HIV rates spiking in rural Saskatchewan

[Darth Wong]

And people from these flatland rural areas still think it's places like Toronto that you have to worry about:

http://www.cbc.ca/health/story/2009/03/19/hiv-rate.html

Saskatchewan's HIV infection rate a 'crisis': top health doctor
Last Updated: Thursday, March 19, 2009 | 6:51 PM ET
CBC News

Dr. Moira McKinnon, Saskatchewan's chief medical health officer, is concerned about the province's rising incidence of HIV. Dr. Moira McKinnon, Saskatchewan's chief medical health officer, is concerned about the province's rising incidence of HIV. (CBC) Health officials in Saskatchewan are pressing the alarm button over what they are calling a "crisis" in HIV infections.

New infections with HIV, the virus that causes AIDS, were detected in 174 people in Saskatchewan in 2008, according to information obtained by CBC News from the provincial Health Ministry. That is a 40 per cent increase over the 124 new cases detected in 2007.

"The crisis is that people are being infected with an invariably fatal disease at an increasing rate in Saskatchewan," Dr. Moira McKinnon, the province's chief medical health officer, told CBC News. "We have a big problem. We're going to have to act quickly and work hard to stop this acceleration. It's an acceleration of rate, it's not just a steady increase."

McKinnon said she would not be surprised if 200 to 300 new infections would be found by the end of 2009.

"A lot of these new cases come from abuse situations and poverty situations," McKinnon added. "So as a community we need to look at the upstream factors and why this has happened."

Danita Wahpoosewyan doesn't know how she acquired HIV, but she tested positive three years ago.

"I didn't believe it," Wahpoosewyan recalled of being told she was positive. "I thought I would never, ever get it."

But Wahpoosewyan was leading a high-risk lifestyle: injecting drugs with shared needles and in a relationship with a man who was HIV positive.

Today, Wahpoosewyan works for a Regina community organization, Red Ribbon Place, on its needle-exchange program for intravenous drug users.

With herself — and much of her immediate family — living with HIV, Wahpoosewyan knows all too well about the statistics that health officials are concerned about.
Rising rate linked to drug use

"I have three nieces... and they all got it," Wahpoosewyan said. "I think they caught it before me. But they were always at my house, fixing."

"Saskatchewan IDU, intravenous drug users, use up to 20 needles a day because they use injectable cocaine," McKinnon noted in trying to account for the province's soaring rate of new HIV infections. "In other provinces, they tend to smoke the cocaine."

McKinnon added that some people are testing positive for a unique, and troublesome, strain of HIV.

"Our HIV cases are not responding well to treatment," McKinnon said. "It also seems to be a more virulent form of HIV."

McKinnon said work has already begun to co-ordinate a response to Saskatchewan's alarming HIV infection rate, including increased testing and developing a strategy with law enforcement, health care and community agencies.

OK, let's review the most pertinent part of that article:

"I didn't believe it," Wahpoosewyan recalled of being told she was positive. "I thought I would never, ever get it."

But Wahpoosewyan was leading a high-risk lifestyle: injecting drugs with shared needles and in a relationship with a man who was HIV positive.

What the fuck? How could someone be so fucking stupid as to not realize they were at a high risk of getting HIV with a lifestyle like that?

[Samuel]

Denial "it only happens to other people".

Although this is really pushing it. DId she know her partner was infected?

[Lagmonster]

Although this is not in any way necessarily connected to the mindset of the woman in the article, I once had a Kentucky preacher say to me with a straight face that only gays get AIDS. And we all remember the "you can get AIDS from toilet seats" bullshit myth from the 80s/90s. There's a lot of misinformation and shitty information going around concerning quite a few diseases and even treatments; it's not inconceivable that a poverty-line idiot druggie might not be up to speed on even the most basic information regarding AIDS.

[TheKwas]

And people from these flatland rural areas still think it's places like Toronto that you have to worry about

Umm... what is this supposed to mean? This is Saskatchewan we're talking about, and assuming from personal experiance and the acedote provided in the article (Danita Wahpoosewyan), we're talking primarly about Saskatchewan's aboriginal minority, which wouldn't give a bloody hoot over Toronto.

