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HIV rates show sharp rise—again
North now surpasses B.C. in new cases for 2004
Only eight months after HIV rates were described by the Northern Health Authority as “lower in the North overall than in the rest of B.C.,”1 its most recent data suggests this is no longer the case.
Unpublished data from the first half of 2004 show that the North now has 7.6 new cases per 100,000 people2—exceeding B.C. as a whole, which shows 6.3 new cases per 100,000 for the same period. That’s up from 2003, when the North reported 6.9 per 100,000—for the entire year—while B.C.’s overall rate was comparatively higher at 10.2 new HIV-positives per 100,000.
The new stats also show that newly reported cases in the North are continuing a steep climb already identified by 2002 and 2003 data. Twenty-three new HIV infections were reported in the North during the first half of 2004—exceeding the total of 21 new cases for all of 2003, which had already almost doubled the 12 new cases reported in 2002. The vast majority of new cases have been diagnosed in Prince George.
“ We have an epidemic,” says Catherine Baylis of Positive Living North, a Prince George agency which provides support to people who have or are at risk of contracting HIV.
‘Not unexpected’
But Northern Health Authority’s chief medical health officer David Bowering uses this term cautiously, pointing out that the term “epidemic” has many accepted definitions. These allude variously to the geographic spread, severity, speed and unexpectedness of a disease outbreak.
Bowering’s favoured definition emphasizes the unexpectedness of a disease outbreak—and in that sense, the North is not experiencing an epidemic.
“ From my point of view, this is not unexpected,” he explains, citing a well-documented high incidence in the North of STDs and HIV-promoting practices as injection drug use, unprotected sex (as suggested by teen pregnancies), and the sex trade. However, he suspects the new data do reveal the “classic front edge of an epidemic.” Bowering predicts they will mimic infection rate patterns in larger centres, and rise sharply for some years before levelling out.
Dr. Michael Rekart, executive director of the HIV/AIDS program at the B.C. Centre for Disease Control, says three new developments may help explain the numbers.
Mandatory reporting
One is a new law, effective May 2003, which compels health professionals to locate and inform current and former sexual partners of people who have tested positive for HIV. Rekart says NHA health professionals are “quite dogged” in fulfilling this new duty, which tends to unearth more HIV-positive people who may not otherwise have presented themselves for testing.
Another factor is a rise in injection drug use—now considered to be the most common means of transmission of the virus in the North as in Vancouver’s Downtown East Side.3 This is especially true in Prince George, where the vast majority of new cases have been diagnosed.
Uncovering epidemic
Another development is a research project associated with the BC Centre for Excellence in HIV/AIDS, now underway in Prince George. Modelled after a Vancouver study, the project offers a cash stipend to street-involved, injection drug-using youth in return for their ongoing participation in research which includes regular HIV testing. This cash incentive may be enticing more people to get tested, thereby producing more HIV-positive results.
“ What might be happening is that we’re uncovering an already existing epidemic,” says Bowering.
Rapidly increasing infection rates aren’t the only cause for concern. The data continue to show that B.C.’s First Nations being hit harder than any other identifiable group, and aboriginal women in particular.
Even considering First Nations’ greater presence in the North (for example, as much of 30 per cent of people in B.C.’s Northwest Nations), they are over-represented in the numbers of new cases.
In 2003, First Nations people accounted for at least 57 per cent of newly diagnosed cases, and already represent more than one third of the 23 new cases in the first half of 2004.
Baylis believes it will be much higher.
Aboriginal face
“ The face of AIDS is changing, and here in the North, that face is aboriginal,” observes Baylis.
Health professionals agree that HIV doesn’t favour one race over another: it simply seizes opportunities for blood-to-blood contact found in high-risk behaviour. But such behaviour, including participation in the sex trade and intravenous drug use, is frequently associated with the social and economic conditions of B.C.’s most marginalized people. And people who believe their choices are limited are more likely to engage in high-risk behaviour.
