CANADA'S HOMEGROWN EPIDEMIC

Health Officials Worry An HIV/AIDS Epidemic Is About To 'Explode'
Among Natives, Writes Andrew Duffy

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."