Reducing the risk
Innovative programs are underway to reduce the high incidence of HIV in Saskatchewan.
"In the last 12 months, (rates have) come down a little bit, but in 2009 our rate was more than double the national rate," said Susanne Nasewich, HIV strategy co-ordinator with the Regina Qu'Appelle Health Region (RQHR). "In Vancouver's downtown east side, there's lots of talk about the supervised injection site and people injecting in the alleys and all of the chaos that goes on there, but their HIV rate is nine per 100,000 people and ours was over 20 per 100,000 in 2009."
Since 2001, the number of HIV cases in Saskatchewan peaked in 2010 with 200 new diagnoses. The Ministry of Health has not released data for 2011, but Nasewich expects the number of new cases will be just under 200.
"While the rates have gone down slightly in the bigger urban areas, there's an increase in the rural areas - for example, First Nations communities ... When we go looking for HIV, we certainly find it," Nasewich said.
The region, province and community groups are working to reduce the number of new infections, improve the quality of life for HIV-infected individuals and reduce the risk for acquiring HIV.
New initiatives under development include peer-to-peer networks. So far, the RQHR has recruited six people with HIV who are recovering and stable. They are being trained to support others with the infection, with a primary focus on people in hospital.
"But we've expanded it to include people who are newly diagnosed with HIV or newly engaged in care, but they're just at the point where they're able to come to the clinic or see the physician and nurse team," Nasewich said. "The biggest piece to that is not only supporting the person with HIV as a client, but the peer mentor because they may be vulnerable in their recovery and we don't want to put them in a position where they might have increased vulnerability."
Contributing to the prevalence of HIV is a lack of access to health care, addiction and chronic poverty.
"Aside from that, there is a lot of stigma about HIV in those communities, so it's not talked about," Nasewich said. "People wouldn't necessarily be going to ask for an HIV test."
The RQHR had 22 per cent of the province's HIV cases in 2010, while the Saskatoon Health Region had 44 per cent of the cases.
One of the biggest drivers of HIV is illicit drug use. The drug of choice for the estimated 2,000 illicit drug users in the RQHR is cocaine.
Nasewich said many addicts inject drugs to relieve their pain.
"We often see the addiction as the problem, but for people who are using it's often the solution," she said. "It takes away the pain. It makes them feel normal and helps them get up in the morning ... When people are using heavy, they will use anywhere from 10 to 30 times a day."
The RQHR distributes about two million needles and related supplies annually. More than 95 per cent of the needles are returned.
During a recent presentation Nasewich made to board members at the monthly Regina Qu'Appelle Regional Health Authority meeting, she illustrated the risks by showing slides of substandard living conditions and housing.
"There is no running water, no toilets," Nasewich said. "That really speaks to the chaos that people live in on a daily basis. So, when we wonder why they just can't pull up their socks and go into treatment and get a job and get fixed, I just have to look at one of these pictures and say, 'Where do you start?' "
She doesn't downplay the challenges ahead, but said there are opportunities as well.
"What we've got going for us is a lot of commitment to this population that is at risk," Nasewich said. "There is a lot of work to do, but we're certainly getting some traction and some of the things we're doing around community engagement and the peer work are really amazing."