Complex and Unique HIV/AIDS Epidemic Among Aboriginal Canadians

Among the HIV/AIDS patients seen at the Vancouver Native Health Society, aboriginals are often diagnosed late and have low CD4 T-cell counts and high viral loads. Opportunistic infections rarely seen now among the majority white gay males who comprise Canada's HIV/AIDS cases are still being diagnosed by VNHS's nurse Doreen Littlejohn: Pneumocystis carinii pneumonia, Mycobacterium avium complex and cytomegalovirus.

The society's Positive Outlook Program sees up to 200 clients per day, seven days a week. "We try to stabilize them as much as possible" with primary health and other services, said Littlejohn. "Then we talk to them about starting a treatment regimen." The program dispenses treatment on site, which it terms "maximally assisted therapy." "We try to address all the determinants of health," she said.

Far more aboriginal Canadians acquire HIV through intravenous drug use (IDU) than non-aboriginal Canadians (53 percent vs. 14 percent), and native women are a disproportionate number of those infected (45 percent vs. 20 percent). A recent study of aboriginal drug-using youth in Vancouver and Prince George found hepatitis C infection rates of 57 percent and 62 percent, respectively. Half were IDUs; their mean age was 23; and HIV rates were 8 percent among both populations.

Around the world, IDU HIV rates can spike from low prevalence to 30-40 percent in a year or two, said Dr. Martin Schechter, an epidemiologist and co-investigator with the Cedar Project. In Prince George, for instance, more IDUs use cocaine, which involves more frequent injection than heroin, and IDUs have less access to care than in Vancouver, said principal investigator Patricia Spittal. About 50 percent of participants are female and many are sex workers, she said.

Very accessible needle exchanges and mobile health vans to assist sex workers should be introduced in smaller centers, said Spittal. Citing the Institute for Aboriginal Peoples' Health as a model, Littlejohn said, "the innovations are going to come at the community level, that is how you are going to get better designed programs."

Back to other news for November 30, 2006