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Blog Archive

  • Intersection of HIV and Hepatitis C

    May 27th, 2016

    intersection

    by Janet Madsen  |  @janet_madsen

    Last week was our annual SpringBoard conference. I love SpringBoard; it’s a day to connect with people from many different communities and to hear new and developing info from research, health care and social services.

    After a welcome from Elder Roberta Price acknowledging our place on the unceded traditional territory of the Squamish, Musqueam and Tsleil-Waututh First Nations, we turned our focus to the intersection of HIV and hepatitis C. As one presenter put it, this is an increasingly pressured partnership. Focusing on both blood borne illnesses together makes sense in some ways, but they are different health challenges with different treatment goals and service needs. Most obviously, hepatitis C can be cured; HIV can be managed but not cured. Both can be transmitted through shared needles, injection equipment or sex; but hepatitis C is far more infectious than HIV. What women need in terms of support for a course of hep C treatment may be very different than what a woman needs for a lifelong commitment of HIV treatment.

    Both viruses are stigmatized, and health care systems don’t always successfully reach the people who could most need help. The day gave us chances to talk about barriers to information, care and treatment. People may feel they are just a number in a system that doesn’t really take into account the emotional factors of health as well as the physical. The impact of colonization and the western model of care can make people feel unsafe and alienated; histories of violence or abuse can make medical appointments frightening and traumatic.

    Two overview presentations led us into the day. Dr. Alexandra King highlighted how HIV and hepatitis C have disproportionately impacted Indigenous peoples in Canada, particularly women. The Truth and Reconciliation Commission reports and the federal government’s pledge to address the recommendations are hopefully going to shift the health realities that put Aboriginal people at risk. Gina McGowan walked us through the ongoing renewal of Healthy Pathways Forward, the BC Ministry of Health’s hepatitis strategy.

    Anne Genovy, who is living with HIV and had successful hepatitis C treatment, co-presented with Dr. Neora Pick from BC Women’s Oak Tree Clinic. Dr. Pick reflected on the recent integration of hepatitis care into HIV care at the clinic, showing the impacts on health that both have on the other. Anne said how important it is to have women-centred services like Oak Tree and Positive Women’s Network. Another woman with HIV who attended noted on her evaluation that Oak Tree’s care is excellent.

    Deb Schmitz (Pacific Hepatitis C Network) and Erica Thompson (The Warm Zone)  presented on the stigma of hepatitis C for women. Deb talked about the assumption of drug use that follows women with hepatitis C, including those who may never have used at all. Erica provided stories of women living with hep C and the challenges they have to face. Source of infection should not affect quality of care, she rightly said. She stressed the importance of peer to peer support both in understanding HCV and going through treatment.

    The importance of peer support was echoed by Claudette Cardinal, a peer research associate with CHIWOS, a national research project on sexual health and access to HIV services. Claudette said that we must support individual readiness for treatment, and not pressure people to start before they are ready. She shared her story of learning her HIV status and her journey to being a peer researcher. Co-presenter Sally brought CHIWOS research findings so far. Women who have been in jail have higher rates of HIV; 30% of their research participants nationally have ever been in jail and have a 4- fold chance of HIV and HCV coinfection.

    It was a fantastic day to learn, challenge, and inspire one another to further work to destigmatize both HIV and HCV and improve care and services to women. Many thanks to AbbVie, our exclusive pharmaceutical sponsor of the event for helping us make this event a reality.

     

     

    Image: DavidPWhelan, MorgueFile

    HIV disclosure is more than a one-time conversation

    May 20th, 2016

    By Erin Seatter  |  @erinlynds

    Decades after the emergence of HIV, disclosure remains one of the biggest challenges for women living with HIV. There’s nothing easy or straightforward about it. When thinking about whether to tell someone about their HIV-positive status, women must consider a range of possible results, for themselves as well as their families.Disclosure to partners

    Some women find that disclosure can help bring peace of mind, with more freedom from fear and stress. Being able to talk honestly about their health and get day-to-day support can be a relief. Very close relationships involve sharing, vulnerability and listening, and sometimes women find that disclosure leads to more open discussions, tighter connections and stronger intimacy.

    But for others, the consequences of disclosing can be devastating. Women may experience rejection and abandonment, leading to social isolation and loss of intimacy. They may be accused of promiscuity, drug use, or sex work. They may lose access to their children, housing or money. Or they may live under threat of losing these things. Emotional and physical abuse often starts, or becomes intensified and more frequent. In some cases, disclosure is lethal.

    For women who don’t want everyone to know their status, confidentiality is a concern. Women in small communities (a rural area, small town, or distinct population in a city) may worry about word getting out and the ostracism that can follow. This same concern can affect women who have migrated and have links to family and community in other parts of Canada or in their home country.

    Without a doubt, disclosure is complicated, and the social, emotional, economic and physical implications are very real. Each woman living with HIV must decide for herself whether disclosure makes sense. What could be good about telling? What could be bad? And what could happen after disclosing?

    Planning is one of the most important parts of disclosure. We encourage women to decide how they want to disclose instead of spontaneously telling someone that they have HIV. This will also allow them time to make sure they’re ready to share the news.

    We also recommend that women connect with an HIV organization and talk with a support worker or peers to help make a plan for before, during and after disclosure. What to say, when and where, are a few of the big questions we encourage women to think about. Safety considerations are also paramount; even if a woman hasn’t experienced abuse from her partner or family, it is valuable to develop a safety plan and be ready to act on it if needed.

    Disclosure is more than a one-time conversation. It’s an ongoing process, one that women living with HIV will negotiate throughout their lives.

    To help women through the process of disclosure, Positive Women’s Network, in partnership with the BC Women’s Hospital + Health Centre, has developed a series of booklets on disclosure:

    • Figuring Out How to Tell Children and Family (available in English, French, Swahili, and Punjabi)
    • Figuring Out How to Tell Romantic or Sexual Partners (available in English, French, Swahili, and Punjabi)
    • If Your Partner Tells You They Have HIV (available in English, French, Swahili, and Punjabi)
    • A Guide for Youth (available in English and French)
    • How Health and Social Service Providers Can Support Positive People (available in English only)

    Please contact Positive Women’s Network if you’d like to order these resources.

    The English and French versions of Figuring Out How to Tell Children and Family, Figuring Out How to Tell Romantic or Sexual Partners, and A Guide for Youth are also available through the CATIE Ordering Centre. Thanks to CATIE for supporting the development and printing of these booklets.

    A version of this post first appeared on the CATIE blog.