Tag Archives: community

Expanding access to HIV point of care testing through community pharmacies: the APPROACH study

By Christine Hughes

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Estimates in Canada suggest that about 21% of people living with HIV do not know it. There are often many barriers to HIV testing including concerns about privacy and confidentiality, low perceived risk of infection, access to testing, and waiting about a week for test results. Current guidelines recommend that HIV testing should be part of routine care and that novel approaches are needed to make testing more available to people who may benefit from it. We know that earlier diagnosis and treatment of HIV leads to better patient outcomes, but also reduces the risk of transmission to others. Most people are tested for HIV by their family doctor or at STI clinics. Point of care (rapid) testing for HIV provides an opportunity to increase access to testing in non-traditional settings, such as community pharmacies.  The test is performed using a finger prick blood sample and test results are available within minutes. Community pharmacists are accessible health care providers, especially in rural settings where health care services may be more limited.

The purpose of the APPROACH study is to determine whether HIV point of care testing in a community pharmacy setting is acceptable, feasible and effective in reaching individuals that may be a risk of HIV infection. This 6 month pilot study is funded by a grant from the Canadian Institute of Health Research and is being conducted in four community pharmacies  (urban and rural) in Alberta and Newfoundland. The Alberta pharmacies are located in Edmonton (Community Members Pharmacy, 10611-101 Street) and Fort McMurray (Shoppers Drug Mart #327, Franklin Avenue). Testing will be available by appointment on weekdays. In order to be eligible for the pilot study, individuals need to be at least 18 years of age and have an active Alberta Health Care number.  

As part of the study, pharmacists will provide pre and post-test counseling and administer the HIV test in a private counseling room at the pharmacy. The HIV test itself is highly accurate and looks for antibodies against the virus.  If the test is reactive (positive), confirmatory testing is needed in order to diagnose HIV infection.  In this case individuals will be provided with a form to have confirmatory testing done at a lab, and will be immediately linked to appropriate care and follow-up.  In order to assess the study objectives, individuals enrolled in the study will be asked to complete a short pre-and post-test survey.

We hope to learn from this pilot study whether the model of HIV testing in a community pharmacy setting is acceptable to individuals requesting testing and whether it addresses some of the barriers to testing.  We also want to learn whether HIV testing is feasible for pharmacists to incorporate into their work routine.  If the pilot is successful we hope to expand to other pharmacies in Alberta and Newfoundland, as well as other parts of Canada.

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The End of Criminalization is Just Good Science

By Marlo Cottrell

As someone who has been living with HIV for over 20 years, I still remember my early years of having to live with this virus. When treatment was often limited and a large number of people were still dying. Trying to navigate through the overwhelming realization that I had to live with this disease, I will tell you that disclosure took practice and I didn’t always get it right as much as I tried. That is a reality for many. Through the decades, we’ve come so far and conquered the enormous summit to accessible treatment here in Canada, easier to manage medication and a life where living with this disease is not a death sentence, but a life with tangible hopes and dreams that flourish.

HIV criminalization has yet to reflect the highly treatable infection we see today; where an undetectable viral15138470_842377852570876_2454002420699421243_o load means the virus stops with us. The legal implications of living with this virus and not disclosing to a partner still garner someone the possibility of convictions of aggravated sexual assault, however. The harshest of sentences relegated to the worst of sexual assaults. Aggravated Sexual Assault: The Criminal Code also allows for increased penalties for sexual assault where the accused “wounds, maims, disfigures or endangers the life of the complainant.” Transmission does not necessarily have to take place. This carries the hefty sentence of the maximum of 10 years in prison and mandatory registration on the sex offender registry list. As a survivor of sexual assault, I find it the implications of this deeply disturbing, when we as human beings when engaged in consensual sex, have the option to protect ourselves. 1 in 5 people living with HIV do not know their status. As a former sex trade worker who advocated for safe sex on a daily basis, I used to tell my clients, “I don’t know where you’ve been and you don’t know where I’ve been. Out of respect for that fact, we need to protect ourselves and each other.” Today, as it stands, if we are undetectable and use a condom, we do not have to disclose. If we don’t use a condom, we must disclose but the risk is zero with an undetectable viral load. I think the crux of criminalization comes down to, who benefits from these laws? We know these laws are not a deterrent for the spread of HIV, which is what the intent was supposed to be. They only perpetuate and reinforce a false sense of security. The goal is to prevent new infections from occurring. I have sat with a former partner in the waiting room with his requisition form for an HIV test, both of us knowing that he should be tested. That crumpled requisition form landed in the bottom of a garbage can faster than you could imagine.

