Inequities in Responding to HIV and Hepatitis C in Atlantic Canada

1
Inequities in Responding to HIV and Hepatitis C
in Atlantic Canada

• Susan Kirkland PhD, C Marshall MPA, M Dykeman
  PhD, G Mugford PhD,
• J MacDonald MN, I Sketris PhD, L Jackson PhD, K
  Peltekian MD, S Taylor MN,
• T Dutchyn MA, A Myles MSc
• CPHA June 2008

2
What is AIRN?

• A network of government, community, academic, and
  other stakeholders with an interest in HIV/AIDS
  and Hepatitis C
• Originated with a core group of researchers from
  a variety of disciplines based at four Atlantic
  universities (UPEI, UNB, Dalhousie, Memorial)
• Funded by Canadian Institutes of Health research
  (CIHR) Interdisciplinary Capacity Enhancement
  Grant 2005 2009
• Work collaboratively with community and
  government stakeholders to reduce inequities,
  create an evidence base to support the
  development of effective strategies, policies,
  programs, and services

3
Rationale

• Although unique, HIV/AIDS and Hepatitis C share
  features in common
• Emerging prevalence among marginalized
  populations
• High risk behaviours associated with transmission
• Stigma and negative impact on the lives of
  infected and affected individuals
• Symptoms can be debilitating, treatment can be
  toxic
• Chronic, serious and potentially fatal health
  consequences for individuals
• Major public health burden for society

4
Health Inequities in HIV/HCV

• Increased prevalence in marginalized groups IDU,
  MSM, incarcerated, youth at risk, immigrant
  population
• Social determinants of health related to health
  outcomes those with less access to resources
  have poorer health outcomes
• Large geographic distances, fewer resources and
  services, sparse concentration of
  researchers/practitioners
• Stigma, discrimination

5
Positive HIV Test Reports(Nov 1, 1985 Dec 31,
2006)
Province/Territory n
British Columbia 12,682 20.3
Yukon 47 0.1
Alberta 4,553 7.3
NWT/Nunavut 42 0.1
Nunavut 3 0.0
Saskatchewan 707 1.1
Manitoba 1,396 2.2
Ontario 27,689 44.3
Quebec 14,112 22.6
New Brunswick 357 0.6
Nova Scotia and PEI 725 1.2
Nfld and Labrador 247 0.4
HCV 3107
PHAC HIV and AIDS in Canada Surveillance Report
to Dec 31, 2006
6
Objectives

1. Contribute to a research agenda in HIV and HCV
   prevention strategies, interventions, and policy.
2. Enhance interdisciplinary collaboration and
   promote cross fertilization for the prevention
   and enhancement of care of both diseases.
3. Train a new generation of researchers to build
   capacity for social research on HIV/HCV in the
   region.
4. Ultimately, shape policy and program responses to
   prevent the transmission of HIV and HCV, and to
   improve the quality of life of those infected and
   affected by HIV and HCV.

7
Building Capacity Through Cross-fertilization

• Cross fertilization occurs at multiple levels
• Across diseases
• Across disciplines
• Across methodologies
• Across sectors
• Across provinces
• Across CIHRs pillars of research (biomedical,
  clinical, health systems and services, and the
  social, cultural factors that affect the health
  of populations)
• Coordinating efforts across the Atlantic region
  will have a much greater impact, particularly
  with respect to information dissemination,
  uptake and policy development

8
Social Determinants Research Agenda

• Social influences that require greater research
  attention
• the intermediate social context or social
  networks
• the macro-level social influences or conditions
• Macro-level forces have been found to be
  especially important in determining rates of
  transmission of HIV and HCV
• gender, racial, and economic inequities
• power imbalances within communities, regions,
  across countries, and globally
• Differential access to health services

9
Environmental Scan

• Identified the range of policies, programs,
  services and research in the region to serve as
  a foundation to guide future research and
  planning
• Highlights
• Significant service gaps in prevention and harm
  reduction approaches across the region
• More initiatives in HIV/AIDS than HCV, although
  greater integration is occurring
• NS only province to have AIDS strategy, standards
  for blood borne pathogens
• Research and policy activities not coordinated
  across the region
• Mechanisms to support coordination of effort do
  not exist

10
Regional WorkshopFrom Research to Policy to
Action!

• Benefits, models, for working together
• Access to best practices
• Sharing resources, responsibility (take risks)
• Avoid duplication
• United voice
• Value, validity

• Defining a research agenda for the future
• Aging
• Labour force participation
• Income support
• Cross issue services
• Why prevention not working
• Housing, mobility, urban/rural

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Community Consultations

• Consultations in 8 communities across Atlantic
  Canada Fall 2007
• 100 participants from multiple sectors
• Key issues
• Access to harm reduction strategies (needle
  exchanges, MMT)
• Prevention education and outreach (sexual health)
• Access to treatment
• Access/promotion of early testing and diagnosis
• Services, supports for youth, youth at risk

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AIRN Atlantic Advisory Committee

• Raise the profile of prevention and management of
  HIV/AIDS and Hepatitis C in Atlantic Canada
• Exchange information, knowledge, and ideas
• Enhance partnerships and promote networking
• Enhance knowledge uptake and utilization of
  research findings into policy, programs,
  practice, and further research
• Contribute to defining an Atlantic Canada
  research agenda of the future

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Summary Observations

• Much research work underway by various players
  government, community, academia
• Greater recognition of the value of research and
  of working together
• Challenges
• using evidence to change policy practice
  (barriers, resource constraints, leadership,
  philosophical beliefs)
• KTE, sharing information, integration to avoid
  duplication

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Are we making a difference?

• Increasing awareness of the inequities and issues
  related to the prevention of and response to
  HIV/HCV in the region
• Increasing the evidence base upon which to make
  sound public policy
• Influencing policy change through consultation/
  collaboration, through AAAC as a direct conduit
  to policymakers, and through development of an
  action plan to follow-up on the consultations
• Ensuring research conducted is responsive to
  regional needs and priorities and involves key
  stakeholders in its design and execution

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Thank you!
To contact us susan.kirkland_at_dal.ca cmarshall_at_n
s.sympatico.ca Website www.med.mun.ca/AIRN