Canadian health researchers are warning that the steady advance of HIV within Canada's native community shares some disturbing hallmarks with the epidemic in Africa.
Statistics published by the Public Health Agency of Canada earlier this month show that natives accounted for nine per cent of new HIV cases in the country last year, even though aboriginals comprise just 3.3 per cent of the overall population.
The infection rate among natives is now three times that in the general population.
"What we have seen over a period of time is that the numbers are just not going down. We continue to be over-represented in the new infections," said Kevin Barlow, executive director of the Ottawa-based Canadian Aboriginal AIDS Network.
The epidemic within the aboriginal community has some unusual and disturbing features.
The virus is much more likely to be transmitted by intravenous drug use in the native community. Women now account for nearly half (45.1 per cent) of all reported HIV cases among natives, while women in the general population make up about one-fifth of reported cases. In all, an estimated 2,300 to 4,500 Canadians were infected with HIV in 2005.
Natives under of the age of 30 also face an elevated risk of contracting HIV as compared to other young Canadians.
What's more, there are troubling signs that the already high rate of HIV infection among the country's one million natives could soon explode.
A recent study by the B.C. Centre for Excellence in HIV/AIDS found that the hepatitis C infection rate -- a common harbinger for HIV -- has skyrocketed among aboriginal intravenous drug users in Vancouver and Prince George.
Patricia Spittal, principal investigator of the Cedar Project study, said HIV/AIDS has the potential to devastate native communities in much the same way that it has ravaged villages in sub-Saharan Africa.
"We have to be worried about the similarities between here and Africa," said Ms. Spittal, an anthropologist who lived for two years at a Ugandan truck stop as part of her HIV/AIDS research in Africa. "The circumstances are the same: When you have human rights violations, and a combination of poverty and despair, you have to be worried."
The Cedar study found that 57.1 per cent of Vancouver's aboriginal injection-drug users had hepatitis C. The situation was even worse in Prince George, a small city of 77,000 in northern B.C. where 62.4 per cent of aboriginal IV drug users tested positive for the disease.
Hepatitis C spreads more rapidly and efficiently than HIV, but both viruses are commonly passed through the sharing of infected needles.
"It's like a warning bell," said Dr. Martin Schechter, chairman of the department of health care and epidemiology at the University of British Columbia. "It's telling us that all the ingredients are there for HIV to catch up to hepatitis C and go even higher."
Preliminary findings of the study were reported last year because members of a native advisory board were so alarmed by its numbers. Researchers found that among aboriginal injection drug users, the HIV infection rate in Prince George was lower (7.9 per cent) than in Vancouver (17 per cent), but experts believe that gap could close rapidly given the elevated rates of hepatitis C.
"The worry is that we're already seeing in the Cedar study prevalence rates in young aboriginal drug users that are worryingly high," said Dr. Schechter. "One potential disaster scenario is that you get the rapid spread of HIV."
Such "explosive outbreaks," he said, have taken place in neighbourhoods in Edinburgh, Bangkok, Vienna and Baltimore, where people gather to share intravenous drugs. Vancouver's downtown East Side experienced a similar explosion in 1996-97, when the prevalence of HIV among drug users climbed rapidly to 30 or 40 per cent.
It has been estimated that Vancouver's downtown East Side, the city's poorest neighbourhood, is home to 4,700 intravenous drug users, about 25 per cent of whom are aboriginal. A 2003 study found that the aboriginal drug users were becoming HIV-positive at twice the rate of others.
"When people tell me they want to work in the developing world, I say, 'OK, let's work on the downtown East Side of Vancouver because those prevalence rates are what you see in sub-Saharan Africa," Dr. Schechter said.
The Cedar study suggests the threat posed by the combination of IV drug use and HIV extends beyond Vancouver's East Side to places such as Prince George.
Researchers found that injection drug users in Prince George tended to shoot cocaine, morphine or dilaudid more often than heroin -- the injection drug of choice on the East Side. Since the effects of other opiates don't last as long as heroin, drug users in Prince George injected themselves more frequently than those in Vancouver, the study found. That behaviour put them at greater risk, since each shared needle increases the chances of contracting HIV.
Ms. Spittal wants to expand the Cedar study to confirm what many native leaders are telling her -- that the situation in Prince George reflects what they see happening in Kamloops, Kelowna and Prince Rupert.
Other studies have shown that natives are over-represented among IV drug populations in cities across the country. A 2004 study by Health Canada that recruited 794 IV drug users in Toronto, Sudbury, Regina and Victoria reported that 40 per cent of them were aboriginals.
"I think that many native service providers are very worried," Ms. Spittal said.
Chief Wayne Christian of the Splats'in First Nation, near Kelowna, said his community, which was once plagued by alcoholism, is now beset with drug issues. Crystal meth and crack cocaine are common.
"I'm really concerned that if it transitions into intravenous drug use, then we're going to have a real problem on our hands," Mr. Christian said.