It is the promotion of zero stigma, zero discrimination and zero new infections that is at the heart of what gets people out and embracing an HIV test. The science has been in for a while now. It protects people from new infections when those of us living with this virus are able to know our status by wiping away the fear of shame and the heavy burden of stigma. HIV criminalization was set forth on a misguided course to protect us, but it does little more than further stigmatize a disease that we are conquering. The end of criminalization is just good science.

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Racialization, Immigration and the Representation of HIV Criminalization in Canadian Mainstream Newspapers

Research and report by: Eric Mykhalovskiy, York University, Colin Hastings, York University, Chris Sanders, Lakehead University, Michelle Hayman, University of Toronto & Laura Bisaillon, University of Toronto 

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For some time now, growing concerns have been voiced by African, Caribbean and Black (ACB) activists, people living with HIV, and AIDS service organizations (ASOs) that ACB people living with HIV are negatively portrayed and overrepresented in Canadian newspaper stories about criminal HIV non-disclosure cases. We investigate those alarming concerns in our report, “Callous, Cold and Deliberately Duplicitous”: Racialization, Immigration and the Representation of HIV Criminalization in Canadian Mainstream Newspapers.

Our report explores mainstream Canadian newspaper coverage of HIV non-disclosure criminal cases in Canada. Our analysis is based on 1680 English-language Canadian newspaper articles about HIV non-disclosure criminal cases in Canada written between 1989-2015. Overall, our findings show that newspapers are indeed a source of profoundly stigmatizing representations of ACB men living with HIV. This should be of great concern because the mainstream media are an important source of public information about HIV as most Canadians do not have close, first-hand knowledge of HIV, people living with HIV or crime.

­Our quantitative findings overwhelmingly support community concerns about overrepresentation. For example, 68% of the articles focus on racialized defendants. Black men, and specifically Black immigrant men, are exceptionally overrepresented in our data. They are featured in newspaper articles three times more often than would be warranted on the basis of the proportion of all defendants they represent. Moreover, this overrepresentation holds true over time. Finally, newspaper coverage is highly concentrated on a small number of sensationalized cases involving four Black men. For example, almost half (802/1680, or 49%) of all coverage since 1989 is concentrated on just four racialized people.

Our qualitative analysis focuses on four Black men living with HIV who have received extensive newspaper coverage. Once more, our findings unequivocally support community concerns about the negative and stereotypical ways ACB men living with HIV are represented. For example, we show how they are represented as dangerous, “foreign others.” One way this happens is when newspaper stories are told in criminal justice time, a technique that objectifies people within a “crime story” genre, treating them primarily as criminal subjects whose personal circumstances are largely ignored. A second way that ACB men living with HIV are represented as dangerous occurs when representations of racialized difference and immigration status are associated with constructions of moral blameworthiness and public health threats. This happens, for example, by including photographs of defendants, by referring to so-called “rare” strains of HIV that originate in African countries, and by identifying defendants by country of origin.

Despite the disconcerting findings, we conclude the report on a hopeful note with possibilities for deepening and extending alternative ways of writing about and representing HIV criminalization. The profound silencing, othering and objectification of ACB defendants in newspaper coverage of HIV non-disclosure criminal cases calls for strategies that create a positive presence, in mainstream media, for ACB men living with HIV. Efforts to work toward that end are underway by ASOs and other organizations that are a part of African, Caribbean and Black communities. We hope that our report will help to inform ongoing public discussion of this issue at such events as the African, Caribbean and Black HIV/AIDS Awareness Day.

