Tag Archives: support

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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Criminalization of HIV Non-Disclosure in Canada

By: The Canadian HIV/AIDS Legal Network 

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In Canada, people living with HIV can be charged and prosecuted for not disclosing their HIV-positive status to a sexual partner in some circumstances. What does disclosure to a sexual partner look like? The act of disclosing one’s HIV status means telling someone you are having sex with that you are HIV-positive. This can include anyone with whom you have a sexual relationship, including your spouse, a regular sexual partner, or someone you might have sex with only once.

In 2012, the Supreme Court of Canada ruled that a person living with HIV has a legal duty to disclose their HIV-positive status before having sex that poses a “realistic possibility of transmission.” The Court determined that using a condom and having a low or undetectable viral load (the amount of HIV in a person’s blood) negated “a realistic possibility of transmission of HIV.” More than 180 people have been charged to date with HIV non-disclosure.

In Canada, people who face criminal charges related to HIV non-disclosure are typically charged with aggravated sexual assault, one of the most serious offences in the Criminal Code. People living with HIV have been charged even if they had no intention to transmit HIV, engaged in behaviours that posed little or even no risk of transmission, and did not in fact transmit HIV to their sexual partners.

The current, overly-broad use of the criminal law increases stigma and discrimination against people living with HIV, spreads misinformation about HIV, undermines public health initiatives and ultimately leads to human rights violations. When people living with HIV still experience overt discrimination and physical violence, disclosure is not easy, especially for those on whom criminalization has a disproportionate impact: women, Indigenous people, migrants and members of the African, Caribbean and Black communities. Furthermore, by equating HIV non-disclosure with aggravated sexual assault, Canadian law harms both people living with HIV and survivors of sexual violence.

But we’ve seen some positive developments in recent years.

In 2014, more than 75 prominent Canadian medical experts signed an important consensus statement, which has been an important tool for advocates and has since been used by defense lawyers representing people living with HIV, judges and scientific experts testifying in court with some positive impacts already emerging.

On World AIDS Day (December 1, 2016), federal Minister of Justice Jody Wilson-Raybould made a historic statement acknowledging the problem of the over-criminalization of HIV non-disclosure and the need for the criminal justice system to adapt to better reflect the current scientific evidence on HIV transmission. Federal Minister of Health Dr. Jane Philpott, echoing this sentiment, has noted that HIV criminalization in Canada is both a problem and a priority for the government to address.

More recently, the Ontario Working Group on Criminal Law and HIV Exposure has called for an immediate moratorium on all prosecutions in cases of HIV non-disclosure while exploring law reform options and working with the province to establish much-needed prosecutorial guidelines to limit the current misuse and overextension of the criminal law. Since Canada’s Minister of Justice, and Attorney General of Canada, has denounced the overly broad use of the criminal law in Canada, why does Ontario continue to unjustly prosecute people living with HIV? Tell Ontario’s Attorney General, the Honourable Yasir Naqvi, to stop unjust HIV-related prosecutions: click here to send your message.

Here’s hoping that both federal and provincial attorneys general listen and take action.

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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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The JTMF West Origin Story

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By Leah Cavanagh

I was delighted to sit down with Joyce LaBriola, Artistic Director of JTMF West (JTMF stands for James Tolin Memorial Fund), to chat about the cause we’re mutually passionate about, HIV and AIDS, learn more about the event she produces, Artists for Life, and what drives her daily.

In the beginning…

Joyce is a Jersey girl, and her activist roots run deep in her home state. She told me about how, when she was back in New Jersey and attending theatre school, her friend James Tolin died of AIDS-related illness. His memory, and his family, became the inspiration for their first event: a two-night zero-dollar-budget, production of “Jeffrey”.

That first production saw Joyce and three of her friends assume an unstoppable attitude, determined to make the event happen “to help take care of his parents” in light of the extreme financial stress James’ palliative care put on his parents. In two nights they raised about $7000.

Thinking back on that event, Joyce says “you know when you do something, and you try for the first time, and it feels…right? Like, this is my purpose. Which sounds rather trite, but that’s what it felt like.” It was then that Joyce and her best friend Tracy vowed to make it real, and JTMF was born.

In New Jersey, JTMF is still going strong 13 years later. Joyce brought the spirit of the organization with her when she came west, and gave birth to JTMF West.

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I asked Joyce how JTMF West identifies beneficiaries of the event and she told me, “we always pick beneficiaries that align with who he was,” saying that it’s important to keep James involved, even though Artists for Life is not actually a memorial anymore. HIV Edmonton is “[the] flagship, [it’s] why we started everything,” but that including Fyrefly “for all the leadership work they do and the anti-bullying work they do, it’s perfect for James.” This year, Artists for Life will also benefit the Theatre Network because “it just felt like the right thing to do…it just seemed inappropriate for us not to respond when they needed help.” Just as JTMF was created as a response to James’ family’s need for assistance, so too does Artists for Life respond – they did a similar thing two years ago when YESS lost integral funding.

Changing the world…

When asked about the success of the Artists for Life event, Joyce humbly says “it wasn’t planned at all, you know. There wasn’t a road map, people really latched on to the concept,” adding, “people are so proud to be Edmontonians, and so proud to help. She forgets to add that it’s a fabulous event, in a really cool location, benefiting really great organizations (I might be biased on that last one).

But it is: Artists for Life marries great Canadian talent with a really cool venue (The Club at the Citadel), all in the name of doing some good for the Edmonton community. If you’d like more info on the event, or if you’d like to buy tickets, click here for the JTMF West Artists for Life event site.

Don’t miss this wonderful event on May 2, 2015, and keep your eyes peeled for JTMF West and HIV Edmonton around the city at the Edmonton Pride Parade and the Pride Run. We’re better together and so grateful for Joyce and JTMF West!

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