December 1 was World AIDS Day and though it’s been 26 years since the human immunodeficiency virus was first recognized, new transmissions still happen every day.
“The less we judge, the more we can help prevent people who inject drugs from catching or transmitting HIV” is this year’s Quebec Ministry of Health and Social Services campaign slogan. Coincidentally, according to Martine Drolet, RN and Program Officer for Sexual and Mental Health for the Cree Public Health Department, intravenous drug use is the most common way for an aboriginal person to contract HIV
“The Cree communities have approximately the same infection rate as the rest of the general population of Quebec,” said Drolet. For the rest of the population of both Quebec and Canada, gay men lead the way with the highest new infection rate.
The numbers are hard to pin down, however. According to Drolet, for every HIV-positive diagnosis there are two unknown cases. What this gets down to really is that though HIV is preventable, people are not taking the necessary precautions to avoid contracting the disease.
“The aboriginal population is very at risk, particularly the women,” said Drolet. “There are a lot of factors like prostitution, lack of power in the relationship, sexual abuse; there is a lot of drug use, too. So it’s all linked and those women are less able to say no or negotiate condom use. It’s all linked to self esteem and we are working hard on that.”
The numbers for AIDS infections among the aboriginal population across Canada is significantly skewed by the concentration of aboriginal intravenous drug users in the Vancouver area. Within the Cree communities there is a great deal more emphasis put on safer sex practices as the rates for some sexually transmitted infections, or STIs, are very high and have been high for some time.
A particular worry is the high rate of Chlamydia infections among the Cree. “I know that the rate keeps increasing. I have to say that I have difficulty with the statistic because I think that we are probably screening much more than the rest of the population of Quebec,” said Drolet.
In the communities, both men and women are being given urine tests to screen for the STI because not only is there a high rate for Chlamydia, there is also a high re-infection rate for those who have already had the STI treated.
“So, this gives us more cases for them despite all of the screening. We are facing the fact that they are not protecting themselves and those people are very, very at risk of getting HIV Because of the remote places, when one person infects another, the disease can spread around the community rapidly,” said Drolet.
To combat new HIV transmission and other STI occurrences, Drolet has made it her personal mandate to improve access to information, education and condoms.
Condoms are now accessible in all of the bathrooms at all of the clinics. This way, “You don’t have to ask anybody. You come in, go in the toilet, you take condoms and you leave and they are free.”
Some communities, such as Mistissini, have condoms available in the band office but they are also available at the wellness centres, from any health professional who works within the community, school nurses, CHRs and summertime street workers. They are always free.
What Drolet has found from focus groups and through talking to community members is that the best place for a young person to acquire a condom is in their home, especially for youth aged 15-29, who are the most at risk.
“Parents, brothers, sisters, uncles, whatever – keep condoms in your place because you generally tend to need them when the clinic is closed and when the wellness centre is closed,” said Drolet, referring to how young people are the least likely to plan to use a condom.
However, knowledge and education are essential partners to condom promotion. Anyone can have condoms on hand but negotiating the use of them between partners is another story.
To teach youth about sexual health, including how to negotiate safer sex, Public Health has initiated two pilot programs in Waskaganish and Waswanipi, in which Grade 9 students come into classrooms to teach students in Grade 8.
“It will be another two years before the sex-ed programs will be implemented in all of the schools, but the good news is that we have school nurses in almost all of the communities,” said Drolet.
Drolet believes that a lack of information on infectious diseases has caused problems in the communities. The fact that sex education classes have never been taught in the communities has contributed to rampant unprotected sex. Drolet also theorizes that the residential school system is to blame: when children don’t have access to their parents, there is no one to teach them about sexuality and relationships.
“All of the rites of passage and cultural knowledge are not transmitted anymore from parents to children and now the adult generation who has children does not know about sex. They don’t know what to say, they don’t know what to teach,” said Drolet.
Whether someone became infected with HIV through sexual contact, using dirty needles or through something as innocuous as a bloody fistfight, the means is irrelevant. The most important thing is that the individual not be judged nor stigmatized.
“We never know who has HIV it could be you, it could be your brother or sister,” said Drolet.
It is estimated that 33.2 million people are now living with the disease world-wide and though modem medicine has made it possible for the infected to live significantly longer than previously, there is still no cure.
For more information go to http://creepublichealth.org