As HIV cases rise across Canada, the numbers have stabilized in northwestern Ontario — for now
Health-care workers credit harm reduction as key to preventing transmission
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.
"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.
Ontario is preparing to shut down 10 supervised consumption sites, 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, 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 for the Public Health Agency of Canada said in an email on Friday afternoon that "the proposals for additional funding from the coalition of community-based organizations are currently being reviewed."
They added that the federal government spent $114.1 million in 2023-2024 "to address sexually transmitted and blood borne infections (STBBI) across Canada."
"This includes supporting the community response to STBBI through stable annual investments of $33.4 million in community-based projects through the HIV and Hepatitis C Community Action Fund and the Harm Reduction Fund," wrote senior media relations advisor Anna Maddison.
"The Government of Canada is committed to working with provincial, territorial, and community partners and stakeholders across the country in support of the global goal of ending HIV and other STBBI as public health concerns by 2030. The contribution of community-based organizations is central to Canada's ability to achieve these targets," she continued.
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, 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."
Maddison spoke of efforts to address discrimination around STBBI that create barriers to care, including the U=U movement, which reminds people that HIV is not passed on through sex when a person living with HIV is receiving treatment and the amount of HIV in their blood remains very low.
Call for inclusive messaging around HIV
Saskatchewan and Manitoba have the highest rates of HIV infections 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.
"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."
For example, there were an estimated 15.2 new infections per 100,000 Indigenous people in Canada in 2020, compared to four new infections for every 100,000 Canadians, according to the Canadian AIDS Treatment Information Exchange.
Meanwhile, Indigenous women made up 85 per cent of all females referred to the Manitoba HIV Program between 2018 and 2021.
"We have to assume that those stats can be somewhat relative to what we see in Thunder Bay," Miller said. "We know Thunder Bay has a large community of Indigenous people and we know that we have a large number of people who use drugs, and we also have a large number of people who are unhoused."
Sending harm reduction workers into the community has proved to be an effective way of connecting with more clients at risk of HIV, Belanger said.
"It's not easy for somebody who might be living on the street to access services at our office here, so we make sure that we have opportunities for them to access testing at other locations that are more readily available to them," she said.
Creating more inclusive messaging around HIV that targets a wider range of demographics is also important in addressing all at-risk populations, Miller said.
Importance of testing, harm reduction supplies
In Ontario's Northwestern Health Unit (NWHU), seven HIV cases have been confirmed this year, compared to 19 the year before — the highest rate to date.
The top two risk factors for infection are people who don't use condoms and people who use drugs, said NWHU's medical officer of health, Kit Young Hoon.
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, 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.
ABOUT THE AUTHOR