If we're talking simply about crime and poverty, I think many people that live in Regina view Toronto as an upper-class paradise in comparison. From Wiki:

Maclean's magazine named Regina "Canada's most dangerous city" in 2008 edition.[49][50] The article used 2006 crime data from the Canadian Centre of Justice Statistics for the 100 largest communities in the nation. Regina's overall crime rate was 143.3% above the national rate. It led the nation in aggravated assaults, and was third in break and enters and robbery. The article states that Regina would be in the top 10% of all US cities for break and enters, and would be among the ten worst US metropolitan areas for robbery. A previous edition of Maclean's had singled out the North Central neighbourhood as Canada's worst neighbourhood.[51]

This is the city that stopped making playgrounds in North Central because mothers would leave their children at them in the middle of the night while they bought their drugs.

[Justforfun000]

"The crisis is that people are being infected with an invariably fatal disease at an increasing rate in Saskatchewan," Dr. Moira McKinnon, the province's chief medical health officer, told CBC News.

Why are we still seeing this kind of scaremongering by people who should know better? "Invariably"? According to the dictionary, that mean always..constant, subject to no change..
This is bullshit. It's been removed from the list of 'fatal' diseases. It's now considered a chronic, manageable condition that can potentially boast little to no impediment to natural longevity with appropriate medication. I don't want to downplay the intent of the article to wake people up in terms of their risk taking and personal health responsiblity, but I'm a little irked at seeing this kind of hyperbole by people who should know better.

"I didn't believe it," Wahpoosewyan recalled of being told she was positive. "I thought I would never, ever get it."

But Wahpoosewyan was leading a high-risk lifestyle: injecting drugs with shared needles and in a relationship with a man who was HIV positive.

Oh you poor dear....how you had NO idea....
What could possibly have been the first clue?

Fuck, I mean I don't judge her for her mistakes per se, but being that oblivious is ridiculous. People in the mid fucking EIGHTIES already knew that sexual contact and injecting drugs were the main risk factors. Was she born yesterday?

[Nieztchean Uber-Amoeba]

Hrm. First, there isn't any fear-mongering among Saskatchewanians about how bad Toronto is. We're aware that Saskatchewan is a cheap, easy place to raise a family and that Toronto's living costs would be prohibitive to the kind of housing and lifestyles we enjoy. Otherwise, most everyone seems to want to gravitate to Montreal and the big cities.

Second, as a Reginan, I haven't heard anything about this, but from the article, I can see why. First, we have atrociously high rates of all STDS (I'm not sure if we're still the Chlamydia capital of Canada, but we were last year). In short, it seems the HIV problem is a First Nations health problem, and since Regina has one of the highest proportions of First Nations in Canada, well, there's your problem. First Nations people live in pretty terrible conditions, all told, most of them are below the poverty line, corruption and alcoholism are rampant, etc. They're the equivalent of America's urban blacks, except that their problems are, to an extent, even more endemic and systemic thanks to the legal mess of Treaty rights and subsequent failed attempts to forcedly assimilate/ segregate/ reconcile the FN people.

And frankly, Regina's crime problems are skewed by our population. We have one of the highest murder rates in Canada, but that's because our population is a little below 200,000, and we had only 8 murders in 2008, as I recall. Of those, nearly all were in North Central, and most were First Nations. There's next to nil crime in the East (suburbs), South (mixed neighbourhoods) or Downtown parts of the city.

Not to say that we're the best city ever (though Saskatchewan is in a great place as far as economics and demographics are concerned). We still have extremely high crime and STD rates for a Canadian city, but we're still nowhere near the crime levels of, say, Baltimore. But we are probably just as racist towards our Designated Minority.

And as far as this woman's ignorance of the dangers of HIV infection, I can kind of see it and kind of not. On one hand, First Nations education is appaling. Thanks to the legacy of Residential Schools, not only are most FN adults ignorant of everything on both sides of the cultural fence, but they strongly distrust the government and sending their children into the evil government's grasp again after they themselves were systemically abused by the system. Reservation schools are, like most things on reservations, horrificly underfunded. And, of course, those traditionalist elders who want to teach their children in old traditional Aboriginial ways give them no useful skills whatsoever and most definitely won't be teaching them about the details and protection against HIV.

