- Saskatchewan has high rates of new HIV diagnoses, particularly among women and Indigenous people
- A study documented intensive outreach by doctors and community groups to pregnant women with HIV in Saskatoon
- This outreach resulted in no cases of babies born with HIV during the study period
Compared to the Canadian average, rates of new HIV infections are higher in Saskatchewan than in the rest of Canada. Among women in their reproductive years, the rate of new HIV infections in that province has been estimated to be about fourfold greater than the Canadian average. A research team in Saskatoon has noted that certain populations in Saskatchewan bear a disproportionate burden of newly diagnosed HIV, including the following:
- Indigenous people
- women
- people who inject drugs
A hurtful legacy echoes today
The researchers advanced an explanation for the situation: “Structural factors impacting Indigenous women contribute to increased risk of HIV exposure. Indigenous peoples are resisting centuries of violent colonial policies, including the Residential School System, ‘The 60’s Scoop,’ and continued disproportionate rates of Indigenous children placed into the foster care system. The downstream impacts are higher rates of violence, poverty, incarceration and lack of adequate housing: all risk factors for problematic substance use and HIV exposure.”
Enabling a better future
A team of doctors—specialists in family medicine, infectious diseases and obstetrics—cooperated and engaged community groups through the Westside Saskatoon Community Clinic. This clinic serves what the research team called the “core neighbourhoods of Saskatoon.” The clinic partners with community-based agencies that can provide access to stable housing, food and, when necessary, legal assistance.
Researchers at the clinic reviewed medical records of pregnant women with HIV who sought care between 2007 and 2017. The review had sufficient data from 55 women for analysis. At the time they sought care, the average profile of the women was as follows:
- age – 27 years
- age at time of HIV diagnosis – 27
- 60% of women were Indigenous; data was missing for most of the remaining women
- 93% of women were diagnosed with HIV before they became pregnant
Results
At the initial clinic visit, the viral loads of participants were as follows:
- 18% had a viral load less than 40 copies/mL
- 22% had a viral load between 40 and 1,000 copies/mL
- 60% had a viral load greater than 1,000 copies/mL
However, thanks to the care, treatment and support the women received, the distribution of viral loads at the time of delivery was as follows:
- 63% had a viral load less than 40 copies/mL
- 24% had a viral load between 40 and 1,000 copies/mL
- 13% had a viral load greater than 1,000 copies/mL
Readers can see that there was a major change in the proportion of women with viral loads less than 40 copies/mL over time. This change was due to some of the women initiating HIV treatment (ART), some resuming ART and others becoming more adherent.
Other issues
Many women in the study faced challenges. However, thanks to help from the clinic and referrals to community groups and other services, many of them were able to stabilize their lives and overcome these. Some challenges they faced were as follows:
Drug use
According to the researchers, 54 out of the 55 women used drugs, many via injections. The most commonly used drugs were as follows:
- opioids – 80%
- cocaine – 33%
- crystal meth – 31%
Women who were diagnosed with opioid use disorder were offered opioid substitution therapy. No information was available about women who had stimulant use disorder.
Unstable housing
Nearly half of the women (45%) in the study had unstable housing. The medical records of the women did not state what proportion who had unstable housing were ultimately offered stable housing. However, the researchers did find that, on average, suppression of HIV occurred faster among women who had access to stable housing.
Vertical transmission
There were no cases of HIV infections among babies born to women in the study. The researchers noted that in the same period in the rest of Saskatchewan, six babies were born with HIV.
Bear in mind
Despite the challenges faced by the women in the study, the researchers stated that the women showed strength and resilience. Many of them were able to achieve better personal health and good outcomes during pregnancy.
A legacy of trauma
The researchers stated: “High rates of substance use amongst this cohort highlights the prevalence of psychological trauma women are surviving. In the literature, there is a strong correlation of injection opioid use amongst people with high levels of early childhood adversity; those with five or more adverse childhood events being three times more likely to engage in injection drug use. Intergenerational trauma as a result of ongoing colonization, institutionalized racism in healthcare and policies that criminalize people who use drugs also create barriers to access prenatal care and [HIV treatment].”
Integrated care and support
The researchers also stated that by offering intensive support the clinic aimed “to reduce systemic barriers and address the holistic needs of women and their families. This may increase the likelihood of engaging in continuous ART to achieve and maintain an undetectable viral load. Increasing intensive support beyond the period of pregnancy to address the needs of women and families holistically and in culturally safe ways must be prioritized and adequately funded.”
—Sean R. Hosein
Resources
Truth and Reconciliation Commission of Canada
REFERENCES:
- Cozart M, Magnusson D, Mondal P, et al. Integrated prenatal care for women living with HIV: Primary care outcomes in Saskatoon, Saskatchewan. Journal of Obstetrics and Gynaecology Canada. 2022; in press.
- Truth and Reconciliation Commission of Canada. Honouring the Truth, Reconciling for the Future: Summary of the Final Report of the Truth and Reconciliation Commission of Canada. 2015. Available at: https://publications.gc.ca/site/eng/9.800288/publication.html