Since 2002, the number of new HIV infections in Saskatchewan per year has risen steadily, from 26 to 200. And while there was a slight drop in 2010, AIDS Saskatoon expects the 2011 numbers will almost certainly show another increase once they are available.
While these numbers pale in comparison to the new cases in Ontario or B.C. each year — there were 1,618 new cases in Ontario in 2008 — they do not reflect the fact that Ontario has 10 times the population of Saskatchewan.
For a province that houses just under three per cent of the Canadian population, Saskatchewan has a disproportionately large HIV problem that is getting worse with each passing year.
The provincial government reports in its 2010-14 HIV Strategy that Saskatchewan had the highest rate of new infections in 2008 at 20.8 per 100,000 people. That is more than double the next highest provincial rate, which was Ontario’s 10.3 new infections per 100,000 people.
“Saskatchewan has 2.5 times the national average per capita,” said AIDS Saskatoon Executive Director Nicole White. “And Saskatoon has the highest [per capita] rates in the country…. Everyone is watching Saskatchewan and how we’re dealing with our HIV epidemic.”
The HIV/AIDS problem in Saskatchewan is notable for many reasons, White says. Among these are the way in which people are getting infected, the ethnic distribution of the disease and the rapid progression of the disease.
While the most common cause for new infections in most areas of Canada is male homosexual sex, Saskatchewan’s increase in infections is caused largely by intravenous drug use. Nationally, 41 per cent of new cases are due to men having sex with other men, while heterosexual sex causes 30.8 per cent of new cases and injection drug use comes in third, causing 19.1 per cent of cases.
By contrast, 75 per cent of Saskatchewan’s new HIV cases in 2009 were a result of injection drug use, and this has gone up from 50 per cent in 1997.
AIDS Saskatoon’s White says the prevalence of injection drug use in Saskatchewan has contributed to the dramatic numbers of HIV infections.
“It’s the fastest way to spread HIV,” she said.
Because HIV is spread through blood-to-blood contact, sharing needles and other paraphernalia that comes into contact with blood is an almost surefire way to spread the disease.
“You’ve heard the message that you don’t share [equipment] with somebody you don’t know,” White said. “But you might share with your partner, cousin, friend, brother, sister.”
Such clustering may be partially to blame for another trend in Saskatchewan HIV cases, that of the inordinately high number of aboriginal people contracting the disease.
Government figures show that aboriginal people comprise eight per cent of all prevalent HIV infections in Canada, while 12.5 per cent of new cases in 2008 were among the aboriginal population. Meanwhile, aboriginal people made up just 3.8 per cent of the total Canadian population according to most recent census figures.
Yet again, though, the numbers in Saskatchewan are exponentially higher. Aboriginal people make up about 16 per cent of the provincial population, but fully 79 per cent of newly HIV-positive people in the province in 2009 were aboriginal, according to the provincial government. And among the injection drug users who tested positive that year, 84 per cent were aboriginal.
“One of the most concerning things [in the province] is that the people who are affected most are those who are most vulnerable,” White said, referring to the fact that the aboriginal population experiences a disproportionately high level of poverty and attendant issues such as substance abuse, violence and, importantly, limited access to health care.
“People are progressing from HIV to AIDS in three years” in Saskatchewan, White said, “and that’s not happening anywhere else in the country. That’s unheard of, and it’s something that is deeply disturbing.”
Indeed, studies on HIV across the country reflect increased longevity for people with the disease. “The increase [in the number of HIV-positive people] is due to decreased mortality related to more effective drug therapy and continued new HIV infections in specific populations,” reads a report from the Ontario Ministry of Health and Long-Term Care.
In stark contrast, the Saskatchewan government’s 2010-14 HIV Strategy says, “Clinicians in Saskatchewan have reported that patients are either presenting late in the disease process, or that they are presenting for diagnosis soon after exposure/infection but are showing rapid progression of HIV.”
The provincial government has publicly recognized this as a major health issue, and its HIV Strategy is meant to combat the problem. The focus is on “expanded access to needle exchange programs” and awareness campaigns as well as close co-operation with aboriginal elders, but White worries whether it will be enough.
Citing the fact that different health regions across the province do not necessarily record data in the same way, which is just one way in which processes can be hampered or slowed down, White expressed some concern about whether the political will to change things would translate to concrete changes.
“Unfortunately I think a lot of those dollars are being lost in organizational structure.”
Correction 01/02/2012: In this article in the Feb. 2 issue of the Sheaf, as well as online, we had incorrectly stated that eight per cent of aboriginal people in Canada were HIV positive. We had intended to report the statistic that eight percent of all persistent HIV infections in Canada consist of aboriginal people.
Graphic: Brianna Whitmore/The Sheaf