In Canada today, prisoners who inject drugs need to share needles, many of which have been used numerous times by other prisoners. Without access to sterile injection equipment, rates of HIV and hepatitis C virus are much higher behind bars than in the broader community. Prison-based needle and syringe programs (PNSPs) are an important way to address this public health problem, yet Canadian correctional authorities often claim they won’t work. A recent study demonstrates that PNSPs are indisputably feasible in Canada and should be implemented now.
A new report, On Point: Recommendations for Prison-Based Needle and Syringe Programs in Canada, outlines the findings of a two-year study that involved consultation with a range of diverse stakeholders, including former prisoners themselves. The research was conducted by representatives from the Department of Criminology at Ryerson University, PASAN (a community-based AIDS service organization that provides community development, education, and support to prisoners and ex-prisoners in Ontario), and the Canadian HIV/AIDS Legal Network (one of the world’s leading organizations tackling the legal and human rights issues related to HIV).
In an era where sometimes difficult, science-based decisions are routinely required of both positive and negative individuals− think when to start treatment, or the relative benefits of PrEP vs condoms− are we doing enough to steer people away from bad decisions?
First we need to acknowledge that even in a non-judgmental environment such as ours, some decisions just aren’t wise. Charlie Sheen and the allure of the goat’s milk cure proved that quite publicly. So did this Facebook commenter opining recently when to start treatment: “It’s best to wait until there is a patch, a spray or a cure.” In fact I suspect there is a fairly large faction (I call them “treatment denialists” ) who aren’t persuaded by START that early treatment works best. Or by PARTNER that it can all but eliminate the risk of transmission.
Lesbian, bisexual and queer women are rarely included in HIV research. Women who have sex with women, and their HIV infection rates, are not captured anywhere because women cannot report having a woman as a sexual partner in Canada’s HIV statistics. The current record only allows women to report HIV exposure either through injection drug use or heterosexual sex. This contributes to the erasure of women’s sexual and gender diversity and fluidity in HIV research. Queer* women are ignored in HIV research: this is a problem and here is why it matters.
There are a lot of new test technologies in the pipeline: both new types of tests in the works, such as rapid syphilis tests or point-of-care HIV viral load testing, and new ways to use existing tests, such as self-testing or online testing.
As testing options increase, we need to think about where they will have the most impact. I learned about this from helping implement a new test technology called pooled nucleic acid amplification testing (pooled NAAT) at six clinics in Vancouver in 2009, as part of a research study to determine the impact of this new type of test on gay men’s lives. With pooled NAAT, blood samples that are negative on a routine screen for HIV antibodies are automatically tested for HIV RNA. This shortens the HIV window period to 10-12 days and means that individuals with very early or acute infection – when HIV viral load and chances of transmission are high – can be diagnosed at a time when standard tests are negative.
There is a quiet tension that exists surrounding HIV and infant feeding. Although practices and recommendations vary around the world, breastfeeding is not recommended for infants born to an HIV-positive woman or trans man in Canada. Instead, HIV-positive parents are counselled to feed their infants with formula.
But I don’t think it is by any means a closed case, even in Canada. The truth is, the debate about HIV and infant feeding (particularly in Canada) has never been more complex. Like so many discussions related to HIV today, scientific advances are changing the way we talk about and consider possibilities. New questions about treatment as prevention, pre-exposure prophylaxis (PrEP), and even levels of ‘risk’ seem to emerge every day.
The CATIE Blog hosts the views and opinions of people and organizations working and volunteering in Canada’s response to HIV and hepatitis C.