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Faces of HIV – Thirty

By Shayne Woodsmith, Faces of Edmonton

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In 1982, Ross Armstrong, a man described by his friend Charles Bidwell, as “full of playful spirit, comfortable in his own skin and so open in expressing himself,” earned his spot to swim for Canada in the first ever Gay Olympic Games. Ross won a silver medal in the 200 metre butterfly and was quoted saying, “There were no losers. The first and the last were cheered equally.” He also learned that organization combined with a political commitment is what produces mass awareness and supported action. This was the spirit of Ross, a man committed to honesty, integrity, and change.

In 1984, Ross Armstrong was diagnosed with AIDS, the first AIDS diagnosis in Edmonton. Shortly after his diagnosis, he became a part of the AIDS Network of Edmonton team (now known as HIV Edmonton), and emerged as the public face of AIDS in Edmonton. Ross died on July 1, 1986, two short years after his diagnosis.

The challenges and suffering Ross endured and the courage he displayed during those first years of the local epidemic led HIV Edmonton to name the hub of their agency, the drop-in centre, the Ross Armstrong Centre. A safe, caring place for HIV positive individuals to meet, have a cup of coffee, or share a nutritious community meal. Breakfast is served every Monday and Friday morning and lunch is served on Wednesdays. Ross Armstrong Week, held Monday and Friday in the middle of each month, provides access to grocery cards, health supplies (multi-vitamins and liquid meal replacement) and hygiene products (razors, shampoo, etc.).

Photography Credit: Shayne Woodsmith
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Faces of HIV – Twenty Nine

By Shayne Woodsmith, Faces of Edmonton

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“I was involved in organizing the first prayer vigil for people with AIDS. We held that in the chapel of the Edmonton General Hospital and we did prayers all night long. We scheduled people to be there and invited people to come pray for those who had AIDS and those who were affected by AIDS. This was in the initial years in the mid-eighties. I went away from this city in the year of 80/81 on a sabbatical from the university, and I had heard something about this rare condition that was being detected in Los Angeles and San Francisco. So when I came back to Edmonton from Texas, people were talking about people coming down with this condition called AIDS, where you don’t die of AIDS, you die from some condition that is acquired because of an immune system deficiency.”

“I used to play volleyball with the first person in Edmonton diagnosed with AIDS—Ross Armstrong. When he came down with it, he was put in the U of A hospital, where I worked. So I would go up to visit him everyday. And everyone was gloved and gowned and masked, and they really didn’t want to go into his room because they were afraid. They had no idea how this was transmitted so they would sort of put his tray of food into the room and then I would go in and visit him and bring his food tray to him. I would say, ‘Ross, I’m sorry I have to look like an alien, but it’s really to protect you from me giving you anything.’ So I would sit on the bed and hug him. Nobody was doing that. And, of course, he died. He was the first person in Edmonton to be publicly known to have AIDS.”

“Even my husband at the time, he came down with AIDS, and when he died in 1989, at his funeral, nobody would say that he had AIDS. We were just enraged. We fought to make it public so it would start being addressed. We had been together for seven years, and he was playing around, and for some reason I didn’t get it.”

“I was the minister of the Metropolitan Community Church and when the folks like Michael Phair got together and applied for a grant to do something about AIDS, they couldn’t receive the grant because they weren’t established as a not-for-profit organization, and they didn’t have charitable status and all the rest of this. I was a friend of Michael’s, so he asked if the church could take our cheque, and I said, ‘Yes.’ And then we paid whatever bills he submitted to us. So we enabled them to work for a year until they got their own not-for-profit. So yes, I was sort of in on the ground floor.”

“The one good thing that came from AIDS is that the community solidified and worked together to face this threat … There are some of us old farts still kicking around from back them, but we probably lost about a generation. As a minister, I did funerals, memorial services, and certainly talked to the people who had HIV. I didn’t get to talk to many parents because so many parents, when they found out their kid had AIDS, they were also finding out that their kid was gay, so they were so in shock that most of them didn’t want to talk to a minister.”

