Download HIV Strategy Coordinator - McMaster University`s Faculty of Health

HIV/AIDS in First Nations
in Saskatchewan
Marlene Larocque BSW, MPH
Aboriginal Health Sciences
McMaster University
February 1, 2013
Agenda
 Introduction Activity
 HIV Basics
 Aboriginal People and HIV in Canada
 Reflection on the Readings
 Treatment, Adherence, Side Affects
 Ethics and Disclosure
 Overview on Current HIV profile in SK
 A closer look at HIV in Saskatchewan
 Discussion, Q/A
Basic Facts about HIV
 Human Immunodeficiency Virus: weakens the immune
system
 Transmission: blood born virus
 HIV can lead to AIDS (Acquired Immunodeficiency
Syndrome) if left untreated and can lead to acquiring with
an opportunistic infection
 The number of people living with HIV in Canada (including
AIDS) continues to rise, from an estimated 64,000 in 2008
to 71,300 in 2011 (an 11.4% increase). PHAC 2011.
HIV Transmission
HIV Transmission
 Transmission: shared/dirty IDU, unprotected sexual
contact with someone who is HIV positive (heterosexual
and MSM)
 HIV is present in 5 bodily fluids: semen, vaginal fluids,
anal fluids, blood, breast milk
 HIV can only be spread when one of these fluids from a
person with HIV gets into the bloodstream of another
person - through broken skin (SK Provincial Leadership Team)
Living well with HIV
 There is currently no cure for HIV; but there is treatment,
living with HIV requires lifelong clinical management and
wellness support
 HIV+ women can have healthy, HIV- children providing
they are under medical supervision
 Improvements to HIV treatment and medications means
fewer pills and increased life expectancy (side effects)
 Unknown is the impact of years of medication on the body
(bone density, cancers, dementia, liver and kidney
functions, etc.)
HIV/AIDS: Aboriginal Peoples in Canada
2011
 Estimated that 390 new HIV infections occurred in
Aboriginal people in 2011 (12.2% of all new infections) vs.
approx 420 new infections in 2008 (12.6% of all new
infections in 2008).
 Infection rate 3.5% higher in First Nations, Inuit and Métis
when compared to non-Aboriginal counterparts
• Summary: Estimates of HIV Prevalence and Incidence in
Canada, 2011 Public Health Agency of Canada
Exposure to HIV Comparison between
Aboriginal/non-Aboriginal in 2011
 Aboriginal
 IDU 58.1%
 Heterosexual 30.2%
 MSM 8.5%
 IDU-MSM 3.1%
 Non-Aboriginal
 IDU 13.7
 Heterosexual
 Endemic 20.3%
 Non-Endemic 20.1%
 MSM: 46.6%
Summary: Estimates of HIV Prevalence and Incidence
in Canada, 2011 Public Health Agency of Canada
Journal Articles
 “AIDS
is Something Scary”: Canadian Aboriginal Youth and HIV
Testing (Mill, J.E.Wong,T. Archibald, C. Sommerfeldt, S.Worthington, C. Jackson,
R. Prentice,T. Myers,T. 2011) Pimatisiwin: A Journal of Aboriginal and
Indigenous Community Health 9(2) 2011
 Social Exclusion as an Underlying Determinant of Sexually
Transmitted Infections among Canadian Aboriginals (Wynne and
Currie, 2011) Pimatisiwin: A Journal of Aboriginal and Indigenous
Community Health 9(2) 2011
 Strengthening Community-Based Approaches to HIV/AIDS & STI
Screening,Treatment & Prevention among Atlantic First Nations
People Steenbeek; Amirault; Saulnier; Morris (2010) Canadian Journal of
Aboriginal Community-based HIV/AIDS Research
 Addressing HIV/AIDS among Aboriginal People using a Health
Status, Health Determinants and Health Care Framework: A
Literature Review and Conceptual Analysis Nowgesic (2010) Canadian
Journal of Aboriginal Community-based HIV/AIDS Research
Themes from the Articles
 Disparities in Health Status (elevated STI’s, chronic






