HIV and Hepatitis C

• How can we prevent HIV and hepatitis C?
• Aboriginal People and HIV in Canada
• Inuit and HIV
• Statistics of Inuit with HIV
• Inuit and Hepatitis C

HIV and hepatitis C are preventable diseases. We know that in order to prevent transmission of HIV and hepatitis C, people must use condoms when they have sex and they must not share pipes when smoking drugs or needles when injecting drugs, tattooing, piercing, or other body art.

If HIV and Hepatits C are preventable, why are people being infected with these diseases?
Well, it may seem easy but there are many different factors leading up to that moment when the condom does or does not get used or whether or not a person uses a clean needle. These factors can actually make it quite complicated to use a condom or to use clean needles.

Keys to Prevention:

1. Before anything else, a person needs to believe that he or she is at risk of becoming infected with HIV and/or hepatitis C. You cannot tell whether someone has HIV or hepatitis C by looking at them. People can have these diseases but look healthy and they themselves might not even know that they are infected. A person must believe that anyone he or she associates with could have HIV or hepatitis C. This is difficult because no one ever thinks that anyone they know would have these diseases. Or, a person might think that they are safe because they live in a particular community or region of the country – they might think that there is no HIV or hepatitis C in their community therefore, they are not at risk.
   
   EVERYONE IS AT RISK OF HIV AND HEPATITIS C.
   
   
2. Second, condoms and/or clean needles and drug injection equipment must be available and readily accessible at the time when a person needs them. This is a difficult one. As we all know, condoms are not cheap and can be embarrassing to purchase. Needles and pipes can also be difficult or impossible to access. Health centres or nursing stations often have condoms available and they might also supply a person with needles.
   
   CARRY 2 CONDOMS WITH YOU AT ALL TIMES IN A COOL SAFE PLACE WHERE THEY WILL NOT GET PUNCTURED.
   
   
3. Third, people need to have knowledge and skills to use condoms and drug equipment safely and properly.
   
   
   Male Condom Instructions:
   
   BEFORE INTERCOURSE
   
   1. Check the expiry date to make sure that the condom is still okay to use.
   2. Carefully open the package so the condom does not tear (do not use teeth or a sharp object to open the package). Do not unroll the condom before putting it on.
   3. If you are not circumcised, pull back the foreskin. Put the condom on the end of the hard penis. Note: If the condom is initially placed backwards on the penis, do not turn it around. Throw it away and start with a new one.
   4. Pinching the tip of the condom to squeeze out air, roll the condom on until it reaches the base of the penis.
   5. Check to make sure that there is space at the tip and that the condom is not broken.
   
   AFTER INTERCOURSE
   
   6. After ejaculation, hold onto the condom at the base of the penis. Keeping the condom on, pull the penis out before the penis gets soft.
   7. Slide the condom off without spilling the liquid (semen) inside the vagina or anus.
   8. Dispose of the used condom and clean the penis and hands with soap and water.
   
   
4. Fourth, people need to feel comfortable bringing up the topic of condoms with someone they are about to have sex with. As we all know, this can be a very awkward and difficult thing to talk about, especially if we really like the person. See CONDOM TALK below.
5. Finally, people need to be respectful of one another’s decisions and choices.

CONDOM TALK

Safer sex means respecting each other!

Say no to anyone who is not willing to practice safer sex with you.

We must use condoms to protect ourselves from sexually transmitted infections, including HIV, and unplanned pregnancies. Comunicating about condoms can be difficult. Here are some tips that might help you in trying to get your partner to use a condom.

If your partner says:
I am on the pill; you don’t need a condom.
You can say:
I’d like to use it anyway. We’ll both be protected from infections we may not know we have.

If your partner says:
I know I don’t have a disease. I haven’t had sex with anyone in months.
You can say:
Thanks for telling me. As far as I know, I don’t have a disease either, but I’d still like to use a condom since either of us could have an infection and not know it.

If your partner says:
I can’t feel a thing when I wear a condom; it’s like wearing a raincoat in the shower.
You can say:
Let’s use lube (water-based lubricant only), it helps improve sensation during sex.

If your partner says:
This is an insult! Do you think I have a disease?
You can say:
I didn’t say that. I care for you. It is best to use a condom and that means I respect you.

If your partner says:
Let's not use a condom just this once.
You can say:
Once is all it takes.

If your partner says:
I don’t have a condom with me.
You can say:
I do, and I would like to use it.

If your partner says:
I won’t have sex with you if you’re going to use a condom.
You can say:
So let’s put it off until you agree because at the moment you are not respecting me.

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HIV is affecting Aboriginal populations disproportionately to non-Aboriginal populations in Canada. Aboriginal peoples make up a growing percentage of positive HIV reports and reported AIDS cases and it shows no sign of slowing down. Aboriginal women make up a large part of the HIV epidemic in their communities and Aboriginal people are infected at a younger age than non-Aboriginal persons.

