Did you know Canada saw a 24.9% increase of new HIV diagnoses in 2022 over 2021? This rise in new cases has not been seen in over a decade. Freddie, Canada’s leading LGBTQ2S+ health provider of a wide range of services, was created to provide healthcare for a community that has traditionally been overlooked, stigmatized and marginalized. We chatted with Freddie chief medical officer Dr. Caley Shukalek to learn more about Freddie’s continued mission to improve sexual health through education, prevention and treatment without barriers for LGBTQ2S+ communities. —Noa Nichol
What inspired you to co-found Freddie, and how does its mission resonate with the LGBTQ2S+ community’s healthcare needs?
As a gay man, I knew that finding affirming and knowledgeable health care professionals was not easy. I also knew that my own experience in a city was likely to be better than it was in rural communities. As a physician, I have a passion for the health of the LGBTQ2S+ community and for sexual health. Knowing Husein [Dr Husein Moloo] in medical school, I understood and trusted his motives for founding PurposeMed and wanted to help him, Pete [MacLeod], and Amaan [Banwait] build Freddie to truly impact PrEP and sexual health access.
Can you share some insights into the unique challenges faced by LGBTQ2S+ individuals in accessing healthcare, and how Freddie addresses these challenges?
First of all, it can be challenging to find a primary care provider in Canada. We have a great healthcare system but it is far from perfect and access to primary care and sexual health is an issue. If you are fortunate enough to have primary care or access to another prescriber, you need to trust they won’t judge you based on identity or behaviours and you need to trust they have the right knowledge to provide exceptional care. Freddie means to put these kinds of providers – affirming, knowledgeable, and experienced – right at the finger tips of the LGBTQ2S+ community. We’ve also tried to make the process of getting care as efficient as we can.
With the recent surge in new HIV diagnoses in Canada, what role do you see Freddie playing in HIV prevention, care, and treatment within the LGBTQ2S+ community?
There is definitely an increase in HIV diagnoses in Canada but we’re seeing slight changes in who is getting diagnosed over time. While Freddie is certainly focused on the health of the queer community, we are here to help any and all persons who might benefit from PrEP (HIV prevention). Nevertheless, the queer community is still disproportionately affected, which is why services like Freddie and other affirming providers of HIV prevention and treatment are so important. Freddie has been piloting HIV care in a few provinces but we’ve been thoughtful about how we do this because we value high quality care and want to make sure we are doing as good a job, or better, than traditional HIV treatment programs.
Could you elaborate on Freddie’s approach to providing inclusive and non-judgmental sexual health services, particularly in destigmatizing HIV/AIDS and other sexually transmitted infections (STIs)?
We take a HIV status neutral approach at Freddie. This is something that was highly publicized from the New York Public Health Department, but the focus is on knowing your HIV serostatus and taking the appropriate steps from there. If a test comes back HIV seropositive, the focus is on connecting that person to ongoing treatment and care. If a test comes back HIV seronegative, the focus is on assessing behaviours and whether that person would benefit from PrEP (HIV Prevention). We have a similar view on STIs: the focus is on testing and knowing your status so that you can treat what can be treated and, if needed, prevent what can be prevented.
In what ways does Freddie leverage technology to deliver healthcare services, and how has this been particularly beneficial for LGBTQ2S+ individuals, especially those in remote or underserved areas?
Freddie uses the technology of our parent company PurposeMed, and some additional tools, to connect patients to prescribers and support staff so that health information can be collected and updated efficiently and so that communication is as easy as possible. There are still many health conditions where in-person care is required – like pneumonia – but PrEP can be safely delivered through virtual care and we have shown that over our almost 4 years of operations. We also understand that the discretion of being able to connect with a provider outside of your community is a positive for some people and technology enables that.
How does Freddie ensure that its services are culturally competent and sensitive to the diverse needs of the LGBTQ2S+ community, including those of different gender identities and sexual orientations?
Fortunately, we have an amazing team that includes many within the community who continuously provide education for our entire company. This means all persons who work with us, patient facing or not, receive training about our business and the importance of affirming care and interactions when they start and in an ongoing fashion. We also readily engage the community – our patients – to ensure we are doing the best we can. I’m proud of the effort that each and every staff member puts into meeting the diverse needs of the LGBTQ2S+ community and know they are doing their best in each and every interaction with patients.
As the landscape of LGBTQ2S+ healthcare evolves, what future initiatives or expansions do you envision for Freddie to better serve its patients and address emerging health concerns?
That’s a great question and I think the answer lies with our patients. My job is to ensure we can build a high quality clinical model to provide the care our patients request. As I mentioned, we are already piloting HIV treatment in some provinces and we offer several additional prescriptions to patients who are getting PrEP. Freddie also has siblings: Frida offers mental health care services and Foria provides gender affirming care. I know that we’d like to see Freddie, Frida, and Foria offering services across Canada and internationally but through our patient feedback I think there are many more things still to come.
Can you share a success story or milestone that Freddie has achieved in advancing LGBTQ2S+ healthcare, and how it reflects the organization’s commitment to its mission?
I think Freddie has had many success stories so far. We are Canada’s largest PrEP prescriber with the vast majority of our patients being first time users – meaning we are significantly increasing the use of PrEP across Canada and hopefully making a difference in reducing the spread of HIV. We have also created a library of health information tailored to the LGBTQ2S+ community that is available for all persons, whether they are a patient of Freddie or not. And through multiple instances of patient feedback, Freddie has also restored some individuals’ faith and trust in healthcare providers and the system as not completely ignoring the needs of the LGBTQ2S+ community.
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