HIV in Canada: A primer for service providers

 

Integrated Approaches to Sexually Transmitted and Blood-borne Infections and Tuberculosis

Key Points

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

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 are 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 integration of HIV and hepatitis C services is being explored in many regions. Owing to the existence of an infrastructure for HIV services (e.g., AIDS service organizations), increased funding and resources to this infrastructure could allow for the uptake of new knowledge and services by these organizations to meet the needs of people at risk for or living with hepatitis C.

However, AIDS service organizations may face significant challenges. Some organizations feel that integration may not be appropriate for their clients. For other organizations, the different stigmas related to HIV and hepatitis C may make integration difficult and may result in poor uptake of services by one or more populations at risk. Additionally, the large number of people living with hepatitis C and their often complex conditions may tax the ability of AIDS service organizations to deliver services. Additional resources, capacity building and knowledge sharing about the integration of HIV and hepatitis C services are important components of any integrated strategy. Holistic harm reduction programming for people who use injection drugs is one model of the integration of HIV and hepatitis C services that has shown promise.

The integration of services for HIV and sexually transmitted infections (STIs) may be more challenging because HIV is a concentrated epidemic in Canada, disproportionately affecting specific populations, while STIs are more generalized to the entire sexually active population. There are concerns that the integration of services for HIV and STIs might dilute the targeted, population-specific interventions needed to respond effectively to the HIV epidemic. On the other hand, integrating information on STIs into existing HIV programs is important because STIs can increase the spread of the epidemic and lead to poorer health outcomes for people living with HIV. Programming that addresses the holistic sexual health needs of gay men is one model of integration that is being explored in several regions of Canada.

The integration of HIV and tuberculosis services is not common in Canada. However, people living with HIV are at greater risk of acquiring tuberculosis and are more likely to develop active tuberculosis that can be transmitted to others. Some populations at greater risk for HIV are also at greater risk for tuberculosis, such as Aboriginal peoples and people who use injection drugs. For these reasons it may be appropriate to consider integrated approaches to HIV and tuberculosis.

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

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