On the other hand, in Regina, at least, there's been a massive STD Awareness advertising campaign over the past few years. You know how I know we're the Chlamydia capital of Canada? They put up billboards telling us that. And since Health is a provincial domain, I assume that this kind of thing has been going on in the rest of the province.

[Broomstick]

"The crisis is that people are being infected with an invariably fatal disease at an increasing rate in Saskatchewan," Dr. Moira McKinnon, the province's chief medical health officer, told CBC News.

Why are we still seeing this kind of scaremongering by people who should know better? "Invariably"? According to the dictionary, that mean always..constant, subject to no change..
This is bullshit. It's been removed from the list of 'fatal' diseases. It's now considered a chronic, manageable condition that can potentially boast little to no impediment to natural longevity with appropriate medication.

Yeah, if the side effects of the medication don't kill you, or shorten your life. It may be relegated to "chronic and manageable" but arguably it's still worse than, say, diabetes or heart disease. If you don't have access to the needed medications it IS a fatal disease. If the virus type you have is resistant to medication you can also be shit out of luck, too.

[Justforfun000]

Yeah, if the side effects of the medication don't kill you, or shorten your life. It may be relegated to "chronic and manageable" but arguably it's still worse than, say, diabetes or heart disease.

Actually part of the reasons it's been demoted to a less serious classification is that the newer drugs are far less toxic than the previous ones used. There are side effects of course, and some of them can be serious, but overall they are very well tolerated and they are quite effective provided drug adherence is practiced with good compliance.

It's actually arguable if it's worse than diabetes or heart disease...both of those tend to shorten lifespan quite frequently, and the complications that come with it are no picnic....neuropathy, bypasses..

They still need more time to say with absolute assurance, but the projections for HIV patients on current meds with no resistance or non-responsive issues, have an excellent prognosis for a near normal lifespan.

If you don't have access to the needed medications it IS a fatal disease. If the virus type you have is resistant to medication you can also be shit out of luck, too.

Naturally...but that's ditto for Diabetes too especially. But even to nitpick a little further, it's not 100% fatal either. That's a myth. There are a small subset of people that are likely to never progress to AIDS. (I know it's Wiki..but it's basically accurate in summing it up)

http://en.wikipedia.org/wiki/Long-term_nonprogressors

[Broomstick]

Yeah, if the side effects of the medication don't kill you, or shorten your life. It may be relegated to "chronic and manageable" but arguably it's still worse than, say, diabetes or heart disease.

Actually part of the reasons it's been demoted to a less serious classification is that the newer drugs are far less toxic than the previous ones used. There are side effects of course, and some of them can be serious, but overall they are very well tolerated and they are quite effective provided drug adherence is practiced with good compliance.

Oh really? Pathologies of how the body handles and distributes fat, soaring levels of lipid in the blood, dysfunctions of the liver and various other organs...? It's arguable how "well tolerated" that all is. Not to mention the "cocktails" require a compliance schedule that very few people really can reliably follow day after day, year after year.

It's actually arguable if it's worse than diabetes or heart disease...both of those tend to shorten lifespan quite frequently, and the complications that come with it are no picnic....neuropathy, bypasses..

Yes, well, compliance is a huge part of any chronic illness. I'm familiar with both heart disease and diabetes due to my family history. The reasons they shorten lifespan have a great deal to do with the same reasons that HIV patients have shorter lifespans: management of these conditions requires strict adherence to a complex and complicated regimen. It is difficult for even well organized and educated people to truly comply with these treatment programs - even more difficult for drug abusers, for the uneducated, for those who lives are in turmoil and chaos for one reason or another. The fact of "follow this set of rules and you'll be healthy and live longer" clashes with the reality of human nature and human lives.

They still need more time to say with absolute assurance, but the projections for HIV patients on current meds with no resistance or non-responsive issues, have an excellent prognosis for a near normal lifespan.

You could say the same of most heart patients or diabetics - the problem is avoiding resistance and keeping on the medication schedule for life, with no breaks. That is very difficult for real human beings to do. It's a problem with every chronic disease or condition.

But even to nitpick a little further, it's not 100% fatal either. That's a myth. There are a small subset of people that are likely to never progress to AIDS. (I know it's Wiki..but it's basically accurate in summing it up)

In fact, there are a few people in the world who can't get HIV at all - it is unable to gain a foothold, their bodies clear it completely. But the rules aren't set for the exceptions, they're set for the regular folks. Even rabies is no longer 100% fatal, but if you're exposed it's best to treat it as if it is so you don't get slack in getting medical help.

