Blood vials for HIV testing (Hoberman Collection/UIG/Getty Images)
In the mid-1990s, Saskatchewan had the lowest incidence of both HIV and AIDS in the country. To put it mildly, things have changed. The rise in the number of new cases since the early 2000s has been dramatic—catapulting from 26 in 2002 to 200 seven years later. Last year Saskatchewan physicians called on the provincial government to declare a public health state of emergency over the high number of people diagnosed with HIV, especially in Indigenous communities, where rates have become comparable to those in some African countries. The Prairie province now has the highest prevalence of HIV in Canada, at almost two and a-half times the national average, or 14.5 cases per 100,000 people.
Since the province started reporting HIV cases in 1985, more than 2,200 cases have been identified, the bulk of them (73 per cent) diagnosed in the past 10 years. Between 2007 and 2016, 1,608 have been reported, tripling the 463 cases found in the previous decade. The number of new cases since 2007 peaked in 2009 at 200, and reached its decade-low in 2014 (112). “I think that was seen as evidence that the problem was solved, says Dr. Stephen Sanche, the head of the infectious diseases department of the Saskatoon Health Region and one of the experts to raise the alarm last year. “But those of us on the front lines could see that this was far from over.” Indeed, in 2016, the number of new diagnoses bumped back up to 170—a six per cent increase over the previous year.
What is clearly an emergency, Saskatchewan physicians say, has not been treated as such by the provincial government. “It seems to be going in the wrong direction,” says Dr. Kris Stewart, a physician who specializes in HIV care. “The humanitarian consequence of this is profound.” Stewart expects the incidence of infection in 2017 to be similar to that of 2016.
"What is clearly an emergency, Saskatchewan physicians say, has not been treated as such by the provincial government."
The key driver of this spike has been injection drug use. According to a 2016 report from Saskatchewan’s ministry of health, cases have shifted from urban centres to rural and remote areas. In 2007, Regina and Saskatoon made up nearly 75 per cent of all new HIV cases, but by last year that share had been sliced in half (35 per cent). Part of the cities’ success in recent years, Sanche says, has been creating better access to addictions services in cities, and linking HIV therapy to methadone—a drug used to treat opioid addictions. But these services are scarce in rural environments. The result, Stewart and Sanche say, is people being diagnosed later in their lives when it’s more difficult to return to normal health.
“We need to have a centrally developed and coordinated strategy with a clinical lead, who has access to a budget and who can look at the province and direct resources to where we need it,” Stewart says. Patients who are on treatment, Stewart reassures, have a near-zero risk of passing on HIV.
That’s not to say the challenges in urban areas have gone away. At Sanctum, Saskatchewan’s first hospice for people living with HIV/AIDS, there is a growing demand for services. The 10-bed facility in Saskatoon operates on referrals and almost always has patients waiting in line to get in. “If we opened up to the community, we would have a never-ending wait-list,” says Katelyn Roberts, the executive director. There needs to be more funding, she notes, for addiction and housing services: “Somebody living with HIV without support and who’s homeless in our community will die within five years.”
To read the complete article by Kyle Edwards, visit Maclean's, here.