Despite its proven biomedical efficacy, pre-exposure prophylaxis (PrEP) remains underutilized among Black immigrant communities in Canada. This commentary focuses on Black immigrants, including those of African, Caribbean, and other racialized Black (ACB) backgrounds—groups often collectively referred to as ACB communities in Canadian public health literature. Disparities in PrEP uptake among these populations are not rooted in individual disinterest but in intersecting structural, cultural, and systemic barriers, including racism in health care, immigration-related precarity, stigma, and gaps in culturally responsive care. While recent policy developments, such as Manitoba’s universal PrEP coverage and expanded access to HIV self-testing, reflect momentum toward more inclusive health care, Canada still lacks a coordinated national strategy to promote PrEP equity among Black immigrants. Drawing on global evidence, this commentary synthesizes reforms and scholarly recommendations from high-income countries, including the United States, United Kingdom, Belgium, Switzerland, and Australia, that have examined barriers to PrEP uptake among racialized and migrant populations and proposed equity-informed responses. We identify recurring strategies across individual, community, and system levels, including culturally anchored health education, peer-led outreach, provider training, and structural reforms to address stigma and institutional exclusion. Recognizing Canada’s decentralized health system and Black immigrants’ distinct challenges, the authors translate these lessons into actionable, context-specific strategies to guide provincial implementation. They also call for further research on how PrEP is understood and co-constructed across diverse subgroups, particularly among women, youth, and undocumented migrants. Achieving PrEP equity in Canada requires urgent, coordinated action grounded in public health justice, intersectionality, and meaningful community engagement.
Nyoni et al. (2026) studied this question.