[Justforfun000]

Oh really? Pathologies of how the body handles and distributes fat, soaring levels of lipid in the blood, dysfunctions of the liver and various other organs...? It's arguable how "well tolerated" that all is.

While some of these examples above are still possible, they are not as common with the newer drugs and the specific regimes. Here's a simple way to show you as one example...lipoatrophy where you lose the fat in your face and limbs...it's a more specific type of lipodystrophy. Yes this was common in the early days of protease inhibitors, but they traced it to certain drugs in particular as a rule.

This is from The Body which is a very reputable site on HIV/AIDS. The question and answer following address this quite well:

http://www.thebody.com/Forums/AIDS/Meds ... 93235.html

HIV Medication Ads
May 25, 2008

This whole lipodystrophy issue is a joke and all most of you do is try to appease us by saying new drugs may not have the same side effects... but how does that help the people who are dealing with it now.... Telling us that we will not get our fat restored, or most of it, is very disheartening and makes us care less about what meds come out in the future.

How come the ads I see all over NYC, re. HIV Medications, show beautiful, shirtless models? This is totally false advertising and I'd love for them to show someone suffering from lipo-side effects. I personally feel that this may be a great way to eradicate this virus. The greed of these pharmaceutical companies, et al, is amazing.

Dom

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Response from Dr. DeJesus

Hi Dom. It is a loaded question, so I will just take a bite at it.

After a big controversy about the use of uninfected people by companies on their ads a few years ago, HIV companies are currently using people really infected with HIV for their ad campaigns; although no one can tell if the models are indeed talking the medication that they are advertising, because this is still private personal individual medical information.

Regarding lipoatrophy, years of research and investigation have narrowed the culprit for lipodystrophy to a handful of medications. So, new drugs in development (and recently approved) are put under a significant amount of scrutiny before they are released to ensure they will not cause this problem. So the ads on lipoatrophy you are seeing with the use of new drugs are probably accurate in terms of not causing this particular problem.

Treatment for HIV as you now requires a combination of several medications, so if someone is taking one of the newest drugs, but it is combined with one of the old ones -- known to cause this lipodystrophy problem-- then the benefit of the new medication in preventing lipoatrophy is lost. Unfortunately for somewhat who has already developed lipoatrophy these new drugs rarely or modestly at best can revert this problem.

I understand and respect your negative feelings toward Big Pharma; on the other hand, --and not intending on defending them--this is the same industry that has made possible the development of the many agents we currently have available to treat this infection; and for patients starting treatment now, prevent this devastating lipoatrophy complication. This industry is also looking for treatments that can potentially revert this lipoatrophy for patients already suffereing from it, but the few drug candidates on study yield just mild improvements. Research in this field still continues.

And to your other comments, some are more liver toxic than others , and it depends a great deal on invdividuals and their own bell curve, lifestyle, alcohol , etc. Still they aren't considered to be HIGHLY liver toxic like certain meds out there.

Of course nobody WANTS this disease and we're still just debating on the most optimistic scenario af a bad situation...of course it'd be better if they didn't need them at all, but at least the current outlook is much brighter than before.

Not to mention the "cocktails" require a compliance schedule that very few people really can reliably follow day after day, year after year.

Again, this used to be true, but is not generally the case anymore. There are now many once a day regimens, and even more 2 a day to choose from. The days when people needed beepers to time their doses and have some of them with food...some on an empty stomach, etc..are passe.

You could say the same of most heart patients or diabetics - the problem is avoiding resistance and keeping on the medication schedule for life, with no breaks. That is very difficult for real human beings to do. It's a problem with every chronic disease or condition.

This is very true and is in fact the most difficult thing to deal with for people infected with HIV. They are actually discovering SOME potential methods of drug holidays...some of them even dropping the dosing to 5 days a week..but it's still in the preliminary stages at this point. For now it's best to go with the idea that your on meds for life until the "cure" is actually discovered.

In fact, there are a few people in the world who can't get HIV at all - it is unable to gain a foothold, their bodies clear it completely. But the rules aren't set for the exceptions, they're set for the regular folks. Even rabies is no longer 100% fatal, but if you're exposed it's best to treat it as if it is so you don't get slack in getting medical help.