Photography Credit: Shayne Woodsmith
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Faces of HIV – Twenty Eight

By Shayne Woodsmith, Faces of Edmonton

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“Visual AIDS is an archive project that started, I think, twenty-six years ago. It was started pre-HIV medication so when a lot of artists were dying off. Artists and friends of artists in the New York area were concerned that their art practices would be forgotten, and all their work would just be thrown out. It started as a grassroots foundation and it grew. So now it’s the largest archive of work and acts as a hub. The work doesn’t always deal directly with HIV, but they deal with issues revolving around HIV such as vulnerability.” “Lately I’ve been interested about the issue of criminalization surrounding HIV, specifically of non-disclosure of HIV where people have been charged, particularly in Edmonton actually—which has some of the most heinous criminal charges laid against people who were convicted of sexual assault, administering biological substances, or attempted murder for not telling their partners they have HIV and then having some kind of intimacy or sexual contact, regardless of transmissions. I don’t know why Edmonton has a gross history of that. It’s just ignorance.” “The courts strengthened the idea that consent should be the ultimate protection so that people with HIV were seen as having negated consent for not disclosing, so that’s the genesis of where these problems became exponential. How do you undo this idea of consent if we’re medicating people in order that they can have autonomy to make their own decisions about consenting and telling people if they’re positive? Does that have to happen? It used to be the case that the courts in Canada would accept the idea that someone’s virological load or ability to transmit is negated because they’re on medication. So the courts went a step further and asked that people use condoms so the only two conditions they would accept without disclosure were if they met those two conditions—they had to have a negligible viral load and they have to had used a condom. Otherwise potentially the law has the ability to come down with these awful charges. It’s fascinating to me, and it also makes me very angry.”

Photography Credit: Shayne Woodsmith
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Faces of HIV – Twenty Seven

By Shayne Woodsmith, Faces of Edmonton

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“This year, I’m President of the board of the Imperial Sovereign Court of the Wild Rose (The Court). Every year when we elect a new monarch in August at the ball, they select two charities who they want to focus their fundraising efforts on, so HIV Edmonton is often one of the charities that is selected because of the work they do in the community and also of course because of the affect that HIV and AIDS has had on the LGBTQ community.“ “HIV Edmonton is celebrating thirty years of doing amazing things in the community. The Court is celebrating its forty years this year, making it one the longest running LGBTQ organizations in Canada. HIV Edmonton and The Court has always had a very close relationship.” “The biggest challenge is apathy because HIV is now treatable. Especially youth often think that they don’t need condoms anymore since HIV doesn’t come with that death sentence … I think the benefit of The Court is that we can reach people that maybe HIV Edmonton doesn’t, like at the bar. And we’ve done a lot of work with youth groups over the years. Hopefully together we can make it clear that HIV hasn’t gone away and it is a life changer.” “Having worked in a bar, I know so many young kids who just won’t use condoms because they think it’s not that important. You’ve got a generation now that is a generation removed from the gay men of the eighties who were at funerals every week. I have a friend who just found out this week that he had contracted. It wasn’t the devastation that I would have expected. I had one HIV scare in the nineties and I was horrified. I couldn’t sleep for the ten days leading up to the results. But he wasn’t that freaked out and he didn’t think it was that big of a deal.”

Photography Credit: Shayne Woodsmith
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Faces of HIV – Twenty Six

By Shayne Woodsmith, Faces of Edmonton

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“Street works has always been about HIV prevention. It is a program that’s run by a council of agencies. HIV Edmonton has been the chair of that committee  for at least fifteen years, so we’ve always been closely tied. Here at Street Works, we target folks who are using injection drugs or who are involved in the street-based sex trade, particularly around HIV and Hepatitis C.”

“We’ve been very lucky to have great collaboration between places like HIV Edmonton, and the Northern Alberta clinic and Street Works and Boyle-Mccauley Health Centre. All of these organizations, we work together really well and I think we can wrap people who are feeling a little lost and marginalized, because of their HIV, in a big hug of trying to give people support and the right kinds of services, right. We don’t overlap on our services. We each are different, but we see the value in working together, I think that’s really key.”

“I’ve worked at the Boyle Street Community Centre for twenty-one years, so I’ve actually watched a lot of people grow up here … There’s been some really great parts of that, but it’s kind of sad too because you don’t want people to be here forever. A lot of people have moved on, but some I’ve known since they were tiny kids.”

