StarPhoenix: Study tracks HIV
Study tracks HIV
Researchers hope to find reasons behind increase in infections
By Hannah Scissons, The StarPhoenix May 6, 2010
Half of those at the highest risk of contracting HIV in Saskatoon have already been dealt one of the harshest blows in life: They were sexually assaulted as children.
That's one of the findings of a research project that is following 1,000 injection drug users and sex trade workers in the city for two years.
The research -- an element of the Saskatoon HIV/AIDS Reduction (of harm) Program, or SHARP -- is aimed at determining why HIV is spreading at an exponential rate in a city where the number of new cases of HIV per year rose to 94 in 2009 from 16 only five years earlier.
Once there's a better understanding of why HIV is spreading, there will be a better chance of preventing new cases in the future, said Mark Lemstra, the lead researcher on the project.
"You can't prevent something when you don't know what the problem is," he said. "Two years from now, we want to be able to specifically recommend actions to reduce HIV."
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The first step of the research was finding and surveying 1,000 injection drug users and sex trade workers who have not tested positive for HIV. The split between the two groups was about 600 injection drug users and 400 sex trade workers, while approximately 200 identified themselves as both daily injection drug users and sex trade workers.
The surveys -- which took place between April 2009 and April 2010 -- consisted of a detailed questionnaire. The respondents were found at four sites in Saskatoon: West Side Community Clinic, AIDS Saskatoon, the Friendship Inn and the SHARP site.
A separate group of 159 people who have tested positive for HIV also filled out the same survey.
The researchers are now examining the extensive data collected, and one of the findings that has already caught their attention is the high number of respondents at risk of getting HIV who have experienced severely traumatic events in their lives.
Those events include being sexually assaulted as a child, being permanently separated from a parent or parent figure when they were a child, being physically assaulted or abused by their adult partner and the death of a child.
Respondents were asked about a total of 13 traumatic events. Two-thirds of them had experienced at least six of the events.
"Some of these things are suggesting they've had hard lives and to just simply say they're an injection drug user and they're making bad choices, it's more complex than that," said Lemstra.
Nicole White, executive co-ordinator at AIDS Saskatoon, wasn't surprised to learn a high number of at-risk people reported being abused. The issues around HIV are complex, she said.
"A lot of these folks have sexual abuse trauma," she said. "That is a huge piece that I really hope as an agency and as a community we can really start to act on, because the silence around this type of thing is just terrible."
The residual impact of residential schools is part of the problem, White said, but many people who didn't attend residential schools are affected by abuse as well.
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The treatment of those with HIV is also a complex issue, said White. Across Canada, many people can live with HIV for decades, but Saskatoon is seeing a high death rate.
"This is not what HIV should be. It shouldn't be looked upon as a death penalty," she said.
Many of those who have HIV and who are at risk of contracting HIV are dealing with addictions that make even talking about treatment difficult, she said. Many are also homeless and don't know where their next meal is going to come from.
White's statements are confirmed by the SHARP survey results, which looked at respondents' socio-economic status.
Some of the findings:
- 75 per cent have less than high school graduation;
- 90.3 per cent are unemployed;
- 71.2 per cent make less than $10,000 a year;
- 33 per cent consider themselves homeless, while 60 per cent don't live in their own home or apartment.
The issue of housing is one that came up not only in the surveys, but also in the conversations the researchers had with respondents, said Lemstra.
"We kept hearing about housing, about people's desires to commit crimes in order to access the justice system so they would have a place to sleep," he said.
Half of the respondents to the survey said lack of adequate and affordable housing is a major problem in terms of accessing care.
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The respondents were also asked about behaviours that could increase their risk of getting HIV.
Failure to practise safe sex was one -- about 20 per cent reported it was too much of a hassle to practise safe sex all the time.
Nearly half of the injection drug users (47 per cent) have shared injecting equipment. The average number of injections per day among drug users was 3.3.
Access to services appears to be an issue among injection drug users: 57 per cent reported they had been unable to get into a drug treatment program, with the biggest concern being the program didn't have room or patients were put on a waiting list.
The Saskatoon Health Region has identified the rising rate of HIV in the area as an "epidemic."
When contacted about the SHARP research, a health region spokesperson said the region preferred to wait to comment on its HIV strategy until after an announcement expected today from the provincial government about a provincewide strategy, because that could mean significant changes to the region's programming.
When the city's latest HIV numbers were released one month ago, the region's chief medical health officer said the trends are worrisome and determining how to prevent the spread of HIV is key.
"Because of the increased numbers we've been seeing in the province and specifically in Saskatoon, we've been working with the province on developing a provincial HIV strategy that is reaching its final form as we speak," Dr. Cory Neudorf told The StarPhoenix in April.
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The managing partner of the SHARP program -- which is primarily funded through grants from Health Canada and supported by the health region as well as a number of city organizations -- is the Saskatoon Tribal Council. The research is only one part of the program; a clinic offering services such as a needle exchange, addiction and mental health counselling and community outreach has been operating in the inner city for two years.
It's no secret that HIV is hitting aboriginal people disproportionately hard, said Ceal Tournier, general manager of the health and family services for the Saskatoon Tribal Council. Most of the respondents to the SHARP survey (87 per cent) identified as aboriginal.
"We do know the urgency," she said. "We deal with it at the community level, the family level, the individual level."
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SHARP SURVEY -- EVENTS EXPERIENCED BY RESPONDENTS
Physical assault by adult partner 58%
Physical assault by someone other than adult partner 58%
Physical assault as a child 64%
Seeing family members assaulted when you were growing up 81%
Sexual assault during adult life 36%
Sexual assault as a child 51%
Seeing someone physically assaulted or abused 79%
Seeing someone seriously injured or violently killed 57%
Losing a child through death 29%
Death/permanent separation
from parent/parent figure before age of 18 48%
Death of adult partner 51%
Attended a residential school 32%
Had a parent/grandparent who attended residential school 65%
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