A test is a test, right? I’ve struggled with the issues of why HIV testing matters over the last 25 years, and over that time I’ve seen the ebb and flow of debates and discussions on why testing is still an important issue for Canada. I’ve also seen the frustration among those who do not have access to testing and why that matters. Yes, knowing your HIV status is still an important health issue for Canadians. However, with the complex array of debates on the pros and cons of testing, including the very real concerns about confidentiality; the need for pre- and post-test counselling; limited access to testing innovations such as point-of-care testing (POCT); the gendered nature of testing along with some popular misconceptions about it, there is definitely room for improvement moving forward. Simply put: We can and must do better in our national leadership around HIV testing issues in this country.
In the lead up to the election, Action Canada for Sexual Health and Rights produced a series of policy briefs that outlined actions the Government of Canada could take on a range of sexual and reproductive rights-related issues. We’ve already seen movement on some of the proposals, but as a whole these briefs still offer a road map to the changes the country needs to make to meet its sexual and reproductive rights obligations.
By Laurie Edmiston and Melisa Dickie
We just returned from the first World Hepatitis Summit hosted by the World Hepatitis Alliance (WHA) in partnership with the World Health Organization (WHO) and the Scottish government. The Scottish government was a partner because Scotland has exercised leadership in the fight against hepatitis C and, unlike Canada, has a national strategy to combat hepatitis C.*
The focus of the World Hepatitis Summit was viral hepatitis, specifically hepatitis B and C. Hepatitis B has a vaccine; giving it to newborns or school-age children in Canada is standard practice. However, this is not the case in much of the developing world, and hepatitis B continues to be endemic in many regions. Some countries including China, Pakistan, India and the Philippines also have significant hepatitis C epidemics.
In Canada we are mostly concerned with hepatitis C, and its disproportionate impact on marginalized populations including people who use drugs, Indigenous communities, prisoners and immigrants and newcomers from endemic countries. Many of us in the HIV field have recently embraced efforts to integrate hepatitis C into our movement.
Some quick facts:
- In many countries, inadequate infection control practices (such as re-using needles and syringes in healthcare facilities) are responsible for hepatitis B and C transmission.
- It is estimated that there are at least 16 million people who inject drugs worldwide, 10 million of whom are infected with hepatitis C, compared to 3 million who are infected with HIV. Hepatitis C prevalence as high as 80% is not uncommon among people who inject drugs in some parts of the world.
- Since 2007, more people have died of hepatitis C than HIV in the United States.
- There is evidence that needle syringe exchange and opiate substitution treatment in prisons reduce injecting risk behaviour. The United Nations and the WHO advocate for needle syringe programs (NSP) in prisons. The Canadian HIV/AIDS Legal Network, CATIE, the Canadian Aboriginal AIDS Network and the Prisoners with HIV/AIDS Support Action Network are engaged in a court challenge to provide NSPs in Canadian prisons.
In light of the hepatitis epidemic, the WHO established the Global Hepatitis Programme in December 2011. The World Health Assembly asked the WHO to assess the feasibility of eliminating hepatitis B and C. To address this, the WHO is currently developing the first global strategy for hepatitis in broad consultation with global stakeholders. In May 2016 the resulting draft will be presented to the World Health Assembly for adoption by member states.
The WHO has developed a provisional document to assist in the development and assessment of national viral hepatitis plans. It is an excellent document that could assist Canada in developing our own hepatitis strategy. Dramatically driving down the hepatitis C epidemic is possible with the recent hepatitis C treatment advances and other key interventions such as safer injection practices, harm reduction and scaling up testing and linkage to care. Preventing and treating saves costs and lives!
How will Canada’s Minister of Health respond? Dr. Gottfried Hirnschall, Director of HIV/AIDS Department and Global Hepatitis Programme at the WHO, told us that Canada is unwilling to sign on to the WHO’s first global strategy for hepatitis due to the inclusion of the term “harm reduction” in the language. At the World Hepatitis Summit, harm reduction warranted minimal mention; it is accepted policy and practice in most of the world. In Canada, every province and most municipalities of every size have needle exchange programs, opiate substitution programs, and we have the example of the exhaustively studied, evidence-informed and highly successful supervised injection site in Vancouver. Yet on the world stage, Canada is represented by anti-harm reduction guardians. Embarrassing and unconscionable.
Laurie Edmiston is Executive Director of CATIE, Canada’s source for HIV and hepatitis C information.
Melisa Dickie is Associate Director, Community Health Programming at CATIE.
I had the honour of attending the recent and first-ever World Hepatitis Summit in Glasgow, Scotland from September 2-4, 2015. What a treat it was to come together with hundreds of other people from around the globe to discuss the often ignored health issue of viral hepatitis. Here I was, “amongst my people,” talking like crazy about viral hepatitis as if it were important or something. How new and novel, because here in Canada viral hepatitis is the conversation we never have, despite the fact that at least 250,000 Canadians are affected by it.
“What is the risk of HIV transmission through condomless anal sex if I am the receptive partner?” “How low is the risk if my viral load is undetectable?” “What’s the risk if my partner was in the acute phase of HIV infection when we had sex?”
Questions about HIV risk aren’t easy to answer and—with all the recent advancements in our understanding of HIV transmission and prevention—things aren’t getting any easier!