General internal medicine's role in ending the HIV epidemic

The updated Canadian HIV Prevention Guidelines arrive at a pivotal moment as shifting epidemiologic trends and widening social inequities reshape HIV incidence in Canada. While men who have sex with men remain disproportionately affected, rising diagnoses among women and Indigenous peoples—particularly in Saskatchewan and Manitoba—underscore the roles of structural marginalization, syndemic health issues, and limited healthcare access. General Internal Medicine physicians frequently encounter seronegative patients with significant risk factors, positioning them as critical contributors to HIV prevention efforts. The new PrEP and PEP guidelines offer clear, pragmatic approaches to risk assessment, prescribing, and follow-up, emphasizing culturally safe, trauma-informed care, and the removal of gatekeeping to support patient-centred prevention. Implementing these recommendations remains a central challenge, yet General Internists are well placed to initiate prevention conversations, reduce stigma, and contribute to sustainable systems that expand equitable access to HIV preventive care.