HIV treatment and testing | A tailored approach for minorities

The AIDS toll is improving in rich countries, but some minorities continue to have high rates of new infections. The time has now come to modify treatment and screening approaches to better serve these patients, according to the International AIDS Conference at the Palais des Congrès in Montreal. In Canada, the focus is particularly on Aboriginal people.

Mathieu Perreault
The Press

Two minorities

Canada is treading water in the fight against the human immunodeficiency virus (HIV), deplores the Canadian Foundation for AIDS Research (CANFAR). And this especially affects two minorities: Aboriginals and Canadians of Caribbean and sub-Saharan origin. “The COVID-19 pandemic has caused significant disruption to services, particularly for vulnerable communities,” said CANFAR CEO Alex Filiatrault. “Several indigenous communities have been confined more restrictively than the rest of the country. In Quebec, Indigenous people are less affected, but Blacks more: they formed 15% of new HIV cases in 2019, in part because they often come from countries where HIV is endemic. This is a proportion four times higher than their demographic weight.

Liver Day

The mantra of researchers tailoring the fight against HIV to the needs of particularly affected minorities is to give them a voice. “We’ve worked with aboriginal communities in Saskatchewan and found a particularly effective approach, ‘liver day’,” says Marina Klein of McGill University. “We measure participants’ liver health, which is affected by hepatitis C. We can also do other tests, such as for HIV and sexually transmitted infections (STIs), and also for diabetes. It is an approach that less stigmatizes infected patients. »

Spirituality

The other pillar of Aboriginal HIV programs is the call to spirituality. “My grandmother used to tell me what I was doing was evil because she had been to residential school,” says Trevor Stratton, an Ojibwa from suburban Toronto who works with CANFAR. “But in mainstream culture, there’s the concept of Two-Spirit, which encompasses gender fluidity and homosexuality. When I reconnected with the elders in my community in the 1990s, they helped me reconcile my bisexuality with my identity. It prompted me to get tested and treated for HIV. I am now working to set up similar programs. »

Prophylaxis for STIs

The other approach that is gaining ground is to fight STIs the same way as HIV: with “pre-exposure prophylaxis” (PrEP, as it is known). “It is increasingly offered for STIs, with post-exposure prophylaxis”, confirms the D^D Klein. Since wearing a condom is no longer necessary to protect against HIV with PrEP, the rate of STIs has increased significantly over the past 10 years among men who have sex with men.