NEW HIV STRATEGY NECESSARY
More than 150 doctors, nurses, social workers, and government officials gathered in Saskatoon on Tuesday to brainstorm new ways to address Saskatchewan’s HIV crisis. Reporter Jonathan Charlton spoke with Dr. Kris Stewart, who’s involved in the treatment o
Q Who do you treat? A Many of the people I see are from the inner city or they’re from rural and remote communities, some people from reserves.
Q The previous provincial HIV plan ended in 2014. Have you noticed any challenges since then?
A I think the province’s early experience with HIV was really concentrated within the cities, and the strategy did a very good job, in my opinion, of improving diagnosis, treatment, and we see the benefits of that in terms of decreases in HIV-related acute care costs and improved numbers in terms of CD4 (white blood cell) counts and numbers of people suppressed.
The challenge, however, has been new infections popping up in remote communities around the province, and that poses a huge challenge. Whatever we’re able to do here, we need to be prepared to do it all over the province. And that’s hard because there are small numbers of cases in many, many places.
Q So are we looking at the same strategy on a smaller scale, or multiple different strategies?
A I think the fundamentals are the same but we have to be very sensitive to the needs of the community. One of the major barriers to our success is the stigma related to HIV. We can’t just walk into a community and expect people to come and see us. The lack of anonymity and people’s concern about no confidentiality can keep them out of care. So we have to really engage the elders and the social services network within that community if we’re going to be successful.
Q Why has that stigma been so stubborn?
A I think it’s a complicated question and I don’t know the answer for sure. But people associate HIV with sexual behaviour and although people engage in sex, they don’t like to talk about it. And so that remains a huge challenge for us to be able to normalize discussions about sexuality and prevention.
Q Injection drug use is generally one of the primary risk factors for HIV transmission. Is that the same in smaller communities?
A It is. We still see the majority of cases in the province are injection drug use, and that includes many communities. What I’m seeing, however, outside the city, is more heterosexual transmission. This is a major concern because that’s a large group of people. Injection drug users are a small group of people who have a very high risk; and heterosexual transmission are a large group of people with a lower risk. But it’s a little bit harder for us to focus our efforts to prevent transmission in that community. It’s a different message and it’s in some ways a bigger challenge.
Q What do you hope is going to come out of this meeting?
A I hope that we have some concrete plans for the future. I think our success is going to be measured by our responsiveness to the needs in the community. We need to identify where we’re not being successful and then shift resources, and if necessary make more resources available.