HIV in Canada: A primer for service providers

 

The Benefits of Integrated Approaches to Sexually Transmitted and Blood-borne Infections

Key Points

  • Integration of prevention and treatment services for HIV, hepatitis C and other sexually transmitted and blood-borne infections is increasingly being promoted and adopted.

The Public Health Agency of Canada, the U.S. Centers for Disease Control and Prevention (CDC) and some provincial governments are increasingly promoting the integration of services for HIV and other sexually transmitted and blood-borne infections. There ae several reasons for this approach:

  • These infections share common modes of transmission and common risk behaviours. Therefore, programs that address behavioural risk factors for one infection can also address risk factors for other infections.
  • These infections disproportionately impact similar populations because they share common social and structural risk factors. Therefore programs that impact the social drivers of one infection can also impact those of other infections.
  • These infections can form synergistic epidemics in which one infection increases the risk of transmission of another infection and/or makes treatment of that infection more difficult. For example, the presence of syphilis can increase the risk of HIV transmission. Therefore, programs that address only one infection may be undermined by the outbreak of another sexually transmitted or blood-borne infection in the same population. Integrated approaches to these infections can facilitate a more holistic approach to sexual health and harm reduction that simultaneously addresses a range of client needs.

The Government of Canada’s five year action plan on STBBIs moves beyond programs that focus on a single disease and looks to programs that address common risk factors, transmission routes, coinfections and approaches to prevention, testing and treatment programs across STBBIs. While an integrated approach to prevention and treatment services is viewed as most effective, an integrated approach also recognizes that there may be a need for disease-specific approaches in some instances.

Resources

A Pan-Canadian Framework for Action: Reducing the Health Impact of Sexually Transmitted and Blood-Borne Infections by 2030 – Public Health Agency of Canada

Accelerating our response: Government of Canada five-year action plan on sexually transmitted and blood-borne infections – Public Health Agency of Canada  

Ending the HIV Epidemic in Canada in Five Years: It’s Time to ACT – Members of the National Working Group on HIV/AIDS Research

Sources

  1. Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly: summary guidance from the CDC and the US Department of Health and Human Services. Morbidity and Mortality Weekly Report. 2012 Nov 9;61(RR-5):1–40.
  2. Church K, Lewin S. Delivering integrated HIV services: time for a client-centred approach to meet the sexual and reproductive health needs of people living with HIV? AIDS. 2010 Jan 16;24(23):189–193.
  3. Kalichman SC, Pellowski J, Turner C. Prevalence of sexually transmitted co-infections in people living with HIV/AIDS; systematic review with implications for using HIV treatments for prevention. Sexually Transmitted Infections. 2011 Apr; 87(3):183–190.
  4. CATIE. New directions in gay men’s health and HV prevention in Canada: pan-Canadian deliberative dialogue report. 2010. Available from: http://library.catie.ca/PDF/ATI-40000s/40224.pdf
  5. CATIE. CATIE Forum New Science, New Directions in HIV and HCV – meeting report. 2013. Available from: http://www.catie.ca/sites/default/files/CATIE-Forum-Report-Final-Nov-2013.pdf
  6. Paquette D, Steben M. Integration of HIV, HCV and other STBBIs [video]. CATIE, 2012. Available from: http://www.catie.ca/en/forum/webcast-archive/integration-hiv-hcv-other-stbbis
  7. Alberta sexually transmitted infections and blood borne pathogens strategy and action plan: 2011–2016. Government of Alberta. Available from: http://www.health.alberta.ca/documents/STI-BBP-Plan-2011.pdf
  8. Manitoba Sexually Transmitted and Blood-Borne Infections Strategy: 2015–2019. Manitoba Health, Healthy Living and Seniors. Available from: http://www.gov.mb.ca/health/publichealth/cdc/docs/stbbi_strategy.pdf
  9. Nunavut Sexual Health Framework for Action: 2012­–2017. Nunavut Department of Health, 2012. Available from: http://www.gov.nu.ca/sites/default/files/files/Nunavut%20Sexual%20Health%20Framework%20ENG.pdf
  10. World Health Organization. Global Health Sector Strategy on Sexually Transmitted Infections 2016–2021. 2016. Available from: http://apps.who.int/iris/bitstream/10665/246296/1/WHO-RHR-16.09-eng.pdf?ua=1
  11. Sepúlveda J. The “third wave” of HIV prevention: Filling gaps in integrated interventions, knowledge, and funding. Health Affairs. 2012 Jul 1;31(7):1545–1552.
  12. A Pan-Canadian Framework for Action: Reducing the Health Impact of Sexually Transmitted and Blood-Borne Infections by 2030 – Public Health Agency of Canada
  13. Accelerating our response: Government of Canada five-year action plan on sexually transmitted and blood-borne infections – Public Health Agency of Canada