HIV: unlocking some of the stories behind the numbers

http://www.outwords.ca/content/mystery-hiv

Unlocking some of the stories behind the numbers

HIV is a charged topic for many because of the stigma, history and reality that surround it. But for gay men in Manitoba and nationwide, it’s a topic worthy of attention. Gay and bisexual men and other MSM continue to make up the greatest proportion of new infections: over 46.6 per cent in Canada in 2011. And MSM (a category created to be inclusive of behaviour rather than just identity) represent 50 per cent of all people living with HIV in Canada according to CATIE, Canada’s source for HIV and hepatitis C information.

While numbers in many other populations are going down around the country, those for queer men continue to rise. In Winnipeg, HIV prevalence among MSM is 19 per cent, states the M-Track survey.

After decades of scientific research, public education and detailed knowledge on how to prevent infection, it may seem confounding that infections are still on the rise. It’s a very complicated issue, according to Olivier Ferlatte, research education director at Vancouver’s Community-Based Research Centre for Gay Men’s Health. He’s worked in HIV research for about a decade. “If there was a very easy answer, I guess we would have probably resolved the epidemic,” he said. Government funding, or lack thereof, as well as approaches used to address the issue are both factors.

The need for a targeted strategy

Ferlatte said there is a lack of funding for HIV prevention that is targeted toward gay men in particular, despite the fact that they represent nearly half of new infections. “Also what we’re seeing is that the efforts that we have are perhaps not really addressing all the causes of the epidemic.” Ferlatte’s research shows HIV risk among gay men is connected to both mental health and substance-use issues. The approach often used for educating gay men about HIV and encouraging changes in behaviours isn’t bad, but it isn’t addressing connected issues that actually increase HIV infection. “One of the shifts in the last several years has really been shifting from dealing only with HIV… to basically looking more at health more holistically and running services that are about gay men’s health,” said Andrea Langlois, manager of community-based research at the Pacific AIDS Network. “And so yes, HIV is within that, but so are other STIs, so is depression, so are all of those related issues.”

However, one of the challenges with this new approach is how to bring services into smaller communities, since a gay men’s health clinic would depend on a dense population to make it worthwhile. Langlois said partnership organizations within smaller communities are one way people are talking about making it work.

Sané Dube is membership co-ordinator with Nine Circles Community Health Centre in Winnipeg, a community-based non-profit specializing in HIV and sexually transmitted infections (STIs) prevention.

Dube acknowledged the HIV program in Manitoba is very Winnipeg-centric, and many patients have to travel to access specialized care. An estimated 25 per cent of new diagnoses are in people living outside Winnipeg. In 2013, three outbreaks of HIV occurred in Northern Manitoba, where communities are often under-resourced. An estimated 1,100 people in total are living with HIV in Manitoba, said Dube.

And, aboriginal Manitobans are disproportionately affected. “In 2012, 61 per cent of all newly-diagnosed people were aboriginal,” said Dube. The effects of race and class on HIV infection rates are well documented in Canada and the U.S. A Fenway Health report released in January found that among MSM, black men were especially impacted in the U.S.

The report from the Boston-based GLBTQ* health and education centre also said that in the U.S., HIV prevention is largely targeted toward heterosexuals and other risk groups, despite MSM representing 64 per cent of new infections. Only 27 per cent of HIV education and risk reduction funding in the U.S. was targeted toward MSM. The director of the Centre for Disease Control’s HIV centre, Dr. Kevin Fenton, even acknowledged funding for gay men was half what it should be due to stigma and homophobia cascading down and resulting in underfunding.

Environmental factors come into play in HIV infection and prevention

The U.S. report also named “resiliency factors” linked to lower rates of HIV-risk behaviour among GLBTQ* youth, such as having openly-gay role models among teachers or family, anti-bullying policies in schools and parental acceptance. Dr. Sean Cahill of the Fenway Institute wrote, “Public health departments should fund campaigns and interventions that promote parental acceptance of gay sons as a resiliency factor that can be protective against HIV infection.”

On the flip side, health disparities affecting gay youth, such as bullying and social isolation, can play into higher risks for HIV. “If we don’t address those epidemics, we’ll really never resolve the HIV epidemic.

We need a holistic strategy that addresses many issues, many health disparities that gay men are facing, because HIV is only one. And we don’t have that. I think it’s getting even worse,” said Ferlatte from Vancouver.

The Sex Now survey Ferlatte helped conduct showed gay men today are experiencing as much discrimination as previous generations, and sometimes more. “[People think that] in today’s age, homophobia and discrimination are less of an issue for gay men. Although we have now perhaps made most of the gains we could have made from a legal standpoint, we’re seeing the climate in which young gay men are building their sexual identity, and it’s hostile to that,” he said. “Things like workplace discrimination…. young gay men still feel they’ve been discriminated against, even though they started working at a point when workplace discrimination was [a] protected [grounds]. This has an impact on their mental health, which has an impact on HIV infection.”

The risk of not knowing

In Vancouver, a shocking one-in-five gay men are HIV positive, found a 2008 sexual health survey called ManCount. That’s in contrast to the general population in the city with a rate of one in 100. Numbers are comparable across Canada. Dr. Terry Tussler worked on the survey and said numbers alone are a big part of the increasing infections among gay men. Being in a fairly fixed population means the percentage of HIV-positive men will increase each year as people within the population sleep together.

The survey also found that 2.5 per cent of men surveyed were HIV positive but believed they were negative. Tussler believes rising infection rates are partly driven by men making decisions under the false assumption they are negative. People who are newly infected have a higher chance of passing on HIV, since they will have a high viral load.

On Dec. 1, this World AIDS Day, it will be 32 years since the first diagnosed case of HIV. An estimated 71,300 Canadians were living with HIV as of 2011, according to ACT. And a quarter of Canadians living with HIV aren’t aware they’re positive. A common mental image of the illness harkens from the late ’80s, but HIV and its treatment have changed drastically. Canadians with access to adequate shelter, food and treatment often live long, healthy lives. HIV today is seen as a chronic illness, rather than a death sentence.

Factors such as class, cultural background, refugee status, type of work, trauma and more can play large roles in people’s access to health care, and thus affect how HIV influences their lives.

This year, the first-annual Prairies HIV Conference by Manitoba and Saskatchewan took place Nov. 4 and 5 in Saskatoon.

– Larkin Schmiedl is a freelance journalist living in Vancouver, B.C. He’s a GLBTQ* contributing editor with rabble.ca, hosted a queer-issues radio show called Gaydio, and loves to write about social and environmental justice.

Published in Outwords, November 2013, Volume 205