Views From the Front Lines: STOP HIV/AIDS
The STOP HIV/AIDS pilot project has been running since 2009/2010. Looking back at the past two years, what would you say are some of the key lessons learned?
Northern Health covers a vast geographical area with a great diversity of people and wide range of services. When we built our STOP HIV team, we had to take it all into consideration. Outside of Vancouver, STOP was focused primarily on Prince George but in the back of our minds, we always had to build for all the communities that are part of Northern Health. We wanted to eventually move the programs we designed for Prince George into those other communities as well.
[As part of the STOP team,] people from every discipline you can imagine sat around the table and it created one big communication mishap. In my opinion, the biggest lesson learned is that developing and delivering a comprehensive, effective and efficient HIV program is very difficult when everyone comes with their own ideas and language of how to achieve those goals. So we had to break down those barriers that existed between sectors and agencies. We developed better language, communication tools and working relationships over the last two years.
People might assume that what works in Vancouver is going to work in the North too. That's not at all the case. The populations we need to focus on here are not the same populations Vancouver focuses on. We are unique in terms of not only the demographics of our population but also the geographical challenges that the North represents.
For example, our population living with HIV is predominantly Aboriginal, approximately 60% women. The populations we work with are very transient. So when they return to their reserve or home communities, we usually lose track of them. This often results in people not having primary care follow-up. The communication between urban care, rural care and on-reserve care is not where it needs to be. Also, for much of our population, alcohol is a driving force in their lives.
To your knowledge, what has the impact of STOP been on services for people living with and at risk for HIV? How has it changed or improved the patient experience?
Additional staff have now been hired throughout Prince George to provide services including an HIV-focused pharmacist who's very mobile. In addition, both our pharmacist and HIV specialist now have access to Telehealth so they can provide services to clients living in surrounding communities.
Are the increased services making a significant impact yet? I don't think so because we're still in the early stages -- we still need to figure out how to improve access for existing clients and potential clients. I believe we have laid the groundwork to truly improve the patient experience, but a lot of hard work remains.
We are in the process of implementing a Medication Adherence Support Program (MASP) for people living with HIV to support those on treatment. The program will provide clients support seven days a week from a holistic care perspective that acknowledges people's mental, spiritual, physical and emotional needs. The program will provide access to antiretrovirals up to 12 hours a day, work with clients to remain engaged with healthcare, to regain independence, achieve stable housing, build self-esteem, etc. ... with the overall goal of helping clients get their life back on track. Each client will have a care plan tailored to their individual needs, to help them meet their desired goals.
Northern Health has hired a communication officer specifically focused on HIV. She is presently working on an HIV education/awareness campaign that will be promoted to all of Northern Health. Central Interior Native Health Society, which has an Aboriginal Health clinic that serves 62 clients living with HIV has a dedicated HIV nurse who is able to triage clients' as needed.
I don't know that the patients necessarily have an improved experience as a result. I think that stigma still plays a major role and drives individuals accessing HIV services or considering accessing HIV services to be overly hesitant. This can result in people not going for testing or receiving proper healthcare. The marginalization of our Aboriginal population, the continued effects of colonization, alcoholism, injection drug use, mental health, the polices of the federal Conservatives are all key components of life that people struggle with every day ... I don't think that we've made a dent in those at all. These factors are rampant. What I would say has improved is access to services, the flexibility of support (client-specific) and the sustainability of that support.
One of the goals of STOP has been to test and treat groups in Vancouver and Prince George who have been disproportionately affected by the epidemic and groups who face multiple barriers to accessing information and care -- including Aboriginal people, gay men and other men who have sex with men, people with addiction, housing and mental health issues, among others. How successful do you think the project has been at reaching these populations?
I think we've made testing more widely available both in terms of who we test (we now offer an HIV test to anyone who's ever had sex once), where we test, and the type of tests offered. However, I don't think that we've reached a greater percentage of the population yet -- not in Prince George anyway.
In Prince George, we focus on people who use the needle exchange. We need to make more of an effort to provide testing and services to the gay and MSM communities because we have seen rates in those communities start rising again recently but we haven't seen any targeted testing. We don't specifically target women. Yes, all pregnant women are screened but I'm not seeing anything that targets women and those other high-risk groups. I think that that's one of the parts of STOP in Prince George where we may have fallen behind; we are working on this.
Among healthcare professionals, there's more awareness. The new full-time HIV testing nurse will focus exclusively on testing high-risk groups. And with the newly hired communications person dedicated to HIV, I think we'll see testing rates go up. Northern Health has organized a series of testing clinics to test for HIV and other STIs as well as provide HIV education. The groups being focused on are federal and provincial parolees (men only), MSM, women (sex trade workers and newly single women), LGBT and people living with mental illness and addiction.
STOP has captured media attention nationally and internationally, and it has sparked controversy. While the strategy has been hailed as groundbreaking, some have also expressed concern that it may threaten people's privacy and autonomy. How do you respond to these concerns?
I do not see how STOP is threatening people's privacy in any way. Testing is confidential. Yes, it's reportable but reporting occurs within a framework of confidentiality. Treatment is confidential within the doctor's office so we're not asking people to tell the world they have HIV. We're looking to inform people and we're looking for those people who are living with HIV and don't know it. So we're essentially trying to protect people and protect future generations. I really don't see questions of privacy and autonomy as issues at all. I have never heard a single person voice this concern. We talk every day about maintaining privacy and confidentiality, and not once have I heard people say that STOP is compromising people's privacy.
This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication Prevention in Focus: Spotlight on Programming and Research. Visit CATIE's Web site to find out more about their activities, publications and services.
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