Pubdate: Mon, 14 Aug 2006
Source: Ottawa Citizen (CN ON)
Copyright: 2006 The Ottawa Citizen
Contact:  http://www.canada.com/ottawa/ottawacitizen/
Details: http://www.mapinc.org/media/326
Author: Andrew Duffy
Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction)
Bookmark: http://www.mapinc.org/find?143 (Hepatitis)
Bookmark: http://www.mapinc.org/women.htm (Women)
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)
Bookmark: http://www.mapinc.org/youth.htm (Youth)

CANADA'S HOMEGROWN EPIDEMIC

Health Officials Worry An HIV/AIDS Epidemic Is About To 'Explode' 
Among Natives, Writes Andrew Duffy

Canadian health researchers are warning that the steady advance of 
HIV within Canada's native community shares some disturbing hallmarks 
with the epidemic in Africa.

Statistics published by the Public Health Agency of Canada earlier 
this month show that natives accounted for nine per cent of new HIV 
cases in the country last year, even though aboriginals comprise just 
3.3 per cent of the overall population.

The infection rate among natives is now three times that in the 
general population.

"What we have seen over a period of time is that the numbers are just 
not going down. We continue to be over-represented in the new 
infections," said Kevin Barlow, executive director of the 
Ottawa-based Canadian Aboriginal AIDS Network.

The epidemic within the aboriginal community has some unusual and 
disturbing features.

The virus is much more likely to be transmitted by intravenous drug 
use in the native community. Women now account for nearly half (45.1 
per cent) of all reported HIV cases among natives, while women in the 
general population make up about one-fifth of reported cases. In all, 
an estimated 2,300 to 4,500 Canadians were infected with HIV in 2005.

Natives under of the age of 30 also face an elevated risk of 
contracting HIV as compared to other young Canadians.

What's more, there are troubling signs that the already high rate of 
HIV infection among the country's one million natives could soon explode.

A recent study by the B.C. Centre for Excellence in HIV/AIDS found 
that the hepatitis C infection rate -- a common harbinger for HIV -- 
has skyrocketed among aboriginal intravenous drug users in Vancouver 
and Prince George.

Patricia Spittal, principal investigator of the Cedar Project study, 
said HIV/AIDS has the potential to devastate native communities in 
much the same way that it has ravaged villages in sub-Saharan Africa.

"We have to be worried about the similarities between here and 
Africa," said Ms. Spittal, an anthropologist who lived for two years 
at a Ugandan truck stop as part of her HIV/AIDS research in Africa. 
"The circumstances are the same: When you have human rights 
violations, and a combination of poverty and despair, you have to be worried."

The Cedar study found that 57.1 per cent of Vancouver's aboriginal 
injection-drug users had hepatitis C. The situation was even worse in 
Prince George, a small city of 77,000 in northern B.C. where 62.4 per 
cent of aboriginal IV drug users tested positive for the disease.

Hepatitis C spreads more rapidly and efficiently than HIV, but both 
viruses are commonly passed through the sharing of infected needles.

"It's like a warning bell," said Dr. Martin Schechter, chairman of 
the department of health care and epidemiology at the University of 
British Columbia. "It's telling us that all the ingredients are there 
for HIV to catch up to hepatitis C and go even higher."

Preliminary findings of the study were reported last year because 
members of a native advisory board were so alarmed by its numbers. 
Researchers found that among aboriginal injection drug users, the HIV 
infection rate in Prince George was lower (7.9 per cent) than in 
Vancouver (17 per cent), but experts believe that gap could close 
rapidly given the elevated rates of hepatitis C.

"The worry is that we're already seeing in the Cedar study prevalence 
rates in young aboriginal drug users that are worryingly high," said 
Dr. Schechter. "One potential disaster scenario is that you get the 
rapid spread of HIV."

Such "explosive outbreaks," he said, have taken place in 
neighbourhoods in Edinburgh, Bangkok, Vienna and Baltimore, where 
people gather to share intravenous drugs. Vancouver's downtown East 
Side experienced a similar explosion in 1996-97, when the prevalence 
of HIV among drug users climbed rapidly to 30 or 40 per cent.

It has been estimated that Vancouver's downtown East Side, the city's 
poorest neighbourhood, is home to 4,700 intravenous drug users, about 
25 per cent of whom are aboriginal. A 2003 study found that the 
aboriginal drug users were becoming HIV-positive at twice the rate of others.

"When people tell me they want to work in the developing world, I 
say, 'OK, let's work on the downtown East Side of Vancouver because 
those prevalence rates are what you see in sub-Saharan Africa," Dr. 
Schechter said.

The Cedar study suggests the threat posed by the combination of IV 
drug use and HIV extends beyond Vancouver's East Side to places such 
as Prince George.

Researchers found that injection drug users in Prince George tended 
to shoot cocaine, morphine or dilaudid more often than heroin -- the 
injection drug of choice on the East Side. Since the effects of other 
opiates don't last as long as heroin, drug users in Prince George 
injected themselves more frequently than those in Vancouver, the 
study found. That behaviour put them at greater risk, since each 
shared needle increases the chances of contracting HIV.

Ms. Spittal wants to expand the Cedar study to confirm what many 
native leaders are telling her -- that the situation in Prince George 
reflects what they see happening in Kamloops, Kelowna and Prince Rupert.

Other studies have shown that natives are over-represented among IV 
drug populations in cities across the country. A 2004 study by Health 
Canada that recruited 794 IV drug users in Toronto, Sudbury, Regina 
and Victoria reported that 40 per cent of them were aboriginals.

"I think that many native service providers are very worried," Ms. 
Spittal said.