“I’m a registered nurse. I love cross-cultural nursing in general and street culture is one that I absolutely love. I think one of my biggest compliments was when one of our guys came up and asked me when I quit using, and I thought, ‘Cool, I look like I use drugs, that’s really great! It’s the hair probably. But I think it was more because I can integrate fairly easily now, which I really like. I always get upset by the idea that service providers have to have strict boundaries and you can’t let anyone know anything about you—this is a community, so we all need to get to know each other. The other thing is we have great staff. I love mentoring. I love their great ideas and excitement”

Photography Credit: Shayne Woodsmith

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Ross Armstrong was an activist and he wanted life to be better for those living with HIV. After his diagnosis in 1984, he became a part of HIV Edmonton’s (previously the AIDS Network of Edmonton) team and emerged as the public face of AIDS in Edmonton. Ross died on July 1, 1986, two short years after his diagnosis.

The challenges and suffering Ross endured and the courage he displayed during those first years of the local epidemic led HIV Edmonton to name the hub of our agency – the drop-in centre – the Ross Armstrong Centre, which is a safe, caring place for HIV positive individuals to meet, have a cup of coffee, or share a nutritious community meal.

The Ross Armstrong Centre is a constant reminder that HIV is not always the biggest issue that our clients face. The biggest hurdle for most of our clients is accessing what they need to survive – their basic human needs. Our client programs allow us to support and assist our clients during the most chaotic times in their lives and to alleviate some of the struggles that they face on a daily basis – such as securing the 500 calories that are required to take their HIV medications. In order to continue to support our clients in this way, we rely heavily on the generosity of donors.

All money raised during this campaign will go towards supporting our clients who, in addition to living with HIV, struggle to meet their basic needs such as food, shelter and access to health and social services. It would be amazing if we could reach $5,000 by the end of the series. Even if it’s a small amount, please consider donating: http://tilt.tc/U2VI.

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Canada Has an HIV Problem

By Brook Biggin

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Saskatchewan docs call for a state of emergency. Trudeau hangs with Bono.

Both of these things happened over the past several days in our country. Both for the same reason: HIV.

Now, I recognize that’s not an entirely fair side-by-side. After all, Trudeau was hosting the Global Fund Fifth Replenishment Conference and Bono, a long-time HIV advocate, was in attendance. It makes sense that the two would share a table – and even an embrace at some point over the weekend. But fair or not, both of those things did happen. The contrast is there. And it is stark.

I can already sense the barbs forming in the eyes of my progressive peers.  In a system with only two parties who have a feasible chance of forming the federal government, one of which just decided that gay people should be allowed to get married – ten years after they were allowed to get married – I get why some progressives don’t respond well when one of their own lobs criticism at the only sane, human option for government we have.

But central to the very word “progressive” – in fact, you can’t even form the word without it – is “progress”. And we do not achieve progress by simply burying our heads in the sand, only to re-emerge to throw darts at our political opponents or fluff those we see as our allies. Progress requires clear, sober reflection on the challenges that face us as a people. It requires that we place people before party. And it requires a commitment to speak truth to power, regardless of whose narrative it strengthens or undermines.

Now, before I get to said truth, it’s important to clarify that I take no offense to Canada’s hosting of the Global Fund’s Replenishment Conference. To bring Bono back into the mix, I wholeheartedly agree with his lyric which states, “Where you live should not decide whether you live or whether you die.” In a world where we have all of the tools available to ensure that people living with HIV and AIDS can live long and healthy lives, it is deplorable that that opportunity be relegated only to those of us who live in high-income countries. So I laud Canada’s commitment to supporting the Global Fund and the work it does to create equity for those living with, affected by, and at risk of contracting HIV throughout the world. However, the good that one does with the one hand does not negate the negligence conducted by the other.

The truth is, Canada has an HIV problem:

1) The Federal Initiative to Address HIV/AIDS in Canada was written in 2004. The top song on the Billboard charts was Yeah!” by Usher ft. Lil Jon & Ludacris. “Desperate Housewives” was in its first season. I was attending a Pentecostal Bible College. That’s how old Canada’s HIV/AIDS strategy is. That’s a problem.

2) With no national pharmacare plan, access to HIV Treatment – AKA what an estimated 70,000 people living in Canada need just to stay alive – is inconsistent. Think of that for a second. There are people in our country in need of medication, without which they will die, who face significant barriers in accessing treatment. And that doesn’t even begin to shine a light on the barriers faced by those whose immigration status might deem them ineligible for access.

