For many people, HIV comes hand-in-hand with other challenges. Housing, employment, healthcare and harm reduction services can all be hard to find, so some organizations bring everything under one roof. Jennifer McPhee looks at the Victoria Cool Aid Society in B.C., which does just that.
In Canada, people who experience homelessness, mental illness or take injection drugs are especially affected by HIV. The Victoria Cool Aid Society is a non-profit organization in downtown Victoria with a long history of responding to this by delivering a full range of integrated services to people who need it most. The Canadian Association of Community Health Centres recently recognized Cool Aid’s trailblazing work by selecting it for a 2019 Transformative Change Award. This recognized its leadership and innovation in the integration of programs, services and advocacy that address the intersection of housing and health.
Garrett Gordon, 52, is a long-time client of Cool Aid. Until five years ago, he had a “bad drug and alcohol addiction” and lived on the street most of the time. He would stop by to pick up HIV medication and clean needles, or to eat at AVI Health and Community Services’ lunch program, located in the same building. Since quitting alcohol and drugs, he’s become a daily user of Cool Aid’s healthy living and support programs. Reached by phone at the mobile home where he now lives, he apologizes for taking a while to answer. He explains that he couldn’t hear the phone ring because he was in the middle of blending a smoothie. “It’s a blueberry, cranberry, pumpkin seed kind of thing with kale and turmeric and all that good stuff,” he says.
Cool Aid was founded in 1968, when it mainly provided emergency shelter to transient youth travelling across Canada. The organization incorporated as the Victoria Cool Aid Society in 1976, several years after opening the “Cool Aid Free Medical Clinic.” It went on to establish British Columbia’s first supportive housing apartments in 1991, and was a pioneer of harm reduction. This is now a widely accepted evidence-based approach that seeks to reduce the risks and harms of substance use without preachiness or requiring abstinence.
Today, hundreds of Cool Aid’s employees work in Victoria, Saanich and Langford providing homes, shelter, healthcare and other services to Victoria’s most vulnerable. Cool Aid currently operates 14 supportive housing apartment buildings, as well as three large shelters that provide a critical link to a wide variety of services for those experiencing homelessness. These include rent supplements, landlord liaison, a dental clinic, a casual labour pool, healthy recreation and other community services such as detox.
Like Gordon, many people living with HIV get to know Cool Aid through its Community Health Centre, designed to make it easier for people experiencing marginalization to connect with healthcare. One of the unique aspects of Cool Aid’s approach is its delivery of HIV care in the context of primary healthcare. The clinic’s family doctors are well-versed in HIV management as well as in opioid agonist therapy, so people living with HIV can see their family physician whether they are dealing with a sprained ankle, HIV-related concern or substance use issue.
Once someone becomes a patient, they have free access to a multidisciplinary team that also includes nurse practitioners, nurse clinicians, mental health and addictions counsellors, dietitians, pharmacists and an acupuncturist. Because these professionals are also involved with HIV care, they incorporate the fact that someone lives with HIV into treatment for different aspects of a patient’s health. Then, if someone’s HIV or mental health issues become too complex for the clinic’s family doctors and counsellors, they can see the visiting psychiatrist or infectious disease specialist. The clinic also offers free medication delivery, and it’s the pharmacist who personally delivers these medications.
Cool Aid’s staff don’t sit around waiting for people who need support to arrive, they go out and find them. Outreach, teaching and advocacy are all significant parts of the team’s work. Staff members hold regular health clinics at Cool Aid’s shelters and housing sites and team up with other agencies to offer things like free HIV testing at a park known for cruising. The staff frequently team up with AVI Health and Community Services—the area’s largest HIV organization located in the same building—to provide joint programs, including a weekly HIV support group. “We run up and down the stairs here all the time to work together, which is wonderful,” says clinical nurse leader Anne Drost.
The principles of harm reduction guide the clinic, and staff strive to meet clients where they’re at in a non-judgmental way. “That might be providing clean needles or crack pipes to help prevent the transmission of illnesses,” says Drost. “It might be teaching someone to inject safely. It could also be smoking cessation or trying to get people to be more physically active. And for people who want to go to addiction treatment, we do the paperwork to facilitate that.” This approach disarms and engages clients, leading to more honest interactions. “People feel comfortable asking questions and telling you what’s going on and you can come up with a plan to deal with a particular concern that’s realistic and achievable for people,” she says. “For a client who might be feeling depressed and overwhelmed, we might set a goal like washing the dishes the next day.”
The entire healthcare team also has access to patient electronic medical records, so clients don’t have to retell their life story every time they see a new member of the team. This system also facilitates collaborative care, says Drost. For example, a nurse may find out that someone has gone off their HIV medication while treating them for a broken leg, and call over a doctor to discuss possibly restarting treatment. Or, a pharmacist may notice that a regular client dropping by to pick up pills looks unwell, and ask a nurse to examine her.
Drost knows most of the clinic’s 230 patients living with HIV by name. “Relationship building is key,” she says. “I know what’s going on in their lives. I know if someone is homeless, if someone got married, if someone’s dog died.” Many of Cool Aid’s HIV-positive clients are seniors and long-term survivors (the oldest is in his 90s) who are dealing with typical age-related conditions like diabetes, cardiovascular illness and arthritis. Newly diagnosed patients are mainly young men who have sex with men. “That is something we need to address as a society,” says Drost. As a way of doing exactly that, Cool Aid’s nurses set up a PrEP program at the clinic that allows serodiscordant couples and men who have sex with men to get access to the HIV prevention drug.
The health centre also runs the Resource Employment Education Service (REES) and the Downtown Community Health Centre. Located in a separate building, REES offers education and support to people living with mental health and addiction issues, access to an employment agency and assistance with an assortment of other tasks such as filing taxes or filling out disability forms. The Downtown Community Health Centre’s free activities focus on healthy living, health promotion and social diversity including cooking classes and an ‘Every Step Counts’ walking and running program, which Gordon participates in. He says he now relies on Cool Aid for everything from daily emotional support to dental work. “The place is a one-stop shop,” he says. “I give it two thumbs and two toes up.”