This province needs to get a grip on its anti-HIV strategy

PROVINCE by Geraldine Malone

Last month Saskatchewan’s deputy chief medical health officer Denise Werker, confirmed that two HIV-positive babies were born in the province in 2015. A third case is under investigation.

But given there had been no HIV-positive children born in the province in any of the last four years, the news is discouraging.

But not surprising.

Better But Not Great

Dr. Ryan Meili works at Saskatoon’s West Side Community Clinic and is one of the founders of the Saskatchewan HIV-AIDS Research Endeavour (SHARE).

“It’s disappointing and upsetting news but I can’t say necessarily that it was surprising news,” says Meili. “Those that are working with people with HIV in the province, and working with people at risk of HIV, recognize the problem certainly continues to exist. We continue to have high incidence rates and lots of people getting sick with HIV.

“The fact that we haven’t had positive babies for the last few years is more surprising than the fact that we have some now,” Meili adds.

In 2009, Saskatchewan’s HIV/AIDS rates were double the Canadian average. In response, the Province created the Saskatchewan HIV Strategy.

The strategy, which ran from 2010-2014, pushed for increased testing and better services to people with HIV. It included educational campaigns, and outreach to rural and indigenous communities.

The final report released last spring showed that the Regina Qu’Appelle Health Region saw a reduction of 435 hospital days for people with HIV and AIDS from 2011 to 2013. Which, not inconsequentially, saved the Region a pile of money — over $500,000 at an estimated average cost per day in hospital of $1,207.

“We know in Saskatchewan it costs upwards of $40 million a year just for acute care response to HIV,” Meili says.

The Saskatoon Health Region’s HIV 2013 special report showed that more people were getting tested for HIV than ever before and HIV-positive results were significantly down in high-risk populations. More HIV positive people were receiving medical care and treatments, which reduce the risk of transmission.

Between 2011 and 2014, prenatal testing increased by 51 per cent — which is critical, because when a mother is known to be HIV-positive she can be given drugs to prevent transmission of the virus to the baby.

“I think there is some reason to be optimistic that the incidence has dropped somewhat,” says Meili. “But it still continues to be a drop from ‘extremely high’ to ‘very high’. We still have incidence rates that are, rather than being triple the national average, more like double the national average. That’s a reason to be happy that things have gotten better, but not complacent.”

The HIV strategy expired and although there have been conversations, so far nothing has replaced it.

It’s Everyone’s Problem

The HIV epidemic hits society’s most vulnerable people the hardest. But at the same time, the number of people getting HIV through injection drug use is declining and those contracting it through sex is on the rise.

In fact, in 2013, more than 20 per cent of people infected with HIV got it through heterosexual sex — up from 13 per cent in 2009.

Overall, the percentage of aboriginal HIV positive individuals has decreased slightly since 2009, but the percentage of Caucasian HIV positive cases has increased.

“This is long been a disease of the “other” — starting with men who have sex with men and moving into populations using drugs and minority populations, so people have always been able to think of this as someone else’s problem,” Meili says.

“The more complacent we are that, ‘oh I don’t participate in those risk factors’, the more likely it is that we are not as careful as we should be — and it starts to get into the rest of the population as well,” he says.

According to the Public Health Agency of Canada, an estimated 21 per cent of the around 75,500 individuals living with HIV in the country are unaware of their infection.

There are major challenges when it comes to tackling the issue — including the concentration of health care services in urban areas and jurisdictional red tape between the federal responsibility on reserves and provincial health care everywhere.

But Meili is optimistic that means Saskatchewan’s experts and leadership can find innovative solutions.
“We could show the world that we are the people that have the minds and the history of taking on challenges like that,” Meili says. “Or we can be the people who said ‘oh yeah, we can’t really handle this. We’re just going to let it continue to smoulder and be a huge problem’, and hope someone else figures it out.

“I’d rather see us be leaders for the sake of the people I see every day in the clinic,” he adds.

In Saskatchewan there are 11.4 new infections per 100,000 people every year. On reserves, it’s 64. Rates are on the rise in Prince Albert, which, experts say,  took a step backwards by introducing a more restrictive needle exchange policy last year.

There are other pockets around the province with exploding numbers — specifically in the north, where there have been reports from the health regions of 12 to 24 new cases of HIV a year.

Meili (and the now-defunct Saskatchewan HIV strategy) suggest it’s time to adopt the 90-90-90 strategy, which came out of the UN AIDS initiative and has been endorsed by the United Nations and Canada’s federal health minister. Its goal is that by 2020,  90 per cent of people living with HIV will know their status, 90 per cent of those people will receive sustained antiretroviral therapy, and 90 per cent of those people will have viral suppression.

“It’s not an easy goal to achieve but it’s a clear and meaningful goal. Not having a goal in place means that we are just floundering or we are having the wrong things as our goal,” says Meili.

“We need to see a government commitment and some government action to follow up on that commitment,” he says.