Yes and based on these people's immune systems, they actually discovered new classes of drugs like Entry Inhibitors. However while Rabies is almost always fatal...HIV has a fairly high amount of people that do not progress and that among other things is why the word "invariably" irked me in this thread in the first place. they estimate 1 in 100 people are non-progressors. 1% is a fairly big number when you're dealing with millions of people in the world infected.

The amount of people worldwide was at 33 million in 2007:

http://www.avert.org/worldstats.htm

If there are about 35 million currently (as a pure guesstimate) , it means 350,000 people will remain as carriers and never progress to AIDS. In fact they say a significant amount of these people are unaware they are infected at all, and this is also what makes them dangerous to others when they are sexually active. It's another reason in a recent thread that I argued on the side of people having to be responsible for their own health and the behaviour that leaves them open to such potential scenarios. Always protect yourself first and foremost is the loudest message they should be sending out there to people.

[Broomstick]

Wow, we have come a long way with HIV, haven't we? I worked at a clinic back in the pre-AZT days when there was nothing for AIDS patients expect treating the infections as they arose and life expectancy at diagnosis was averaging six months. It would still suck mightily to have the virus but yeah, there's been progress. A lot of it.

[Justforfun000]

Broomstick Wrote:

Wow, we have come a long way with HIV, haven't we? I worked at a clinic back in the pre-AZT days when there was nothing for AIDS patients expect treating the infections as they arose and life expectancy at diagnosis was averaging six months. It would still suck mightily to have the virus but yeah, there's been progress. A lot of it.

Yeah. it's been nothing short of amazing actually. Living here in the gay village, I'm updated by new treatment methods and HIV issues quite regularly in the local gay magazine publications put out monthly to show "what's on". There's always editorials and advertisements as well, so I'm pretty up to date for a laymen.

These days you really can try to mitigate the bad news by stressing to newly infected that (because you're here in Canada anyway...), you have a very long, generally healthy life ahead of you providing you suck it up, accept that you WILL almost certainly have to take medication at some point for the rest of your life barring a newly discovered cure, and you must be very, very adherent. However adherence is infinitely simpler now as we touched on in the previous posts. before these once a day/twice a day regimens were available, people were having to take up to 30 pills a day and at all weird hours of the day and night. Some with food, some on an empty stomach...it was insane. So Broomy was absolutely right about how difficult it used to be to follow this kind of protocol. Now it's down to approximately 3 pills a day at least...maybe 5...Hell....I take more supplement pills a day than that. lol.

Now in truth the new drugs also have quite long half-lives, so even people that occasionally miss a dose entirely have a negligible concern on mutation and resistance. Realistically they say a missed dose here and there is no major concern, but this really should be taken as a very conditional warning....if it is TRULY once in a while...like once every 6 to 8 weeks, it's no problem..but if you get complacently stupid and start regularly missing doses, then you give a chance for the virus to mutate and you start needing to look at other analogues in order to control it. If you are incredibly stupid enough to end up resistant to practically all drugs, (and this is actually quite rare thankfully), then you ARE in trouble and then the term "invariably fatal" might be a little closer to the truth...

But hey, at least you don't even have to pay for the treatment. Most people I know that aren't well-off apply for drug disability for low-income people and once accepted based on your monthly income, they pay a couple hundred dollars deductible a few times a year and most presription drugs are covered free. Very lucky for people in this country...these drugs cost over the $1000 mark per month as a rule. Isn't that insane? Phew.

So we can at least save people from a horrible downslide into death these days, and even the treatment itself reduces the person's infectivity dramatically, so this is all good news for the future of HIV rates, but the hardest part is stopping new infections from people not looking after their own health responsibility appropriately and many others out there that are infected due in most cases to random unsafe sexual encounters, and because in many cases their culture, fear of homophobia in cases dealing with same-sex activities, admission of having sex with prostitutes or even just unlucky partners that picked it up outside the high-risk categories, all fear the stigma attached to this disease & do not get tested and keep their heads in the sand.

I've always said that the reason this scourge is so deadly is the way it's piggybacked with sex. You couldn't have picked a better vector to fuck with people's common sense.