British Columbia, Vancouver Island in particular, is in the midst of health tragedy that many of us find hard to describe. In one sense, we can trace the beginning of this crisis to Thursday, April 14th, 2016 when the chief medical office, flanked by the B.C. Minister of Health, declared a public health emergency to address what had already been four terrible months of overdose-related deaths. Since then, I have been privy to receiving periodic updates from the B.C. Coroner Service on the ever-climbing death toll—the most recent post released mid-September.
On a personal note, this ever-escalating human tragedy started for me on December 21st, 2015, three weeks after the Royal Jubilee Hospital in Victoria had stolen from their premises what has since been described as the largest theft of fentanyl in the history of the Vancouver Island Health Authority. On that afternoon of December 21st, the body of a much-liked client was discovered in a parkade less than a block from the region’s largest needle exchange. He died of an overdose.
Lack of access to HIV treatment and care among other complex factors contributes to these alarming rates: in many rural or remote areas, HIV-specific services are simply not available, or the small size of the community creates concerns around confidentiality for those accessing care. Indigenous people in Canada — many of whom are surviving a legacy of colonization and the intergenerational effects of residential schools — continue to experience systemic discrimination and extremely high rates of incarceration. In this context, the criminalization of HIV non-disclosure may be perceived as yet another form of institutionalized violence and discrimination, amplifying the negative impact of the HIV epidemic on Indigenous communities.
A global study released last year revealed alarming figures concerning women living with HIV and violence. Among 945 women living with HIV from 94 countries who participated in the study, 89 per cent reported having experienced or feared violence before, since and/or because of their HIV diagnosis. Violence they experienced was reported to be higher after HIV diagnosis from their intimate partner and others in their social network. The troubling nexus between HIV and gender-based violence spurred the Canadian HIV/AIDS Legal Network, HIV & AIDS Legal Clinic Ontario and METRAC to produce a legal information guide for women living with HIV who are facing — or at risk of — “intimate partner violence” — that is, physical, sexual or psychological harm from a current or former partner or spouse.
In addition to being an exceedingly common experience among women living with HIV, intimate partner violence and HIV are both stigmatized, isolating people who are affected. Intimate partner violence also increases women’s vulnerability to HIV. Women who have violent partners are more likely to have forced sex, are less likely to negotiate condom use, and are more likely to be abused when they insist on condom use— which poses greater risks of HIV transmission.
After a long battle, the SABSA solidarity co-operative clinic – an acronym which translates roughly to service at a low-threshold of accessibility – succeeded in negotiating a service agreement with the Québec Ministry of Health on July 20th, to continue to offer its services to members of the Saint-Roch and Saint-Sauveur communities in Québec City.
From its beginning, CATIE has shared information with people living with HIV so that they can take better care of their health. In Fall 2015, we undertook a national online survey to better understand the information needs of people living with HIV today. The survey results may confirm what you already know about your clients’ information needs. Or perhaps they contain a surprise or two. Whatever the case, the results help guide all of us in how we can best serve our clients.
The CATIE Blog hosts the views and opinions of people and organizations working and volunteering in Canada’s response to HIV and hepatitis C.