HIV as chronic illness: caregiving and social networks in a vulnerable population.

We sought to understand the support networks of people living with HIV (PLWH) in the Canadian cities of Winnipeg and Regina, particularly of their network of caregivers and with a focus on people from disadvantaged and/or stigmatized communities. Using a variation of the Photovoice method, 31 study participants took photographs of their everyday realities and were then interviewed. Among the findings was the heavy reliance on institutional caregivers and on nonhuman sources of support. There was evidence of peer-to-peer networks of care, but the strongest connections were with their formal caregivers. HIV as a chronic condition among disadvantaged and/or stigmatized groups requires paying special attention to informal and formal care dynamics and to where social or family networks cannot meet the basic needs. Honing in on and enhancing these features through programs and services can only improve the situation of stigmatized yet hopeful and resilient PLWH.

Feasibility and success of HIV point-of-care testing in an emergency department in an urban Canadian setting.

BACKGROUND: Approximately 26% of Canadians living with HIV are unaware of their status. Point-of-care (POC) HIV tests have been introduced to simplify and expand HIV testing. OBJECTIVE: To evaluate the feasibility and acceptability of POC testing in an emergency department (ED) setting in Winnipeg, Manitoba. METHODS: A cross-sectional study of unselected adults presenting to the ED at the Health Sciences Centre Hospital (Winnipeg, Manitoba) was performed. Study procedures included pre- and post-test counselling, administration of the INSTI HIV-1/HIV-2 Antibody Test (bioLytical Laboratories, Canada) and a brief questionnaire. Venous blood samples were collected from participants for confirmatory testing on all reactive and indeterminate specimens. RESULTS: In total, 501 adults participated in the study. The majority of participants were younger than 40 years of age, approximately one-half (48.5%) were women and 53% self-identified as Aboriginal. Nearly one-half (49.1%) of the participants had undergone previous HIV testing, although 63% of these tests were performed more than a year earlier. A total of seven individuals tested reactive with the POC test, all of whom were confirmed positive using serological testing (1.4%) and were linked to an HIV specialist within 24 h. Nearly all of the participants (96%) reported satisfaction with the test and believed it belonged in the ED (93%). CONCLUSIONS: Of the participants tested, 1.4% tested reactive for HIV, which is significantly higher than the reported prevalence in Manitoba and in other similar studies conducted in North America. Furthermore, all individuals were linked to timely care. The present study demonstrated that this particular busy tertiary care ED is an important and feasible location for HIV POC testing.

INTRODUCTION: Environ 26 % des Canadiens qui sont atteints du VIH ne connaissent pas leur statut. Les tests du VIH au point de service (PDS) ont créés pour simplifier et généraliser le test du VIH. OBJECTIF: Évaluer la faisabilité et l'acceptabilité du test au PDS au sein d'une urgence de Winnipeg, au Manitoba. MÉTHODOLOGIE: Les chercheurs ont procédé à une étude transversale auprès d'adultes non sélectionnés qui se sont présentés à l'urgence du Health Sciences Centre Hospital de Winnipeg, au Manitoba. Pendant l'étude, les interventions incluaient des conseils avant et après le test, l'administration du test INSTI de recherche des anticorps anti-VIH-1/VIH-2 (bioLytical Laboratories, Canada) et un bref questionnaire. Ils ont prélevé du sang veineux pour effectuer un test de confirmation sur tous les échantillons réactifs ou indéterminés. RÉSULTATS: Au total, 501 adultes ont participé à l'étude. La majorité avaient moins de 40 ans, environ la moitié (48,5 %) étaient des femmes et 53 % ont eux-mêmes précisé qu'ils étaient des Autochtones. Près de la moitié (49 %) avaient déjà subi un test du VIH, mais 63 % de ces tests avaient été exécutés plus d'un an auparavant. Au total, sept personnes étaient réactives au test au PDS, toutes confirmées comme positives au test sérologique (1,4 %) et ont été orientées vers un spécialiste du VIH dans les 24 heures. Presque tous les participants (96 %) se sont dits satisfaits du test et pensaient qu'il était caractéristique de l'urgence (93 %). CONCLUSIONS: Sur les participants qui ont subi le dépistage, 1,4 % était réactif au VIH, ce qui est considérablement plus élevé que la prévalence déclarée au Manitoba et dans d'autres études similaires d'Amérique du Nord. De plus, toutes les personnes ont été orientées rapidement vers des soins. La présente étude a démontré que cette urgence de soins tertiaires achalandée est un lieu important et faisable comme PDS pour effectuer le test du VIH.

Characterizing the HIV epidemic in the prairie provinces.

