On Monday January 22, the Centre for Gender and Social Justice and Trent Oxfam co-hosted a Creating Spaces event focused on HIV/AIDS. Zoe Easton facilitated the event with questions, which were answered by David Macmillan and Ariel O’Neill.
Macmillan is a freelance HIV outreach consultant whose focus has been on HIV education and presentation in the gay, bi, queer, and other men who have sex with men community in Ottawa. O’Neill is Women and Community Animator for PARN – Peterborough AIDS Resource Network – and is also involved in the Women and HIV/AIDS initiative. “The initiative is a community-based response to HIV and AIDS among cis and trans women in Ontario,” which considers the structural and societal factors that increase women’s risk factors for HIV. Find out more at www.whai.ca.
The discussion started with an explanation of HIV/AIDS. HIV is human immunodeficiency virus, and AIDS is acquired immune deficiency syndrome. HIV is transmitted person to person through bodily fluids. AIDS cannot be contracted; it is the progression of HIV. In Canada, through medications this progression can be stopped, and symptoms can be limited.
The main impact of HIV/AIDS is the effect on the immune system. The higher an individuals viral load, the more their immune system is compromised. When people have AIDS, they tend to die from optimistic infections, such as pneumonia and tuberculosis. Additionally, if HIV is not treated it can lead to neurocognitive impacts later.
Macmillan stated that, “HIV is really sneaky, in that you can go for years without having any symptoms.” O’Neill added that in Canada, “AIDS is not a health issue for the most part. People who are privileged by geography, to live here in Canada and Ontario, and have access to medication. So, HIV is the onus that we deal with.”
The speakers noted that there are two types of tests for HIV. The standard test, which you can get at your health care provider. In Peterborough, you can also get tested at the sexual health clinic, or on Tuesdays and Thursdays at PARN. There is also rapid anonymous HIV testing, which is not available in Peterborough, but is in Oshawa or Port Perry. The main difference is the anonymity.
O’Neill noted that there are issues with the system. Specifically, that if you are found to be reactive, it is reported, and contact tracers follow up with you. Although there is some variance based on community, generally tracers track down those with which a positive individual has had sex. This controversial practice is an issue because it makes it appear that someone who is HIV-positive is a major public health risk and does not have the right to confidentiality, which adds to the stigma.
Stigma is also the main barrier to getting tested. People are often shamed for getting HIV, but there is also a lot of stigma surrounding HIV. For example, there is stigma sounding sexuality and drug use, both of which influence HIV.
Macmillan stated that “HIV effects everyone. It effects some people more than others due to the social determinants of health,” such as socioeconomic status. Although there are groups of people who are more at risk, such as injection drug users, and men who have sex with men, there is a lot of intersectionality in HIV. Homophobia, misogyny, racism, and patriarchy all play a role in the stigma and risk of HIV.
HIV non-disclosure is criminalized in Canada. In October 2012, it was ruled that HIV status had to be disclosed unless a condom is used, and the HIV-positive person has an undetectable load. An undetectable load is when there is so little of the virus in a person’s system that it is difficult to transmit.
Criminalization is seen as negative because it discourages testing, and stigmatizes people with HIV. Macmillan stated that “criminalization discourages people from taking responsibility for their sexual health. It places the emphasis for taking responsibility on HIV-positive [people], but completely taking that responsibility away from HIV-negative people.”
Additionally, Macmillan discussed the issues with this law. He noted that not everyone can achieve a low viral load, and that not everyone can negotiate condom use. Without these aspects the law states that HIV status must be disclosed. If HIV status is not disclosed, an HIV-positive person can be charged with aggravated sexual assault.
Being HIV-positive does not mean that there is something wrong with the person, or that they cannot have a sex life. Macmillan advises that, “Having sex with someone who is HIV-positive and is on medication, and is undetectable, is safer then having sex with someone who doesn’t know their status.”
Which is why it is important for people to know their status. Easton stated, “If you’re going to get tested for some things, you might as get tested for everything.” O’Neill added on that it is “really important to be an advocate for yourself.”
There are many organizations in Ontario that work in the HIV sector. O’Neill noted that some of the system of organizations is fantastic “because it’s this idea of collective impact, that you have folks who are working in community and they’re feeding up into a larger movement to affect change. You’re sort of focused on similar platforms, certain areas you work, but then we all have certain geographic differences.” For example, she noted that those in Peterborough are going to have a different experience than those in Toronto.
The work that is being done locally positively impacts global health. The work that is done locally is reported to the province, who then reports to UNAIDS, which is an international organization dealing with HIV/AIDS. The tool kits and information that is created here is used internationally.
The goal is 90-90-90, meaning 90% of people know their status (i.e. have been tested), 90% of people diagnosed with HIV will be engaged in care, and 90% of those engaged in care will be virally suppressed.