As HIV cases rise across Canada, the numbers have stabilized in northwestern Ontario — for now

While there’s been a 35 per cent jump in human immunodeficiency virus (HIV) cases across Canada, the numbers have stabilized in northwestern Ontario — and health-care workers largely attribute it to harm reduction services available in the region.

The incident rate in the Thunder Bay District Health Unit’s (TBDHU) catchment area was higher than the Ontario average between 2018 and 2021, with an outbreak declared in 2019 following a surge in cases.

Sixteen cases were confirmed in 2021 alone, but the health unit has since tracked 16 cases from 2022 to now.

Our outbreak really impacted individuals who are homeless, underhoused and who are using substances, and so we have a street outreach team here that really supports individuals in accessing testing, said Kandace Belanger, manager of street outreach, harm reduction and sexual health programs for the TBDHU.

Still, the national trends are concerning — there were 2,434 new HIV cases last year, according to the latest Public Health Agency of Canada (PHAC) report. (new window)

This is a drastic change upwards and we need drastic action to change it, said Ken Miller, who’s executive director of the Canadian AIDS Society and lives in Thunder Bay.

WATCH | HIV rates dropping globally, but up in Canada

HIV rates dropping globally, but up in Canada

Between 2010 and 2021, new HIV infections decreased globally by almost 22 per cent, suggests a new study from The Lancet HIV medical journal. But in Canada, the opposite is happening: in 2023, there was a 35 per cent increase compared to the year before.

Ontario is preparing to shut down 10 supervised consumption sites (new window), including Path 525 in Thunder Bay, due to new rules about their proximity to schools and child-care centres.

These sites offer a number of services, including needle exchange programs, which health-care workers say are essential in preventing the spread of blood-borne infections.

Harm reduction programming plays a really important part in HIV prevention, Belanger said. Meeting people where they’re at and establishing those relationships really helps [to] understand what people need.

While Miller wants harm reduction services incorporated into the province’s new homelessness and addiction recovery treatment (HART) hub model (new window), he’s also calling for policy changes at the federal level to better support people living with HIV.

‘Law reform is needed today’

In July, a coalition of 20 organizations, including the Canadian AIDS Society, submitted two proposals to Health Canada, calling for:

• An additional annual $7.2 million over five years to hire 100 more staff for community-based organizations that serve patients with/at risk of HIV and hepatitis C.
• $150 million in bilateral funding over three years to provinces and territories, to help them meet the government’s goal of eliminating HIV as a public health threat by 2030.

This is what we all see as meaningful ways forward, Miller said of the proposals.

CBC requested comment from Health Minister Mark Holland on the two proposals. A spokesperson said a response would be sent on Friday, at which time this story will be updated.

In Canada, people must legally disclose their HIV status when there is a realistic possibility of transmission to others. Failing to do so may result in criminal charges and being added to the sex offender registry.

While the Department of Justice Canada reviewed this law last year (new window), Miller said nothing has changed.

These laws disproportionately affect people who are of a lesser socioeconomic standing, he said. Canada must stop criminalizing people living with HIV. Law reform is needed today.

Call for inclusive messaging around HIV

Saskatchewan and Manitoba have the highest rates of HIV infections (new window) in the country, at 19.4 and 19.3 people, respectively, per 100,000 population, according to the PHAC report. While the leading cause of HIV nationally is sexual contact, Manitoba’s main cause is injecting drugs with tainted needles.

Miller said it’s important to recognize how HIV trends have changed since the 1980s epidemic. (new window)

This was seen as a gay illness for so long, and so everything was just really geared in that direction, Miller said. We have messaging that misses the mark on communities who need to hear it.

In Canada, people must legally disclose their HIV status when there is a realistic possibility of transmission to others. Failing to do so may result in criminal charges and being added to the sex offender registry.

While the Department of Justice Canada reviewed this law last year (new window), Miller said nothing has changed.

These laws disproportionately affect people who are of a lesser socioeconomic standing, he said. Canada must stop criminalizing people living with HIV. Law reform is needed today.

Call for inclusive messaging around HIV

Saskatchewan and Manitoba have the highest rates of HIV infections (new window) in the country, at 19.4 and 19.3 people, respectively, per 100,000 population, according to the PHAC report. While the leading cause of HIV nationally is sexual contact, Manitoba’s main cause is injecting drugs with tainted needles.

Miller said it’s important to recognize how HIV trends have changed since the 1980s epidemic. (new window)

This was seen as a gay illness for so long, and so everything was just really geared in that direction, Miller said. We have messaging that misses the mark on communities who need to hear it.

Similarly to the TBDHU, ramping up public education and harm reduction efforts has helped stabilize case numbers, she said.

Getting people tested early and onto treatment as soon as possible has helped reduce the spread, allowing those who’ve tested positive to live a long, healthy life, Young Hoon said.

Needles, sterile drug equipment and condoms — all harm reduction tools — have shown to be effective in reducing the spread of HIV.

Equally important, though, is ensuring people are supported in both using and returning drug equipment, so it’s not discarded in the community.

A huge benefit of harm reduction programming in general, but of the needle distribution program in particular, is that it does link clients to other services such as primary care services, sexual health services, getting them tested for infections including HIV and then also linking them to treatment services, Young Hoon said.

While needle exchange programs will still be offered in the region after Thunder Bay’s supervised consumption site closes at the end of March (new window), Miller said concern remains about what the suspension of this service will mean for the community’s most vulnerable.

We need political will to stand up and stop the division and start doing what’s right for people over what’s right for votes, he said of both the HIV and opioid crises.

Quite frankly, we’re at a point where I’m so tired of seeing my friends die.

Both Young Hoon and Belanger said they want people to remember that HIV testing is free and can be done confidentially. More information can be found on the health units’ websites.

This article is republished from RCI.