Helping Canada’s most HIV-affected province

Nurse tells LHP about cause of region’s high infection rate and new initiatives that hope to address problem

Helping Canada’s most HIV-affected province

Racism, stigma and shame remain obstacles to addressing Canada’s HIV problem, according to a long-serving registered nurse in the country’s most-affected province.

Susanne Nicolay, clinic and projects co-ordinator at Wellness Wheel, a non-profit organization that aims to increase access to chronic diseases in Saskatchewan, talked to Life and Health Professional about its new pharmacy point-of-care testing program and the launch of its “Get Tested” guide.

The province has the highest infection rate in Canada and, despite robust partnerships with the regional health authority and the province’s universal health coverage now covering HIV medication, including PREP, since March’s budget, tackling the problem remains a huge task.

Nicolay said the reasons for Saskatchewan’s HIV statistics are multiple. The influx of cocaine in the early 2000s changed the drug of choice and because it is cut many times over by the time it reaches the province, people inject more frequently (10 to 30 times a day), which increases risk. The region’s geographic challenges, multiple people living in one structure, a long-standing high rate of Hep C infection, and attitudes towards race and poverty, exacerbate the problem.

Nicolay’s own opinion is that while many organizations, companies and individuals are supportive, general attitudes towards those with HIV have not changed much in the 25 years she has worked in the field.

She said: “There’s been tremendous change around technology and testing, around medication, around detecting the virus and we know so many more things. But I don’t really feel that much has changed. We are still seeing extremely high rates in parts of our province.

“I know there are a lot of competing challenges but when I talk to peers, nurses, people in my personal life who don’t know we have this challenge, part of me wonders if this is a product of racism. What if it was my demographic, a white female? Would it be different?”

Allowing pharmacists to administer POC HIV testing is important in opening up access across the province, especially to at-risk Indigenous people and drug-users. Many pharmacists who dispense methadone may also dispense anti-retrovirals to those living with HIV.

Nicolay said that despite the government’s routine offer of testing, only about 8% of the population are being tested, with a lack of access to a primary care provider or a lab one of the main problems. This new POC testing will make that easier.

She said: “Pharmacists are gaining more confidence to have more conversations about HIV, what it is, where do you access care and what care looks like. They have become more knowledgeable around this collaborative.”

The free Get Tested guide follows many months of consultations with communities to create a guide which may be used to offer HIV, and other forms of testing, with Indigenous and other communities across Saskatchewan. It also includes information on how to ensure anyone who does test positive is given the support and treatment information necessary.

That, and the POC testing, is supported by a ViiV Healthcare Canada grant awarded through its healthcare organization support for innovative programs across Canada.

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