Sexually active people urged get tested, regardless of risk
Nearly 80 per cent of the new HIV infections in the province involve Indigenous people.
That’s a statistic Nicolay hopes to change.
She works on a project called the Wellness Wheel. The mobile clinic provides primary and chronic disease care to residents of 12 First Nations communities, and has connections with eight others.
Despite the epidemic, HIV has been put on the back burner, Nicolay said.
“If we were seeing significant increases in certain populations of other disease processes, I think we would see a different response,” she said. “I think there is a lot of stigma in the way that people acquire HIV, there’s a lot of blame that goes with that.”
“There’s a tremendous undercurrent of racism that exists in systems for sure, on the ground and with the public in general,” she continued. “That’s part of it.”
Nor do we talk enough about HIV, so people don’t realize HIV is a chronic, manageable disease now, Nicolay said.
She’s also concerned health-care providers don’t offer the test routinely. “They’re going to look at someone and say, ‘You look a certain way’ or ‘You have track marks’ or ‘You live in this part of the town’ so we may or may not offer testing based on our visual assessment of you,” Nicolay said.
She believes there are multiple reasons why the HIV rate started climbing in Saskatchewan in the early 2000s, including injection drug use.
“We can’t escape that,” Nicolay said. “But that’s not to lay blame on people who use substances and it’s not to single them out as if it’s their fault in any way. We all bear responsibility as far as I’m concerned.”
The drugs of choice changed in the early 2000s from morphine, talwin and Ritalin to powdered cocaine, which was cut so people were using many more times a day to maintain the level of drug in their system.
Most times people don’t believe they’re sharing contaminated drug equipment, but “in the wee hours of the morning, you might grab the wrong needle, you might grab the wrong cooker — it all looks the same, there’s no way to tell one from the other,” Nicolay said.
The clinics are developed in partnership with local First Nations communities and leaders.
“We reinforce the idea that access to HIV care is not an enigma, this is part of the work that we do on a regular basis and if we work with them and are led by the community to do the work around HIV that we won’t abandon them,” Nicolay said.
Those testing positive for HIV at the mobile clinic aren’t referred to Regina, Saskatoon or Prince Albert.
“We’re going to come back, we’re going to draw your blood, we’re going to link you with a provider in your community, if that’s what you want,” Nicolay said. “We’ve got a pharmacist who can talk with you, so we try to make all of that care seamless for them in a way that works for them on the ground in the community.”
At every opportunity, she talks with community members about being tested for HIV and hepatitis C.
Testing is recommended for everyone over the age of 13 who has ever been sexually active, regardless of risk, she said.
“I don’t care if you’re married, don’t care if you’re monogamous, don’t care if you’re an injection drug user but haven’t done that for 10 years,” she said. “We’ve levelled the playing field and we want to offer that to everyone at least every five years on a routine basis, because HIV is a chronic disease.”
Despite advancements around treatment and testing, the stigma associated with having HIV remains.
Vidya Reddy believes stigma is partly why people resist getting tested. Reddy is an education and information specialist with AIDS Programs South Saskatchewan (APSS), a non-profit organization based in Regina that is primarily involved in HIV prevention.
“Today, the treatments that are available have changed the prognosis for this particular diagnosis and it’s managed more like a chronic disease, more like diabetes or hypertension,” Reddy said. “People diagnosed with HIV can lead a very normal life and, with simple precautions, the chances of them spreading the disease can be zero.”
Aside from promoting awareness about the need for prevention, such as using safe injection supplies and condoms and practising safe sex, it’s important to ensure people know their HIV status, he said.
“If it’s positive, get on treatment as soon as possible,” Reddy said. “That cannot only have a positive impact on the health of a person diagnosed with HIV, but it can also help prevent the spread of HIV to other people in the community.”
“Here in Saskatchewan, about 60 per cent of people diagnosed with HIV each year report injection drug use,” Reddy said. “That’s where community-based organizations like APSS come in. We distribute more than 1.4 million new needles and injection supplies each year.”
The organization also collects more than 1.3 million needles from Regina and the surrounding area yearly.
To prevent a further escalation of this “Saskatchewan-specific crisis,” highly targeted, focused prevention initiatives are needed.
“Especially in the hot spots in Saskatchewan like the Kamsack area and the surrounding First Nations communities,” Reddy said.
The Saskatchewan Health Authority is providing resources for hot spots, but communities must work at raising awareness and reducing stigma, he said.
“They need to help people in their own communities, because the resources are available.”
In an emailed statement, Indigenous Services Canada said: “It is important to note that this strain of HIV can be treated with antiretroviral therapy and the transmission can be prevented just as effectively as other strains, which reinforces the importance of prevention, early diagnosis and early treatment of Hiv-infected persons.”
If strains of HIV further mutate, the implications are bad, not just for Saskatchewan but for the rest of Canada, Reddy said.
“Whether it’s these new strains or the old existing strains, prevention is the key,” he said. “It’s important that we get a grip on the rates of infection we have in Saskatchewan right now. We are just desperate to make a change.”