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Saskatchewan faces HIV emergency, say doctors

By Lauren Vogel | CMAJ | Sep. 19, 2016

Saskatchewan doctors are decrying government inaction to curb HIV as rates spike to double the national average. (Photo credit: ktsimage/iStock)

Saskatchewan’s high rates of HIV are a public health emergency and government inaction is part of the problem, warn doctors.

New cases of the virus have spiked since the expiry of Saskatchewan’s HIV strategy in 2014 says Dr. Ryan Meili, one of a group of 30 physicians who are urging an immediate outbreak response and provide most of the HIV care in the province. There were 158 new cases in 2015, up from 112 in 2014. That’s 13.8 cases per 100 000 people — almost double the national rate.

“We’ve been consistently the highest for ten years and at times close to triple the national average,” says Meili. “We’re nowhere near meeting the size of the problem.”

The doctors want the province to ensure that 90% of people with HIV are diagnosed, 90% of those diagnosed receive treatment, and 90% of those treated have low enough viral loads to prevent further transmission. This 90-90-90 goal is recommended by UNAIDS and endorsed by the federal government.

In 2015, HIV experts identified the steps to achieve this goal in Saskatchewan, from increased public education and testing to coordinated treatment and support; however, “the province has not been taking the necessary action,” says Meili.

“They’ve refused to commit to that goal and they’ve not done even some of the simpler things, such as covering antiretroviral therapy completely, so we have patients who are HIV-positive and want to be on treatment, but aren’t because they can’t afford it,” he explains.

Meanwhile, there has been no new strategy to replace the provincial plan that ended in 2014. Concerned physicians have had “a number of meetings” with the government, says Meili, but provincial officials “don’t give any rationale” for the delay.

With timely treatment, HIV shouldn’t be a death sentence, yet doctors in Saskatchewan say they continue to see patients dying at higher rates than elsewhere in Canada simply because the patients were unaware of their status until too late. The longer the outbreak is unaddressed, the more difficult it becomes to contain, adds Meili.

As the disease gets out of the larger communities to rural communities and reserves, testing gets harder, treatment gets harder, the appropriate outreach supports all get harder to deliver.

Dr. Ryan Meili

The doctors are also urging increased federal action to curb HIV on reserves. Indigenous people have been hit hardest by the outbreak, accounting for 71% of cases in the past decade despite making up less than 20% of the province’s population.

“HIV has always been a disease of the ‘other’: first, gay men, and now, racialized and poorer populations,” says Meili. “As such, it’s always been easier for mainstream Canada to say this is somebody else’s problem.”

Dr. Ibrahim Khan, Health Canada’s regional medical health officer for Saskatchewan First Nations, acknowledges that the government still has “a lot to do,” but attributes some of the spike in new cases to increased testing and awareness about HIV.

Health Canada has increased funding for projects to combat HIV on Saskatchewan reserves, providing an extra $800 000 on top of $1.53 million in base funding for initiatives in 2016-17. However, it’s up to communities to request those funds and implement programs that are appropriate to their needs, says Khan. The federal government can’t impose programs where they aren’t wanted, and he says that negative attitudes towards HIV patients are partly to blame for slow uptake.

That’s starting to change, Khan says, and the federal government has been in talks with two tribal councils that could “dramatically” increase the number of point-of-care testing sites on reserves. Currently, there are seven sites across about 80 communities, but if the tribal councils come on board, each could open sites in an additional six or seven communities.

The federal government is also hoping to expand its “Know your status” pilot project which offers nurse-led community-based HIV testing and case management. The program has been adopted by two central Saskatchewan communities and “above 90% of the clients are on treatment and have a suppressed viral load,” says Khan. “We’re going with what the communities and leadership are telling us and they find it very successful so that’s where Health Canada is investing in future.”

Health Canada recently met with a “strong coalition of First Nations leadership” to work together to implement and promote the program, he adds. “That’s a turning point.”

Saskatchewan’s ministry of health declined to comment at this time.

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