3) We now know these things: 1) The majority of new HIV infections can be attributed not to people knowingly living with HIV but instead to those who are unaware of their status. 2) People living with HIV who are diagnosed, have access to HIV treatment and take it as prescribed, thus achieving an undetectable viral load, are non-infectious and cannot transmit the virus to others. AND YET people living with HIV in Canada continue to be criminally charged, convicted, and many sent to prison for failing to disclose their HIV status even when, based on ample evidence, there is no risk that transmission would actually occur. Yet there has been no attempt by policymakers – some of the same ones who were in attendance at the Global Fund Replenishment Conference – to provide updated guidance to police and prosecutors to ensure that our legal system and how it is implemented is based upon facts and scientific evidence as opposed to stigma and phobias which disproportionately impact indigenous people, queer people, and people of colour.

And that is just a start. I am only one man with one lens and one set of experiences. If I had more space or if this was co-written with others living with or affected by HIV, I’m sure the list would be much longer. But length is irrelevant to the fact that the gaps addressed in that list are unacceptable. And regardless of which conferences are hosted by whom, which celebrities celebrate our leaders, and which HIV activists are seduced into inaction by a tall, handsome man in a salmon shirt, until all of the challenges on that list are addressed, it will remain unacceptable.

So, to Prime Minister Trudeau, Minister Philpott, and the range of other policymakers, leaders, and bureaucrats who have the power to shape our country’s response to HIV and AIDS, do strive to create equity amongst the people of this earth. Do reaffirm our commitment as a global player that refuses to face inward and ignore the needs of those in need. But do not allow what is shiny in one hand to distract you from what is slipping from the other. This is not a call for either/or. It is a call for both/and. And you will be held accountable.

 

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Faces of HIV – Twenty Five

By Shayne Woodsmith, Faces of Edmonton

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“I was thirty-six when I was diagnosed. I guess for me, what it’s meant is it delayed my life a lot. I thought I was going to be dead. I had little kids … Now, my daughter has a law degree, she opened her own business, then she got elected in Calgary and now she’s the Minister of the Alberta Status of Women and Services. On World AIDS Day, my daughter had the opportunity to do a speech at the Alberta Legislature and she introduced me, her mother. It was a very touching speech. She almost started to cry because she said she remembers wondering if her mom was going to die. I know what she lived through. If her mom would have been diagnosed with breast cancer, she could have had the support of her teachers, friends and neighbours, but she had to worry about them finding out. I’m sure you’ve had friends come stay overnight. But if the parents found out that the mother was positive, do you think they’d ever come back again? I think people still don’t get that there are people out there who’ve lived this totally alone their whole life. They still don’t talk about it or tell people, they’re still afraid of it.”

Photography Credit: Shayne Woodsmith

————————————————————————–

Ross Armstrong was an activist and he wanted life to be better for those living with HIV. After his diagnosis in 1984, he became a part of HIV Edmonton’s (previously the AIDS Network of Edmonton) team and emerged as the public face of AIDS in Edmonton. Ross died on July 1, 1986, two short years after his diagnosis.

The challenges and suffering Ross endured and the courage he displayed during those first years of the local epidemic led HIV Edmonton to name the hub of our agency – the drop-in centre – the Ross Armstrong Centre, which is a safe, caring place for HIV positive individuals to meet, have a cup of coffee, or share a nutritious community meal.

The Ross Armstrong Centre is a constant reminder that HIV is not always the biggest issue that our clients face. The biggest hurdle for most of our clients is accessing what they need to survive – their basic human needs. Our client programs allow us to support and assist our clients during the most chaotic times in their lives and to alleviate some of the struggles that they face on a daily basis – such as securing the 500 calories that are required to take their HIV medications. In order to continue to support our clients in this way, we rely heavily on the generosity of donors.

All money raised during this campaign will go towards supporting our clients who, in addition to living with HIV, struggle to meet their basic needs such as food, shelter and access to health and social services. It would be amazing if we could reach $5,000 by the end of the series. Even if it’s a small amount, please consider donating: http://tilt.tc/U2VI.

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