Chief Wayne Christian of the Splats'in First Nation, near Kelowna, 
said his community, which was once plagued by alcoholism, is now 
beset with drug issues. Crystal meth and crack cocaine are common.

"I'm really concerned that if it transitions into intravenous drug 
use, then we're going to have a real problem on our hands," Mr. Christian said.

The Splats'in First Nation, a community of 750 people, has suffered 
one fatal drug overdose and another suspected one during the past three months.

Mr. Christian believes drug addiction has flowered in his community 
because of the poverty, despair and dysfunction that resulted from 
what he called "genocidal" government policy.

In B.C., he said, adult natives have been scarred by experiences with 
residential schools and foster care, leaving them ill-equipped to be 
parents themselves. The resulting family breakdown and pain, he said, 
have led many young people to escape into the drug underworld.

Ms. Spittal considers the HIV infection rate among B.C.'s natives to 
be a human rights and child protection issue.

"When you see high levels of pain, despair, poverty, and the impact 
of colonization, I can't rant enough about that," she said. "It's 
really important to locate this discussion there -- in the erosion of 
culture and identity that are directly related to residential schools."

Native leaders fear drug use is on the rise at First Nations 
communities across the country.

Crystal meth has invaded many native reserves, said the Canadian 
Aboriginal AIDS Network's Mr. Barlow, because it's relatively easy to 
manufacture on site. Crystal meth often acts as a springboard to IV 
drug use, he said, drawing natives into city neighbourhoods known for 
their drug cultures.

"I would say B.C. is very similar to what is happening in most of the 
western provinces," he said. "If you go to downtown Winnipeg, 
Edmonton, Calgary or Regina, you will see very similar situations."

Intravenous drug use is at the heart of the native epidemic. More 
than half (53 per cent) of all new HIV infections among natives are 
attributable to infected needles. In the general population, only 14 
per cent of new infections were attributed to IV drug use last year.

The use of injected drugs is central to the elevated risk of 
contracting HIV faced by aboriginal women and youth.

"It's such a volatile area of concern," Mr. Barlow said. "Let's say 
if one person is positive and they're sharing needles with three or 
four individuals. Then the numbers jump that quickly. If those people 
then share needles, the numbers can grow exponentially. That's the challenge."

The sex trade and the prison system, both of which contain 
significant native populations, also act as dangerous vectors for HIV 
infection.

Mr. Barlow said more research needs to be done to better understand 
the epidemic within the native community and the perceptions, 
practices and barriers to effective prevention. With a budget of $1.2 
million, the Aboriginal AIDS Network delivers research, training and 
prevention programs across the country.

"When we look at the populations that are at-risk groups within the 
aboriginal population -- sex trade workers, injection drug users, 
inmates, youth, two-spirit (gay) men -- we have to find different 
ways of creating awareness in our communities," Mr. Barlow said.

"We have these multiple layers that make it really hard to engage 
people and get them receiving services, and changing risk behaviours."

Mr. Christian, who has worked as a drug and alcohol counsellor for 14 
years, said he fears many aboriginal drug addicts are going to cities 
because First Nations don't have the expertise to deal with their 
problems on reserves.

He wants the federal government to spend more money on programs that 
offer drug addicts clean needles and safe, temporary housing. Housing 
is a critical measure, he said, because it offers drug users an 
alternative to living on city streets, where they often first engage 
in IV drug use and high-risk sexual behaviour.

"People have to understand that harm reduction is part of the 
continuum of healing," said Chief Christian.

"We have to do things now if we really believe that our children are 
our future. We have to take action, not tomorrow, right now, and put 
things in place."

In Prince George, a city task force has developed a strategy to 
address the IV drug problem. Hours at the needle exchange program 
have been extended and a van has been purchased to bring clean 
needles to addicts on the street.

But Mary Teegee, manager of community health and development for 
Carrier Sekani Family Services in Prince George, said new money for 
the HIV epidemic is scarce.

"It's very frustrating," Ms. Teegee said. "There's no big influx of 
resources coming to the North like there was in Vancouver in the 
early 1990s, even though we have the same or higher HIV rates. Is it 
systemic racism? I don't know, but there has to be something done."

Three of her young cousins in northern B.C. are now HIV-positive. One 
fell into a downward spiral after he was dumped without support from 
foster care.

"He said, 'My family became the people on the streets of Prince 
George'," Ms. Teegee said. "He ended up getting addicted to drugs; he 
ended up in jail and contracted HIV."

The federal government will spend $55.2 million this year on its 
national HIV/AIDS strategy. Funding for the federal initiative is 
scheduled to rise to $84.4 million in 2008, when $5.9 million will be 
earmarked for aboriginal programming.

Ontario Regional Chief Angus Toulouse, chair of the Assembly of First 
Nations' health and social development committee, said the federal 
government agreed to a $1.3-billion investment in native health under 
the Kelowna Accord. But that deal has not been honoured by the 
Conservative government of Prime Minister Stephen Harper.

"It's just a matter of time before whole aboriginal communities are 
wiped out because of the HIV/AIDS epidemic," Mr. Toulouse warned. 
"It's essential that the children and youth are instructed about the 
disease and about the behaviours that will really put them at risk. 
That's the kind of action plan and activity we need."

Ms. Spittal believes concerted action must be taken, given that 60 
per cent of Canada's native population is under the age of 30 and 
increasingly at risk.

"Our message is: hit hard, hit fast. We do have an opportunity to 
make a difference," she said. "But if we continue to ignore it, we 
are going to see so many more infections."
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MAP posted-by: Beth Wehrman