HIV a public health emergency in Saskatchewan: doctors

[Dr. Ryan Meili, left, is one of 30 Saskatchewan doctors who signed an open letter this week urging the provincial government to declare a public health state of emergency over the high rates of HIV infections. CBC/Kathy Fitzpatrick]

By Dene Moore

Three babies were born HIV-positive in Saskatchewan last year.

The rate of new infections is more than double the national rate and in some of the hardest-hit communities, infection rates rival some of the poorest and most under-developed nations in the world.

Yet the provincial government has no strategy in place to combat what is — in most of the developed world — a manageable chronic disease.

Now a group of Saskatchewan doctors is calling on the provincial government to declare a public health state of emergency over the continued spread of HIV and AIDS in the province.

“We’re continuing to see high levels or mortality and morbidity, so people getting sick and actually dying from their HIV, which is seen very rarely in other parts of the country,” says Dr. Ryan Meili, one of 30 Saskatchewan physicians who signed an open letter this week to the provincial government.

For the past decade, Saskatchewan has had the highest rate of HIV infection in Canada.

There were 158 new cases diagnosed last year. That amounts to 13.8 cases per 100,000 people, more than double the 2014 Canada-wide rate of 5.8 per 100,000.

“Spread across the entire province, 158 new cases may not seem like a lot,” says the letter from the physicians.

“However, certain communities — urban, rural and reserve — have been hit particularly hard, with local epidemics that rival some of the hardest hit regions of the world.”

In the past decade, 1,515 people in the province have been diagnosed with HIV. Seventy-one per cent or 1,075 cases were First Nations and Métis people, though indigenous people account for just 20 per cent of the overall population.

“With timely diagnosis and using the tools we now have available for managing HIV, hospitalization and death due to HIV complications should be rare events. Unfortunately, as physicians, we are regularly seeing patients who are very sick from the effects of HIV, many of whom did not know that they were HIV-positive,” the doctors say.

At least nine Saskatchewan infants were born with HIV in the last decade, three last year alone.

A strategy adopted in 2011 to reduce HIV rates expired in 2014 and has not been renewed, Dr. Meili tells Yahoo Canada News. The province has had no strategy in place then.

The doctors want the Saskatchewan government to adopt the 90-90-90 goal of the World Health Organization’s UNAIDS: 90 per cent of those who are HIV-positive know their status; 90 per cent of those diagnosed on antiretroviral treatment; 90 per cent of those on treatment with a level of the virus low enough to prevent transmission to others.

“Meeting 90-90-90 would bring an end to AIDS in our province,” the doctors say.

Dr. Rolando Barrios, assistant director of the B.C. Centre for Excellence in HIV-AIDS, says the approach has been very effective.

What’s happening in Saskatchewan today is comparable to what was happening in Vancouver’s Downtown Eastside decades ago.

“I was a frontline clinician back in 1991 to 97 in the Downtown Eastside and I can tell you, I feel for these physicians from Saskatchewan talking about the need for a public health emergency,” he tells Yahoo Canada News.

“Every single day you’re seeing cases and you’re thinking, ‘there’s something wrong here. There are more cases than we should have.’”

But a multi-faceted strategy that includes mental health treatment, harm reduction, access to medication and education has helped to drastically reduce new infections and mortality, he says.

Dr. Meili says Saskatchewan doctors have asked the province to follow suit — to no avail.

“It’s been a pretty disappointing lack of response,” he says.

Dr. Meili says despite multiple meetings with the health minister for well over a year, his group has never been told why the province will not adopt a strategy to fight the spread of HIV and AIDS. In fact, they haven’t even been officially informed that their appeal has been rejected.

“I can’t accurately ascribe motivations but some of the possibilities would be, one, that they think if they commit to the goal it’s going to cost them and they don’t want to spend the resources on this,” Dr. Meili says.

“The other would be that perhaps this is not a population that they’re as concerned with, not their core supporters.”

The health ministry wasn’t immediately available for comment.