“ HIV spreads into aboriginal communities along the routes of poverty and oppression,” Baylis explains. “And poverty and oppression aren’t letting up.”
Although almost all of the new cases are diagnosed in Prince George, people shouldn’t assume this is simply an urban problem. Many new HIV-positives originate from other northern communities.
As the nexus of north-south and east-west travel routes, Prince George is a common stop for many folks who are just passing through to somewhere else. And Bowering suspects that many people from small towns, who believe they’ve been exposed to the virus, opt to get tested in Prince George out of well-founded concerns about privacy and the crushing stigma associated with AIDS.
Those who test positive may be more likely to settle in Prince George, to take advantage of a comparatively wider range of health and social services while still being reasonably close to home.
Are we ready?
It’s not yet clear if the Northern Health Authority is adequately prepared to deal with the immediate and long-term challenges of an onslaught of new HIV cases.
At least five days of public health nursing time are required for each new case, not including additional time needed to notify former partners and collaborate with other service providers to complete treatment plans.
And agencies that deal with HIV-positive clients are questioning whether health service providers in the North are sufficiently educated about medical treatment of HIV and sensitized to social issues around the disease.
“ One of our HIV-positive clients described an incident where she went to a hospital emergency room for treatment of [complications relating to] her condition,” relates Deb Schmitz of Positive Living North West in Smithers.
“ She was sent away quickly with a prescription, and told she couldn’t be treated because there was no ‘isolation room.’ There is absolutely no need for HIV patients to be treated in isolation rooms!”
To Schmitz, who is helping the Northern Health Authority draft an HIV strategy for the North, such reports belie shocking levels of misunderstanding among many health service providers about HIV and AIDS.
Bowering agrees that much work needs to be done in this area, but also says he’s not aware of any new health dollars specifically targeted for the treatment of new HIV-positives.
“ As we come to terms with this, it’s not just about making diagnoses. It’s also about long-term care.”
(Footnotes)
- Northern Health Authority news release, Dec. 9, 2003.
- Note: A more complete picture of HIV incidence in Northern B.C. could be had by comparing numbers of new cases with actual numbers of people tested, between regions and in particular regions over time. Ideally, such comparisons would factor in the differing behaviour characteristics of groups tested. This information was not available from the Northern Health Authority.
- Sharing other blood-contaminated drug paraphernalia, such as crack pipes, or having unsafe sex—thought to be strongly associated with the use of the inhibition-supressing drug crystal meth—are other important routes of HIV transmission.
©Larissa Ardis
Going to the roots
A Prince George initiative is hoping to address some of the root causes of why people make choices which put them at risk for HIV.
The Fire Pit is a new drop-in centre at Fourth Avenue and George Street. Although anyone can drop in to enjoy food, painting, drumming, singing, and talking circles—or simply hang out and chat, Fire Pit activities emphasize First Nations culture.
The Fire Pit is designed to reinforce positive aspects of First Nations experience, and, indirectly, to promote awareness of how it has been impacted by colonialization. To Fire Pit co-ordinator Cathy Baylis, a member of the Annishnabe First Nation, that awareness is a precursor to the emotional healing that will break intergenerational cycles of substance abuse and social disenfranchisement.
For her, it began by learning about one of the most destructive expressions of colonialism: forced attendance by First Nations children of government-sanctioned residential schools.
“These schools rearranged and eroded our traditional ways of life, and our entire family structure, for generations,” explains Baylis, whose father attended residential schools. “They left a legacy of unresolved grief, trauma and loss on many levels. People try to cope with that pain by turning to drugs, alcohol and abuse.”
As she learned more, much became clear: “Issues I’d thought were just about me were actually about something much bigger. This is a critical shift in thinking that needs to occur for healing to begin.”
The Fire Pit’s location, in the basement of the Central Interior Native Health Society, is no accident. Organizers hope the CINHS will become a primary health care delivery centre, where even the most at-risk and marginalized can easily access—on terms that speak to their day-to-day realities—doctors, HIV support workers, drug & alcohol counsellors and social workers.
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