the North End Community Health Centre in Halifax. Dr. Lisa Barrett gestures at the unopened boxes of PrEP medication stacked neatly in a storage closet. “Five years ago, we’d have had a waitlist for these,” she tells me. “Now we can actually meet demand, but that doesn’t mean everyone who needs this is walking through our door.”
I’ve traveled to Nova Scotia to see firsthand how Canada’s new HIV prevention guidelines are transforming care on the ground. Released in November 2025 by the Canadian Association for HIV Research (CAHR), these guidelines represent the most significant shift in our approach to HIV prevention in more than a decade.
“The message is clear—physicians should not be gatekeeping PrEP,” explains Dr. Barrett, an infectious disease specialist who contributed to the guidelines. “We’ve moved beyond asking ‘why should this person get PrEP?’ to ‘why wouldn’t they?'”
Pre-exposure prophylaxis, commonly called PrEP, is a medication regimen that, when taken regularly, is over 99% effective at preventing HIV transmission. First approved in Canada in 2016, access has been uneven across provinces, often limited by physician comfort, insurance coverage, and patient awareness.
Walking through the clinic’s waiting area, I notice educational materials in seven languages. A poster shows diverse faces—young and old, various ethnicities, genders, and relationship statuses. The caption reads simply: “Ask about PrEP today.”
The 2025 guidelines specifically address physician hesitancy, a factor that Public Health Agency of Canada research identified as a key barrier. According to their 2024 survey, 38% of primary care physicians reported discomfort discussing sexual health histories, particularly with patients outside LGBTQ+ communities.
“We’re finally acknowledging that HIV prevention isn’t just for certain communities,” says Jordan Sang, director of prevention at the Canadian AIDS Society. “Anyone who is sexually active could benefit from having this conversation with their healthcare provider.”
The guidelines specifically call for physicians to initiate PrEP conversations with all sexually active patients, not just those traditionally considered “high-risk.” They also emphasize simplified screening protocols and recommend against denying PrEP based on perceived adherence challenges.
In Vancouver’s Downtown Eastside, nurse practitioner Mandeep Kaur shows me a mobile health unit that provides walk-in PrEP consultations. “Before these guidelines, we had to document multiple risk factors before insurance would cover PrEP,” she explains while preparing for afternoon rounds. “Now we can prescribe based on a patient saying they want this protection.”
This represents a major philosophical shift. Previous approaches required healthcare providers to assess HIV risk based on detailed sexual history and behavior patterns—questions that many patients found invasive and stigmatizing.
The new Canadian model draws inspiration from Australia’s successful prevention program, which saw new HIV diagnoses drop by 42% between 2016 and 2022 after implementing similar access policies.
Dr. Sean Rourke, scientist with the MAP Centre for Urban Health Solutions at St. Michael’s Hospital in Toronto, emphasizes the financial case for expanded access. “Every prevented HIV infection saves our healthcare system approximately $1.3 million in lifetime treatment costs,” he notes. “PrEP pays for itself many times over.”
While the guidelines have been widely praised by advocacy organizations, implementation challenges remain. Provincial health plans vary in their coverage, with some still requiring quarterly HIV testing and regular physician visits that create barriers, especially for rural Canadians.
“I drive three hours each way to get to an appointment where a doctor will renew my prescription,” says Michel Tremblay, whom I meet at a community forum in Sudbury. “The medication is covered, but the time off work and gas money add up. These new guidelines sound great, but will they actually change anything for someone like me?”
Indigenous communities face additional challenges. In Norway House Cree Nation, Manitoba, health director Dayna Grieve describes efforts to integrate HIV prevention into existing community health approaches.
“We’re adapting these guidelines to honor our traditional understanding of wellness,” she tells me during a phone interview. “It’s not just about making medication available—it’s about providing culturally safe spaces where our people can discuss sexual health without judgment.”
The guidelines specifically acknowledge this need, including a section on culturally appropriate care developed in consultation with Indigenous health organizations across the country.
For younger Canadians, access has been simplified through virtual care options. Twenty-two-year-old student Alex Chen shows me the app on their phone where they schedule quarterly check-ins and arrange medication delivery.
“I found out about PrEP through TikTok, not my doctor,” they explain. “The guidelines are changing things for doctors, but honestly, most of my friends still learn about this stuff online.”
The new approach also emphasizes education for healthcare providers. Medical schools have been directed to incorporate comprehensive HIV prevention training, and continuing education credits are available for practicing physicians.
Dr. Barrett acknowledges there’s still work to do. “Guidelines are just words on paper until they change actual practice,” she says as we wrap up my visit. “But they give us something concrete to point to when advocating for our patients.”
As I leave the Halifax clinic, a young woman nervously approaches the reception desk. I overhear her ask, “I saw online you can get something here that prevents HIV? Can I talk to someone about that?”
The receptionist smiles and hands her an intake form. “Absolutely. The doctor will discuss PrEP with you today.”
It’s a small moment that encapsulates the vision behind Canada’s new guidelines: a future where HIV prevention becomes a routine, accessible part of healthcare for anyone who needs it.
