Since the initial outbreaks of COVID-19, the majority of Canadian medical personnel have been focused on tackling testing, contact tracing, and treatment related to the pandemic. Among these medical personnel are doctors and nurses who under normal circumstances treat patients with other infectious diseases such as HIV, hepatitis C, chlamydia, and syphilis. Due to this diversion in personnel, access to testing and preventative/early-intervention care measures for other infectious diseases have been extremely limited; “When you look across the country, the anecdotal evidence is that [HIV] testing is almost non-existent,” said Gary Lacasse, executive director of the Canadian AIDS Society. He pointed to issues in both the availability of HIV and other infectious disease testing, as well as the official tracking of testing and early-prevention measures.
It’s essential to note here that it didn’t have to be this way – if the Canadian government had prioritized stricter lockdown measures and curbed the initial spread of COVID-19 from the outset of the pandemic, the public healthcare system would be much better equipped to treat other infectious diseases while also monitoring the spread of COVID-19. Even though the state of public health since the onset of the pandemic means that resources have been stretched thin, this is not an excuse for the erasure of these diseases and those who live with them. Rather, it is our responsibility to ensure that our government’s strategies for continuing to address COVID-19 adequately accommodate those living with other infectious diseases.
The fight for HIV and other infectious disease treatment is an ongoing one. In 2016, Canada committed to achieving three key targets aimed toward the elimination of HIV as a public health threat by 2030:
1. diagnosing 90 per cent of people with HIV;
2. treating 90 per cent of those diagnosed;
3. a 90 per cent success rate of suppressing the virus to undetectable levels in those treated.
Supervised consumption sites, HIV prevention clinics, and counselling services have all been cornerstones to Canada’s strategy to combat the spread of other infectious diseases, yet all of these have taken a hit from reallocation of resources due to COVID-19.
Existing structural inequities in the treatment of infectious diseases
It’s important to recognize the disproportionate impact that these infectious diseases have on communities that already receive a significantly lower standard of care from the public health system.
Intravenous drug use contributes to the spread of HIV and other infectious diseases, for example, through needle sharing. Since those struggling with addiction or who are homeless are statistically more likely to take drugs intravenously, they are put at a higher risk. Indigenous communities are also disproportionately exposed to a rise in infectious disease; pre-COVID-19 counts report that although Indigenous people represent 5 per cent of Canada’s population, they account for approximately 11.3 per cent of new HIV cases reported in Canada. Colonialism, racism, social exclusion, and suppression of self-determination have all been identified as determinants that have influenced Indigenous health and increase the risk of contracting HIV. Within this, lack of culturally safe care – meaning care that is compatible with Indigenous structures of knowledge and allows for self-determination – presents a structural barrier to Indigenous people attempting to access HIV treatment.
Structural inequalities such as poverty, stigma, homelessness, and inequitable public health access have been exacerbated by the pandemic. As many Canadians face job insecurity and loss of housing, the associated level of susceptibility rises. As health resources are diverted to address the pandemic, the availability of resources for individuals in precarious situations decreases, effectively limiting the routes through which an individual can access support. The effects of COVID-19 are also not distributed evenly across socio-economic and racial groups: both low-income workers and people of colour have had to contend with higher rates of COVID-19 infection and job loss due to the pandemic. This results in people of racialized groups and people in financially precarious situations simultaneously having to contend with heightened susceptibility and limited access to testing, early-intervention measures, and care that would curb the spread of HIV and other infectious diseases.
Breaking down stigma and barriers of access: a harm reductionist approach
Stigmatization creates a barrier to the accessibility of resources that has to be broken down in order for early testing and prevention strategies to have a fighting chance; this is why taking a harm reduction approach is essential in any efforts to help those living with HIV or other infectious diseases. Stigma, “the negative association of a person or group who share characteristics of a certain disease,” stops people from accessing treatment by making individuals reluctant to seek as well as treat that diagnosis. Stigmatization can take a significant mental health toll through increasing isolation, anxiety, and depression, all of which can result in hesitancy to access care. This makes destigmatization an essential first step to combating the spread of HIV and other infectious diseases. Destigmatization has proven its importance within a larger framework of harm reduction; it has played a tangible role in increasing the accessibility of supervised consumption sites throughout the opioid epidemic.
In spite of this, de-stigmatization alone is not enough. The only way to fully combat the rise of infectious diseases during the COVID-19 pandemic is through material support to harm reduction initiatives, including supervised consumption sites, needle exchanges, and HIV prevention clinics. HIV self-testing kits, recently approved by Health Canada, are a promising development to mitigate the risks associated with the current strain on the healthcare system, although they are currently inaccessible; they aren’t readily available at pharmacies yet, and cost $34.95 plus shipping from bioLytical (an issue for those who are homeless or housing-insecure). All of these things are proven to reduce HIV infections, yet have received little support since the start of the pandemic. Dr. Alex Wong, an infectious disease specialist at Regina General Hospital, believes that the public health system is “going [to] play catch-up for years” with the new rise in HIV and other infectious diseases. This presents a fork in the road: either we take this moment to recentre healthcare practices to cater to those most vulnerable and invest now in preventative and early-intervention care measures for HIV and other infectious diseases, or we continue to fail those most impacted by inequitable healthcare access.
During COVID-19
The Canadian government has failed not only people living with HIV and other infectious diseases, but also the medical personnel and frontline workers that have worked throughout the pandemic to meet public health demands. Frontline medical personnel have been fighting COVID-19 for over a year now, and provincial governments continue to emphasize reopening and economic gains amidst surging COVID-19 case numbers. This only prolongs the diversion of public health resources, disadvantaging those living with HIV and other infectious diseases and threatening the implementation of effective care measures in the future.
It is imperative to remember that these competing crises of COVID-19 and other infectious diseases could have been controlled, had both federal and provincial governments been proactive and more carefully managed public health resources in responding to the pandemic. Lockdown measures aimed at eliminating spread with continued economic aid to individuals (such as CERB) could have mitigated the felt effects of financial precarity that lead to increased susceptibility to the spread of HIV and other infectious diseases. These measures could have also shortened the duration and intensity of COVID-19 spread in Canada, resulting in greater availability of health resources to devote to prevention and early-intervention care for HIV and other infectious diseases, as well as limited the frontline healthcare worker burnout that may prove limiting in the future. The Canadian government should already have done more.
Looking forward
In regards to infectious diseases, maintaining the status quo demonstrates not only a profound moral failure on the part of the Canadian government at all levels, but also a fundamentally structural issue that needs to be addressed. This is a structural issue that can only be remedied through destigmatization, accessible testing, and early-intervention/care measures.
These are all feasible steps, and although they inherently require structural change, taking action in the community makes a difference. We can get involved at a local harm reduction initiative, such as AIDS Community Care Montreal, Head and Hands, and CACTUS Montreal. locally. We can practice destigmatization in our social environments, as well as our academic and professional environments. We can support calls on the government to provide services like supervised consumption sites, to provide better education and protection to people susceptible to HIV and other infectious diseases.
The road out of COVID-19 will be difficult, and will have serious implications for our social and economic circumstances. Dealing with the compounding effects of crisis after crisis will leave many having a difficult time processing the trauma of the past year. For those processing this alongside processing a heavily stigmatized infectious disease diagnosis, the difficulty will only grow, especially without adequate intervention and care. We have a responsibility, as individuals and as a society, to do everything in our power to ensure that our public health institutions are protecting those who are systematically left unprotected amongst us, particularly those impacted by the rise of HIV as well as other infectious diseases.