BACKGROUND: The numbers and demographics of HIV-positive patients in care between 2003 and 2007 in the prairie provinces were examined. METHODS: Estimates of HIV-positive patients presenting to care between 2003 and 2007 were obtained from four clinic registries in Manitoba, Saskatchewan and southern Alberta. Detailed data were collected from clinical records of new patients in 2007. RESULTS: By the end of December 2007, 2263 HIV-positive persons were in care in Manitoba, Saskatchewan and southern Alberta. Males and females accounted for 1674 (74.0%) and 589 of the cases, respectively. Overall, there was a 12% increase per year in new HIV cases to care between 2003 and 2007 (P=0.026), with the rate of increase for males being 60% higher than for females over this time period (P=0.002). In 2007, there were 222 new HIV cases to care (37.4% female). Heterosexual contact was the most common HIV risk, but diversity was seen across sites with frequent injection drug use and men who have sex with men risk in Saskatchewan and southern Alberta, respectively. The Aboriginal population remains heavily over-represented, with approximately 36.0% of new cases being Aboriginal. Late presentation was common across all care sites, with 35.1% of cases presenting with CD4 counts of less than 200 cells/mm(3). DISCUSSION: Heterosexual risk is the most common risk reported for HIV acquisition, but injection drug use risk remains significant in Saskatchewan. Aboriginals are over-represented at all sites, and in Saskatchewan accounted for the majority of new cases seen. In contrast to national trends, numbers of new and late diagnoses are increasing in the praire provinces, and this has significant treatment implications and potential public health consequences. Further efforts need to be made to facilitate earlier testing and linkage to care. BACKGROUND: The numbers and demographics of HIV-positive patients in care between 2003 and 2007 in the prairie provinces were examined. METHODS: Estimates of HIV-positive patients presenting to care between 2003 and 2007 were obtained from four clinic registries in Manitoba, Saskatchewan and southern Alberta. Detailed data were collected from clinical records of new patients in 2007. RESULTS: By the end of December 2007, 2263 HIV-positive persons were in care in Manitoba, Saskatchewan and southern Alberta. Males and females accounted for 1674 (74.0%) and 589 of the cases, respectively. Overall, there was a 12% increase per year in new HIV cases to care between 2003 and 2007 (P=0.026), with the rate of increase for males being 60% higher than for females over this time period (P=0.002). In 2007, there were 222 new HIV cases to care (37.4% female). Heterosexual contact was the most common HIV risk, but diversity was seen across sites with frequent injection drug use and men who have sex with men risk in Saskatchewan and southern Alberta, respectively. The Aboriginal population remains heavily over-represented, with approximately 36.0% of new cases being Aboriginal. Late presentation was common across all care sites, with 35.1% of cases presenting with CD4 counts of less than 200 cells/mm3. DISCUSSION: Heterosexual risk is the most common risk reported for HIV acquisition, but injection drug use risk remains significant in Saskatchewan. Aboriginals are over-represented at all sites, and in Saskatchewan accounted for the majority of new cases seen. In contrast to national trends, numbers of new and late diagnoses are increasing in the praire provinces, and this has significant treatment implications and potential public health consequences. Further efforts need to be made to facilitate earlier testing and linkage to care.

HISTORIQUE: Les chercheurs ont examiné le nombre et la démographie des patients positifs au VIH soignés entre 2003 et 2007 dans les provinces des Prairies. MÉTHODOLOGIE: Les chercheurs ont pu évaluer le nombre de patients positifs au VIH qui ont consulté pour la première fois entre 2003 et 2007 d'après quatre registres cliniques du Manitoba, de la Saskatchewan et du sud de l'Alberta. Ils ont également recueilli les données détaillées des dossiers cliniques de nouveaux patients en 2007. RÉSULTATS: À la fin de décembre 2007, 2 263 personnes positives au VIH étaient soignées au Manitoba, en Saskatchewan et dans le sud de l'Alberta. Les hommes et les femmes représentaient 1 674 (74,0 %) et 589 cas, respectivement. Dans l'ensemble, on a constaté une augmentation annuelle de 12 % des nouveaux cas de VIH soignés entre 2003 et 2007 (P=0,026), le taux d'augmentation pour les hommes étant 60 % plus élevé que pour les femmes (P=0,002). En 2007, on a recensé 222 nouveaux cas de VIH soignés (37,4 % de femmes). Le contact hétérosexuel représentait le principal risque de VIH, mais on remarquait une diversité selon les lieux, le risque posé par la consommation fréquente de drogues par injection et par les relations sexuelles entre hommes étant observé en Saskatchewan et au sud de l'Alberta, respectivement. La population autochtone demeure lourdement surreprésentée, puisqu'environ 36,0 % des nouveaux cas étaient d'origine autochtone. Une présentation tardive était fréquente partout, la numération de CD4 étant inférieure à 200 cellules/mm3 à la présentation dans 35,1 % des cas. EXPOSÉ: Les contacts hétérosexuels constituent le principal risque déclaré d'acquisition du VIH, mais la consommation de drogues par injection demeure importante en Saskatchewan. Les Autochtones sont surreprésentés partout, et en Saskatchewan, ils représentent la majorité des nouveaux cas observés. Contrairement aux tendances nationales, le nombre de nouveaux diagnostics et de diagnostics tardifs augmente dans les provinces des Prairies, ce qui a des répercussions thérapeutiques importantes et des conséquences potentielles en matière de santé publique. Il faut faire davantage d'efforts pour favoriser la tenue de tests et des mises en relation plus rapides vers les soins.