The Splats'in First Nation, a community of 750 people, has suffered one fatal drug overdose and another suspected one during the past three months.
Mr. Christian believes drug addiction has flowered in his community because of the poverty, despair and dysfunction that resulted from what he called "genocidal" government policy.
In B.C., he said, adult natives have been scarred by experiences with residential schools and foster care, leaving them ill-equipped to be parents themselves. The resulting family breakdown and pain, he said, have led many young people to escape into the drug underworld.
Ms. Spittal considers the HIV infection rate among B.C.'s natives to be a human rights and child protection issue.
"When you see high levels of pain, despair, poverty, and the impact of colonization, I can't rant enough about that," she said. "It's really important to locate this discussion there -- in the erosion of culture and identity that are directly related to residential schools."
Native leaders fear drug use is on the rise at First Nations communities across the country.
Crystal meth has invaded many native reserves, said the Canadian Aboriginal AIDS Network's Mr. Barlow, because it's relatively easy to manufacture on site. Crystal meth often acts as a springboard to IV drug use, he said, drawing natives into city neighbourhoods known for their drug cultures.
"I would say B.C. is very similar to what is happening in most of the western provinces," he said. "If you go to downtown Winnipeg, Edmonton, Calgary or Regina, you will see very similar situations."
Intravenous drug use is at the heart of the native epidemic. More than half (53 per cent) of all new HIV infections among natives are attributable to infected needles. In the general population, only 14 per cent of new infections were attributed to IV drug use last year.
The use of injected drugs is central to the elevated risk of contracting HIV faced by aboriginal women and youth.
"It's such a volatile area of concern," Mr. Barlow said. "Let's say if one person is positive and they're sharing needles with three or four individuals. Then the numbers jump that quickly. If those people then share needles, the numbers can grow exponentially. That's the challenge."
The sex trade and the prison system, both of which contain significant native populations, also act as dangerous vectors for HIV infection.
Mr. Barlow said more research needs to be done to better understand the epidemic within the native community and the perceptions, practices and barriers to effective prevention. With a budget of $1.2 million, the Aboriginal AIDS Network delivers research, training and prevention programs across the country.
"When we look at the populations that are at-risk groups within the aboriginal population -- sex trade workers, injection drug users, inmates, youth, two-spirit (gay) men -- we have to find different ways of creating awareness in our communities," Mr. Barlow said.
"We have these multiple layers that make it really hard to engage people and get them receiving services, and changing risk behaviours."
Mr. Christian, who has worked as a drug and alcohol counsellor for 14 years, said he fears many aboriginal drug addicts are going to cities because First Nations don't have the expertise to deal with their problems on reserves.
He wants the federal government to spend more money on programs that offer drug addicts clean needles and safe, temporary housing. Housing is a critical measure, he said, because it offers drug users an alternative to living on city streets, where they often first engage in IV drug use and high-risk sexual behaviour.
"People have to understand that harm reduction is part of the continuum of healing," said Chief Christian.
"We have to do things now if we really believe that our children are our future. We have to take action, not tomorrow, right now, and put things in place."
In Prince George, a city task force has developed a strategy to address the IV drug problem. Hours at the needle exchange program have been extended and a van has been purchased to bring clean needles to addicts on the street.
But Mary Teegee, manager of community health and development for Carrier Sekani Family Services in Prince George, said new money for the HIV epidemic is scarce.
"It's very frustrating," Ms. Teegee said. "There's no big influx of resources coming to the North like there was in Vancouver in the early 1990s, even though we have the same or higher HIV rates. Is it systemic racism? I don't know, but there has to be something done."
Three of her young cousins in northern B.C. are now HIV-positive. One fell into a downward spiral after he was dumped without support from foster care.
"He said, 'My family became the people on the streets of Prince George'," Ms. Teegee said. "He ended up getting addicted to drugs; he ended up in jail and contracted HIV."
The federal government will spend $55.2 million this year on its national HIV/AIDS strategy. Funding for the federal initiative is scheduled to rise to $84.4 million in 2008, when $5.9 million will be earmarked for aboriginal programming.
Ontario Regional Chief Angus Toulouse, chair of the Assembly of First Nations' health and social development committee, said the federal government agreed to a $1.3-billion investment in native health under the Kelowna Accord. But that deal has not been honoured by the Conservative government of Prime Minister Stephen Harper.
"It's just a matter of time before whole aboriginal communities are wiped out because of the HIV/AIDS epidemic," Mr. Toulouse warned. "It's essential that the children and youth are instructed about the disease and about the behaviours that will really put them at risk. That's the kind of action plan and activity we need."
Ms. Spittal believes concerted action must be taken, given that 60 per cent of Canada's native population is under the age of 30 and increasingly at risk.
"Our message is: hit hard, hit fast. We do have an opportunity to make a difference," she said. "But if we continue to ignore it, we are going to see so many more infections."
© The Ottawa Citizen 2006
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