Community collaboration key to combating province’s HIV problem
After getting involved in a program called Know Your Status, which was developed by Big River First Nation in 2010, Dr. Stuart Skinner saw the importance of collaboration when it comes to battling the HIV problem in Saskatchewan.
“I think it’s really important to partner with communities and have them lead the way in terms of the programming that they know will work best for the people in that community,” said Skinner, a University of Saskatchewan clinician and researcher.
Know Your Status is more of a concept than a program, said Skinner, who visits 11 different outreach sites, including rural communities and First Nations, to help implement the approach.
It helps communities develop programs related to HIV and Hepatitis C in a way that combines the strengths of western medicine with traditional and cultural approaches and makes treatment and care as accessible as possible.
“I believe in that holistic approach, the medicine wheel,” said Skinner. “If we’re going to try and work towards health and wellness for First Nations people, all those other areas around culture and spiritual and mental health is really critical.”
Saskatchewan HIV infection rates in 2016 — the most recent available data — were more than 10 times the national average in some areas and nearly 80 per cent of people with HIV in the province are Indigenous.
In December 2017, Skinner received a $2-million grant from the Canadian Institutes of Health Research to refine and expand Know Your Status.
It involves close to 50 scholars, clinicians, policy-makers and knowledge users and “nearly half the participants are Indigenous community members, chiefs, and people who’ve experienced the infections” according to the Uofs.
To be used over five years, the program is still in its early stages as Skinner and others work through developing what they hope some of the key outcomes will be.
The grant will allow for the implementation of the approach into six new communities, and expand it where it’s already in place to include things such as mental health and addictions programming.
“It’s two pieces: to expand the concept and individualize it to each community,” he said. “It’s not a cookie-cutter approach. Every community is different and unique, and the challenges and barriers are different and unique.”
Since the beginning of Know Your Status in 2010, Skinner said he has seen the difference it can make. “The number of people who are accessing care and able to access testing has significantly increased,” he said.
The communities that have had the Know Your Status approach the longest are seeing 90-90-90 indicators, which means 90 per cent of people are being diagnosed, 90 per cent of those diagnosed are receiving treatment, and 90 per cent of those receiving treatment have an “undetectable viral load,” said Skinner.
He said he has also seen the stigma and fear surrounding HIV decrease in the communities he has worked in.
“The biggest challenge is still around access to mental health and addiction programs and services,” said Skinner, adding that a lot of HIV in Saskatchewan relates to underlying risk factors.
While Know Your Status doesn’t just impact Indigenous communities, Skinner said the work they are doing with First Nations is being done in what he feels is the true spirit of reconciliation.
“The incredible work happening in so many First Nations is amazing, considering all the challenges, and the feedback for me has been really positive,” he said.
“The support they provide me in many different areas is tremendous, and I’ve certainly made a lot of friends. There are really good relationships that have been developed.
“From a health-care standpoint we can have a significant impact. I’ve seen the success, and so that just motivates me more.”
In February, the Saskatoon Tribal Council, Ahtahkakoop Cree Nation, and Big River First Nation are hosting the second annual Know Your Status forum in Saskatoon.
The event will offer a Speaking From the Heart workshop for Indigenous people living with HIV or hepatitis C who would like to share their stories.