Alexander Tsang, a third-year Sauder student, started using PrEP in summer 2020 after a Grindr hookup.
“It was pretty sketchy,” he recalled of the hookup.
Tsang, who is from Vancouver, said he contacted a few clinics around the city before he was able to get on PrEP through the BC Centre for Disease Control (BCCDC).
“It was hard to find the right people. But eventually, the people that I did contact sent me to the correct places.”
For Tsang and many other Queer people who have sex with men, taking PrEP is a way for them to feel safer when hooking up.
“I feel pretty liberated,” Tsang said. “Because we have a whole generation of gays that are dead [because of HIV]. I don’t actually have to suffer that.” He has since stopped taking PrEP because he is now in a monogamous relationship.
PrEP, or HIV pre-exposure prophylaxis, refers to any drug that reduces one’s risk of contracting HIV, said Dr. Mark Hull, a UBC clinical associate professor and research scientist at the BC Centre for Excellence in HIV/AIDS (BCCFE). In BC, the most common form of PrEP is Truvada, although other medications are available through private insurance.
The BCCFE, which operates out of St. Paul’s hospital in downtown Vancouver, oversees the distribution of PrEP across the province. According to a BCCFE report, 4,299 people were taking PrEP in BC in the second quarter of 2022.
Under current BCCFE guidelines, PrEP is primarily recommended for three groups of people — men who have sex with men (MSM), those who have a partner recently diagnosed with HIV and Transgender women — who are considered at high risk of HIV acquisition. The BCCFE considers having condomless anal sex, along with other conditions like scoring a 10 or higher on the HIV Incidence Risk Index for MSM, as indicators of high risk.
Hull, who helps oversee the BCCFE’s guidelines, added that other people who are at risk but don’t fall under the three listed groups can still get on PrEP in some cases.
“There’s an option to apply to the provincial program with your doctor who assesses and feels you’re at risk for your type of exposure,” he said.
Barriers to access exist
Like Tsang, Rafsun, an international masters student studying forestry, said it took him a while to find a provider. His name has been changed since he is not out to everyone in his life.
Rafsun said he spent two years trying to get on PrEP in Canada, but admitted he wasn’t trying too hard during that entire period.
He said part of the challenge was not knowing if he was even able to get on PrEP as an international student.
In BC, PrEP is free under the Medical Services Plan (MSP) — something which is unique to the province, Hull said. International students are covered under MSP, although it takes three months for coverage to begin.
Hull acknowledged that international students might face an extra barrier when trying to get on PrEP.
“Depending on their status, it does get a little bit more tricky to figure out,” he said, adding that international students not covered under MSP could try going through a privately-funded provider.
Another challenge for Rafsun was finding someone to provide PrEP for him.
“Every time I called UBC Hospital or anywhere I go, they [couldn’t] really guide me where to go. So it was really confusing,” Rafsun said.
He said he called UBC Student Health three times in the past year to get STI tested — a BCCFE requirement to get on PrEP — but that the staff just “said some general answers and didn’t really send [him] anywhere specific.”
“I just thought that UBC Hospital would be providing PrEP because at least my undergrad school [in the US] used to,” he said.
In a written statement sent to The Ubyssey, UBC’s Chief Student Health Officer Noorjean Hassam wrote that UBC Student Health provides PrEP to students on a case-by-case basis.
“Student Health Services believes PrEP is important to provide and will work with students individually to determine if it is an appropriate course of action for them,” she wrote.
Feeling PrEPared
Rafsun eventually got on PrEP earlier this month after a friend told him about the Boulevard Youth Clinic, an STI clinic in Vancouver, in January. He went to the clinic where a doctor helped him complete the necessary STI tests and blood work.
“The doctor was really supportive … by making sure that I had the points [of information] to get the PrEP,” he said.
A couple weeks later, Rafsun was able to pick up his prescription from the pharmacy at St. Paul’s Hospital downtown — although he said this also could be a barrier for students.
“I guess it makes sense,” he said, noting that St. Paul’s is near Davie Street, a historically 2SLGBTQIA+ neighbourhood. “But also it’s so far from UBC and other places.”
“I prefer there be more providers for sure.”
Due to limited provincial funding, Hull said the pharmacy at St. Paul’s is essentially the only PrEP provider in the city of Vancouver. But, he said the program can be flexible.
“If you identified a local pharmacy that was more convenient for you — especially if you live further out from downtown — then they make a lot of effort to try and send it to your community pharmacy,” he said.
When asked if the BCCFE had considered working with UBC Hospital or the Shoppers Drug Mart on campus to provide students with PrEP, Hull said the centre would be willing to do so, but that he doesn’t think a conversation has happened yet. Hassam did not comment on this in her written statement.
Regardless of the challenges, Rafsun said he feels safer going into hookups now that he is on PrEP. He and Tsang said they both believe people who are eligible under the BCCFE guidelines and are sexually active should consider taking it.
“The pros just outweigh the cons so much,” Tsang said. “So final conclusion: get on it.”
This article is from Reclamation, The Ubyssey's 2023 sex and relationships issue. Read more personal essays and student stories from Reclamation here, and sexual health and education articles here.