Northern Ontario preps for HIV outbreak

Health officials in Saskatchewan are cautioning their counterparts in northern Ontario that swift action is needed if the region hopes to avoid an HIV outbreak similar to the one the prairie province has been struggling with for years.
The warning comes as northern Ontario witnesses growing numbers of injection drug use, primarily associated with the prescription drug addiction epidemic in First Nations communities, and consequent increases in rates of Hepatitis C.
Dr. Johnmark Opondo, the medical health officer with the Saskatchewan HIV provincial leadership team, told Wawatay News that in 2003 Saskatchewan was facing similar conditions to those faced by northern Ontario today. At that time in Saskatchewan injection drug use was rising sharply, especially in First Nations communities, and the province was seeing an increase in Hepatitis C cases.
An explosion of HIV soon followed, and Saskatchewan has been dealing with the highest per capita rate of HIV in Canada ever since. Saskatchewan is also the only Canadian province where the majority of new HIV cases come from injection drug use.
“If the risk factors are all there, all it takes is one or two HIV positive people and it can spread,” Opondo said.
In northern Ontario, communities like Cat Lake First Nation are seeing huge increases in injection drug use. In Cat Lake’s case, for example, over 500 needles were turned into the community’s nursing station in December and January, an astonishing number considering Cat Lake’s population is only 500 people and there is no official needle exchange program.
Claudette Chase, the medical director of Sioux Lookout First Nations Health Authority, told Wawatay News on Feb. 2 that Cat Lake is not the only community where injection drug use is rising. Chase said the authority has witnessed a spike in Hepatitis C rates across northern Ontario.
“HIV is obviously on our minds,” Chase said. “Numbers of HIV have been steadily rising in First Nations communities across Canada, moving from west to east.”
The transmission of HIV in Saskatchewan may also hold lessons for northern Ontario. Although experts expected the disease to spread between the province’s three major urban areas – Regina, Prince Albert and Saskatoon – Opondo said transmission has largely happened between First Nations communities and the city they are connected to.
For example, HIV rates in Saskatoon are more closely tied to the reserves around it, with transmission pathways going back and forth between First Nations and Saskatoon. The same is seen in Regina and Prince Albert, where HIV spreads between the cities and the surrounding communities, rather than from city to city.
That has AIDS activists in Thunder Bay alarmed. Bob Manson, AIDS Thunder Bay’s education outreach officer, calls it a “perfect storm” of risk factors for an HIV outbreak in both Thunder Bay and northern communities.
“We know there is an injection drug use problem (in Thunder Bay), with sharing of needles, from the high Hep C rates. And we know there is a lot of unprotected sex going on from the STI outbreaks that we’ve seen in the city,” Manson said. “So far the HIV rate in Thunder Bay has been relatively stable, but we know it’s a perfect storm of risk factors here.”
Manson said it is imperative that education programs get ramped up, as recent surveys show many people still do not know how HIV is transmitted.
He also wants to see needle exchange programs set up across the North to try and stem the rising Hepatitis C infections caused by sharing of needles.
Opondo agreed that needle exchange programs are vital. Drug addictions are so powerful, he said, that even knowledge of the risk of infection will not stop an addict from using dirty needles if no clean needles are available.
Saskatchewan started its provincial HIV strategy in 2010. One element of that strategy Opondo highlighted was having teams of health care providers travelling to reserve communities to do regular HIV and Hepatitis C testing. Opondo said the travelling teams have allowed the province to catch the diseases in early stages and start treatment right away. He also said the teams provide an important public education role, because testing for HIV in a small communities brings the issue to the public’s attention in a graphic way.