I’m Pharmacy: Overcoming HIV stigma in health care

As a pharmacist working in central Ontario, Andrew Schonbe saw significant gaps in access to important HIV prevention and management medication. “I wanted to fill those gaps and ensure that individuals at risk or living with HIV could receive consistent access to care,” he said.

According to Canadian AIDS Treatment Information Exchange (CATIE) there were an estimated 63,1100 Canadians with HIV at the end of 2016 and about 14 per cent were unaware that they have HIV. Schonbe is now the owner of an Ontario-wide HIV clinic and pharmacy through which he leads a health team of nurse practitioners, sexual health counsellors and social workers. The PrEP Clinic offers both online and in-person appointments. “Through our work we help to educate individuals, encourage testing and we also connect people to prevention medication like PrEP,” said Schonbe. PrEP stands for pre-exposure prophylaxis and is a prescription medication typically taken daily to reduce the risk of acquiring HIV. “We also support some of the risk factors that may lead to HIV so having support from sexual health counsellors and social workers is important in this area.”

Overcoming stigma, barriers to care

Schonbe worked with a developer to launch a mobile HIV prevention app where patients across Ontario can access PrEP Clinic care directly from their mobile device. As an online portal, the app helps to overcome a number of known barriers to care. “If you’re in a region of the province where there is no access and you don’t have a family doctor, for example you can’t get started on PrEP. And there are certainly some marginalized communities that simply don’t have access and possibly face stigma and discrimination in access to appropriate care,” said Schonbe. Some members of the LGBTQ community may be at higher risk for acquiring HIV and when they seek out services they can be discriminated against based on their gender identity or sexual orientation. “This really impairs peoples’ ability to access care and feel comfortable reaching out to health care providers,” he said.

“My ultimate goal would be to get to a day where my service isn’t even required, where folks across Canada can access these services stigma-free, discrimination free and in a comfortable environment." 

The app provides a wide availability of video appointment times to make it easier for people to get in touch with a prescriber. When the patient is ready to start the medication they would then connect with Schonbe, review the medication, how to take it properly, navigate drug interactions and drug coverage, and manage potential side effects. 

A key challenge is reaching people in the community who are unaware that they have HIV and do not know where or how to get tested. In addition to the app, Schonbe is also committed to using social media to help build awareness. “I’ve done a lot of social media outreach over the years and I’ve connected with people who otherwise had no one to talk to or maybe didn’t feel safe talking to a health care provider. I’ve been able to answer questions and refer people to testing who maybe have never been tested,” he said. 

Schonbe also works to raise awareness about U = U, or undetectable = untransmittable, which means that someone living with HIV on effective treatment can actually have the virus under such control that it cannot transmit the virus to a partner. "This is very liberating for individuals living with HIV and also helps to educate the public to be aware of what the risk really is," he said.  

Recognizing the power of harm reduction

Not so long ago, Schonbe was unfamiliar with PrEP medications and admits he didn’t fully appreciate the power of harm reduction when it comes to patient care. “It took a little while for me to pick up and realize the importance of what harm reduction means. There’s a lot of stigma and people have a lot of misunderstanding about how beneficial these tools are for our patients’ health,” said Schonbe who describes his change in perspective as “a real 180” and has taken on providing education to other health providers in this area.

Looking to the future

Schonbe is driving toward a future where access to HIV testing and management is consistent and equitable. “My ultimate goal would be to get to a day where my service isn’t even required, where folks across Canada can access these services stigma-free, discrimination free and in a comfortable environment."