HIV

• Aboriginal peoples represent 23.4% of positive HIV test reports with information on ethnicity
• According to the 2001 Census, Aboriginal peoples make up 3.3% of the Canadian population
• In 1998, 18.8% of positive HIV test reports were among Aboriginal peoples
• This increased to 25.3% in 2003
• During 1998-2003, females represented 44.6% of positive test reports among Aboriginal peoples
• From 1998-2003, youth (<30 years) made up 31.4% of positive HIV test reports among Aboriginal peoples

AIDS

• Before 1993, 1.2% of reported AIDS cases were among Aboriginal peoples
• This increased to 13.4% in 2003
• Before 1993, females represented 11.9% of reported AIDS cases among Aboriginal peoples
• In the year 2003, this percentage increased to 44.0%
• Before 1993, 40.6% of Aboriginal AIDS cases were among youth (<30 years)
• From 1999-2003, youth represented 13.0% of Aboriginal AIDS cases

For more information about HIV and Aboriginal people in Canada, please refer to the Aboriginal Epi-Note produced by Health Canada and the Canadian Aboriginal AIDS Network website.

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In 1987, when news of the first Inuk woman to have AIDS was announced, most people thought this was a unique case and of little concern. Now, nearly 20 years later, we know that this was not a unique case. We know that there are many Inuit living with either HIV, hepatitis C or both, and many more who are living with one or both of these diseases but do not know that they are infected.

HIV is moving through Inuit communities differently than it has in other Canadian populations. In the South, HIV started as primarily a homosexual disease – moving within gay populations and affecting mostly gay men, men who have sex with men, and people who use injection drugs. Only recently in the South, has it been considered a heterosexual disease, with young women being the group for which the rate is increasing the fastest. In Inuit communities, HIV has always been a heterosexual disease – passed between men and women during sex and between people who are sharing drug equipment.

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The statistics with respect to numbers of Inuit in Canada with HIV/AIDS are questionable. In 2003, the number of Inuit reported to have AIDS was 18. While this number may seem small, it only accounts for AIDS cases and not Inuit who have HIV.

In addition, many Inuit do not get tested for HIV, either because of fear or they simply do not know enough about it. If Inuit do get tested, they often get tested in southern urban centres, where their ethnicity might not be recorded. This means that Inuit HIV positive tests are likely getting lost among broader Aboriginal or Canadian statistics. Therefore, we do not have a clear picture of how many Inuit have HIV/AIDS.

What we do know is that we have some of the highest rates of Sexually Transmitted Infections (STIs) such as Gonnorhea and Chlamydia and teen pregnancy in Canada. These facts indicate that unprotected sex (sex without a condom) is happening. And where there is unprotected sex, there is high risk for life threatening diseases such as HIV and hepatitis C.

Often the most difficult part of prevention is convincing people that they are at risk of infection – that everyone is at risk, that it only takes one encounter with someone who is positive for a person to become infected, and that one cannot tell whether a person is HIV or hepatitis C positive from looking at them. HIV and hepatitis C prevention is about empowerment. It is about giving people the tools they need to protect themselves from HIV and hepatitis C. Individuals need to have confidence to initiate conversations with their friends and sexual partners about sexually transmitted infections and using condoms. Everyone has the right to health and therefore, the right to stay HIV and hepatitis C negative. In sexual relationships, women and men must be able to insist that condoms be used and their partners must respect their choices.

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Hepatitis C is another virus that poses a threat to Inuit however, as with HIV, reported rates of Hepatitis C among Inuit are unreliable. We do know that there are Inuit in the North who have hepatitis C, although we are not sure exactly how many. We also know that many Inuit received hospital care at the time the blood system was contributing to the hepatitis C infection rate in Canada. As many people who have hepatitis C experience few or no symptoms, we are concerned that there are people who have hepatitis C and don’t know it and how this could result in an explosion of Inuit with hepatitis C.

Inuit, HIV and Hepatitis C: Summary

• There is no indication that the spread of HIV or hepatitis C are slowing down anywhere in the world
• HIV and hepatitis C are present in Arctic communities and are a real threat to Inuit
• The most common route of HIV infection for Inuit is through unprotected heterosexual sex
• High rates of pregnancy as well as sexually transmitted infections (STIs) such as Chlamydia and Gonnorhea, are evidence that Inuit are engaging in behaviour that puts them at risk for HIV infection
• Increased travel between Arctic communities and urban centres increases the chance of HIV and hepatitis C being introduced to a Northern community
• Inuit youth often leave home communities to pursue education in a southern city which increases their risk of coming in contact with HIV or hepatitis C
• Inuit inmates in federal prisons live in a high risk environment for HIV and hepatitis C infection and may bring either or both diseases back to their home communities upon release from prison
• Inuit living with either HIV and/or hepatitis C in urban centres may decide to return to their home communities as their disease/s progress, which requires community members and health staff to have basic understanding of precautions and treatment

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