conditions, injuries, suicide,
Access to Health Services: delayed testing and
diagnosis, time from diagnosis to care, treatment in
medical facilities
Education Levels and knowledge about health (low
screening, wait for signs of illness)
Barriers: Confidentiality, attitudes towards sexual
health, transportation,
Mental/emotional wellness: abuse, assault, violence,
poverty, isolation
Risk-taking, Social networks
Urbanization, racism
Structural Inequities
 Colonization (social disruption)
 Cultural Continuity (western and
traditional conceptualization of health and
wellness)
 Access to Health Services (holistic,
accessible, culturally competent care)
 Health Policy for First Nations in particular
 Geography (rural/remote location)
 Self-Determination / community control
 Poverty (depth and scope of material
poverty)
HIV rates in Saskatchewan 20012011
HIV by Self-Reported Ethnicity (2001-2010)
HIV Cases by Self-Reported Ethnicity in Saskatchewan,
2001 to 2010
180
160
Number of Cases
140
120
100
80
60
40
20
0
2001
2002
2003
2004
2005
2006
2007
Year
Aboriginal
Non-Aboriginal
2008
2009
2010
Selected Risk Factors 2001-2010
Number of HIV Cases per Selected Risk Factors,
Saskatchewan 2001-2010
180
160
140
Number of cases
120
100
80
60
40
20
0
2001
2002
2003
2004
Total MSM
2005
2006
Total IDU
2007
Heterosexual
2008
2009
2010
Overall Objectives: Saskatchewan HIV
Strategy 2010 to 2014
 Decrease the number of new HIV
infections
 Improve the quality of life for
infected individuals
 Reduce the risk factors for
acquisition
Saskatchewan HIV Strategy, 20102014-Four Pillars
 Community Engagement and Education (to reduce risk
and reduce stigma)
 Prevention and Harm Reduction (to promote safer
behaviors)
 Clinical Management (patient first approach)
 Surveillance and Research (understand disease
characteristics to inform treatment plans)
Positive Voice Stories
Social Determinants of
Health
Broader Determinants
 Poverty
 Education
 Racism
 Employment
 Addictions
 Access to health services
 Colonization
 Housing
 Culture
 Gender
 Early childhood
development
 Coping Skills
 Social disruption
 Residential School
 Geography
 Inter-generational
impacts
HIV Testing/ Results
Three C’s of HIV testing
 Pre/Post Test Counselling (risk factors, window period, when to
pick up results, risk reduction, legal and ethical obligations, link
into care/community services)
 Consent (cannot be coerced)
 Confidential (results will not be shared with the public)
 HIV is a reportable infection (for surveillance)
 Contract tracing (confidential and original case not revealed)
 Age, location, gender, risk factors
 HIV Testing in Canada is opt-in (must request)
 Pregnant women with high-risk behaviour are opt-out
 A blood test is the only way to know for sure if an individual has
HIV (can live without symptoms for months/years)
2 types of HIV tests in Canada
Standard Testing
Point of Care (RAPID)
 Results in 7-10 days
 Results in minutes
 Blood Test
 Finger prick
 Detects HIV
 Detects HIV antibodies
antibodies
 No confirmatory test
 Results
 Results
 Positive
 Negative
 Preliminary positive
 Preliminary negative
 Unknown
 Must be confirmed though
a standard test
Additional Tests
 A + HIV result only detects HIV antibodies; need the
full picture of HIV to determine options and a treatment
plan
 More blood work: determine cd4 count (strength of
immune system) and viral load (amount of HIV virus
in your blood), check for STI’s, HCV, TB, etc
 Co-Infection and treatment of co-morbid conditions
 Infectious Disease Physician recommends a
treatment regime with patient participation and
monitors the numbers over time
Adherence
 Adherence is sticking to your drug schedule. It is
very important because even missing pills
occasionally can sabotage long-term success in
using anti-HIV drugs. Managing your health, page 137
 Improved drugs reinforce improved adherence to HIV
medications
 A good relationship and support from ID physicians,
pharmacists, social worker, spiritual care provider,
family, partners, Nurses can facilitate adherence
Side Effects of antiretroviral therapy
 ‘Usually’ last 4-8 weeks
 Both long and short term side effects
 Nausea, diarrhoea, vomiting, sleeplessness, fatigue, weight loss, fat

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


redistribution, loss of appetite, headaches, decreased bone density
HIV + individuals might throw away meds
Absorption of medication is compromised
Mental wellness: fear, stigma, unknown future, job, financial
insecurity, stress
Social support, nutrition, clean water
Keeping a diary/journal to record health (CATIE)
Resistance to HIV medications
 At the base of drug resistance is the fact that HIV is a little
sloppy about making copies of itself. The new copies often
contain changes, called mutations. These small changes in the
genetic material of the virus result in changes to the way the
virus is put together. Some mutations may allow the virus to
replicate even when antiretroviral drugs are being used. This
ability to replicate in the presence of antiretroviral drugs is
called drug resistance.
 Resistance to one drug can cause cross-resistance to
other drugs in the same class, even if you haven’t
taken those drugs before.

A Practical Guide to HIV Drug Treatment, page 91
Ethical Disclosure
 Ethical considerations of who/when to tell (partner,
family, co-workers, employers, etc)
 Legal obligations R vs. Cuerier, to inform sexual
partners if there is ‘significant risk’ , but a gap remains
about the use of condoms during intercourse
 Dating and having HIV is sensitive and scary
 First Nations: benefit through SA, but must disclose
status to the SA worker
Emerging Themes/Considerations
 On/Off Reserve health

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


care delivery and
protocols
Co-Infection (TB, HCV)
chronic conditions
Accurate data/ numbers,
age, gender
Point of Care Testing
Case management and
advocacy (social
determinants of health)
 Contact tracing challenges
 Disclosure and legal
obligations
 Education materials to
encourage awareness and
reduce stigma
 Community readiness and
capacity
 Unique characteristics of
each community
(leadership, location)
National HIV/AIDS Organizations
 Canadian Aboriginal AIDS Network
 Canadian AIDS Society
 Canadian Association of HIV Research
 CATIE Canadian AIDS Information Exchange
 Social Research Council (University of Toronto)
 Nine Circles in Winnipeg
 Provincial and Local AIDS Service Organizations
across the country (All Nations Hope, AIDS
Saskatoon)