Four questions with the Manitoba HIV/STBBI Collective Impact Network

The Manitoba HIV/STBBI Collective Impact Network is an initiative to eliminate sexually transmitted and blood-borne infections (STBBIs) as a public health threat through collective and collaborative action. The network is hosted by Nine Circles Community Health Centre in Winnipeg. Mike Payne and Laurie Ringaert, the strategic facilitators for the Network, answered a few questions from CATIE about how the Network is addressing STBBIs in the province.

1. What is the landscape for HIV and STBBIs in Manitoba and how does it compare to the rest of Canada?

In 2018, Manitoba had the third-highest rate of HIV diagnoses in Canada (behind Saskatchewan and Quebec). The Manitoba HIV Program served approximately 1,400 people living with HIV who received care at one of the program’s three sites in Winnipeg and Brandon. Injection drug use has become the most likely mode of HIV transmission in this program. Transmission rates from injection in the Manitoba HIV Program are nearly double compared to the Canadian average. This makes access to harm reduction services vital to prevention.

Treatment is a challenge, as Manitoba is one of the few provinces that do not provide comprehensive coverage for HIV medication. Difficulty accessing coverage can result in delayed or interrupted treatment and sometimes a lack of treatment altogether.

More than half of people receiving care as part of the Manitoba HIV program are Indigenous, despite making up only about 20 percent of the province’s population. This proportion has been rapidly increasing in recent years, with Indigenous people accounting for 66 percent of new diagnoses and 81 percent of new cases in all women diagnosed with HIV.

Though not unique to Manitoba, long-standing systemic racism in our province’s healthcare system contributes to these inequities in HIV. This includes a lack of culturally safe services, a lack of targeted awareness and education campaigns, and a lack of information about insurance coverage for pre-exposure prophylaxis (PrEP).

Due to specific immigration processes in Manitoba, our province also attracts the third-highest number of immigrants per capita in Canada. Immigrant and newcomer populations are a priority population for STBBIs, especially for those coming from countries where hepatitis C and B are endemic.

Syphilis is also of major concern. A forthcoming Manitoba epiSummary report will look at how cases increased dramatically in 2018 and primarily affected inner-city, young, marginalized and heterosexual populations.

2. What is the Manitoba HIV/STBBI Collective Impact Network and why was it started?

The Network was established in 2016 to tackle HIV and STBBIs in our province, based on the collective impact network model for addressing complex social problems through a multi-sectoral and collaborative approach. By understanding system gaps and barriers, and bringing together diverse stakeholders, we intended to develop a community-based and culturally responsive approach that could create change at a system level. The Network’s ultimate goal is to reach Canadian HIV targets for 90-90-90, and to end HIV as a public health threat.

The members of the Network include a variety of players from different sectors, including:

• People with lived experience
• Community-based health and social service providers and agencies
• Regional health and social service providers
• Researchers
• Academics
• Regional and provincial policy makers

3. What has the Network accomplished since its inception?

Since launching in 2016, we’ve made significant strides. These include nine large network events, several webinars and the implementation of a number of collaborative teams within the network. Some achievements to date include:

• Involvement and engagement with First Nation organizations and people with lived experience on project teams.
• Completion of a Stigma Index Survey to understand the challenges experienced by people living with HIV in Manitoba. This is part of a larger project to develop community-based strategies and tools to address stigma in communities.
• Development of a community readiness guide to help build capacity and integrate community culture and resources into HIV interventions for Northern First Nation communities.
• Introduction of dried-blood-spot testing in partnership with the Public Health Agency of Canada. Dried-blood-spot testing will help increase access to STBBI diagnosis, particularly for remote communities.
• Creation of “event-based” testing in Manitoba on National HIV Testing Day (June 27), to help find undiagnosed individuals and engage them in care.

The Network has also partnered with the CIHR Centre for REACH in HIV/AIDS on research and evaluation related to HIV and hepatitis C. Our network has been able to join many of their existing funded projects to help expand our impact.

4. What lessons can other regions learn from the Network?

A collective impact approach has been key to mobilizing stakeholders across sectors and facilitating relationships. By coming together to address complex issues, we can better understand each other’s perspectives and come up with innovative strategies together.

Access to Internet for many remote Northern communities has also been an issue. Particularly during the novel coronavirus disease (COVID-19) pandemic, community and stakeholder engagement is becoming increasingly virtual and technological barriers can be a challenge.

An ongoing challenge and key to success has been to secure enough funding for projects. This ensures that working groups and teams have adequate administrative support, but also to help fund evaluation, learning activities, travel and communication to bring remote and rural partners together.

By taking a collective approach, we have been able to motivate and energize each other to reach our common goals.

Mike Payne is the executive director of Nine Circles Community Health Centre and the administrative lead for the Manitoba HIV Program leadership team. Nine Circles is a community-based health centre, specializing in care, treatment and support for Manitobans living with HIV and hepatitis C. Mike’s responsibilities include oversight of regional and national collaborations, including the Manitoba HIV/STBBI Collective Impact Network and Manitoba’s community-based research program (in collaboration with REACH 3.0 and St. Michael’s Hospital).

Laurie Ringaert is the co-strategic facilitator of the Manitoba HIV-STBBI Collective Impact Network. She also serves as its developmental evaluator and the Manitoba regional REACH coordinator as part of this initiative. She has degrees in science and occupational therapy and community health sciences. Laurie is a member of the Canadian Evaluation Society, the American Evaluation Association, the International Association of Facilitators, Social Value Canada and the Blue Marble Evaluation Network. She was recently named as a Champion of the Common Approach to Impact Measurement. Laurie is the principal consultant of Change Weavers Consulting.