Photo by fieldtripp. Flickr/Creative Commons.

“There’s a health crisis in Ottawa.”

Chris Dalton’s pronouncement contains not a trace of drama, but it’s hard to reconcile with the city I see at the moment. It’s springtime in the national capital, and it’s beautiful—the bike paths along the canal and rivers are getting busy, trees are flourishing in greens and reds, and the historical architecture in the core of the city glints beneath the sunlight.

But even in a well-groomed capital city, social inequities are playing out with detrimental health consequences. If you’re paying attention, they’re apparent. As a social worker, Dalton is paying attention.

“It started when I worked at the Shepherds of Good Hope, which is a shelter in Ottawa, back in 2010. That’s kind of the last-chance shelter in Ottawa,” he says, explaining that people end up there after they’ve been kicked out of the other shelters. Despite different policies towards drug use among shelters, people continue to bring drugs inside.

“We’ve made it as hard as possible to use drugs, and people are still doing it. Shutting doors and pushing people out into the streets is not deterring people from using drugs.”

Ottawa is one of the leading cities in Canada when it comes to HIV and hepatitis C infections among drug users, and last year there were at least 36 overdose deaths.

As part of the Campaign for Safer Consumption Sites (CSCS) in Ottawa, Dalton is working to change ineffectual approaches to drug use, “by bringing people inside and treating them as human beings with health problems instead of criminals committing illegal activity.”

The people behind CSCS want to see a facility modeled on Insite, Vancouver’s supervised injection facility. The benefits of Insite for not only people who use drugs, but also the wider community, have been extensively documented: reductions in public drug use, needle sharing, neighbourhood litter, and long-term health expenditures; increases in use of counselling, detoxification, and addiction treatment services; and prevention of HIV and hepatitis transmission as well as overdose deaths. In Vancouver, support for Insite has grown since its inception. Now, the police department, current and former mayors, and local business associations are in favour of it. Such is the magnitude of the positive community change created by the facility.

CSCS already has support from health professionals, including nurses and community health centre staff; Dr. Mark Tyndall, head of infectious diseases at the Ottawa Hospital; and Dr. Lynne Leonard, an epidemiologist at the University of Ottawa. Members of the Drug User Advocacy League and other groups of people who use drugs stand behind the proposal. Recently some members of the police force have even vocalized support, according to Dalton.

Focused on Ottawa’s ByWard Market and Lowertown area, where three of the city’s biggest shelters are located, CSCS organizers are now striving to build and demonstrate community support for the establishment of a safe consumption site. A few weeks ago, they hit the streets, knocking on doors and talking to residents.

“We surveyed people in the neighbourhood as well as gave information,” says Dalton, who admits that the response from residents was better than expected. Of the people spoken to, most were not knowledgeable about the impact of safer consumption sites. Some people became supportive when they learned more about it. Others maintained their opposition to the idea, citing concerns such as increasing numbers of drug users and littered needles—concerns that Insite has shown to be unfounded, as the facility has actually helped decrease public drug use and litter. Overall, according to Dalton, among surveyed residents there was “about 78% support for a site in Ottawa” and “65% support for a site in the ByWard Market.”

The need to gain community support for a health initiative with clear benefits may seem bizarre. After all, clinics and hospitals are opened without so much grumbling and groundwork.

But the Supreme Court ruling that allowed for the continued operation of Insite in 2011 was double-edged.

It meant that the life-saving and life-dignifying work of Insite could go on. The judges ordered the federal government to grant the needed exemption to the Controlled Drugs and Substances Act (CDSA) that would allow drug users to safely access the facility. It was a slapdown to the federal government’s intransigence in the face of mountains of evidence demonstrating the beneficial outcomes of Insite for the community.

At the same time, the ruling didn’t open the floodgates to more safe injection sites. The court affirmed that the decision was not “an invitation for anyone who so chooses to open a facility for drug use under the banner of a ‘safe injection facility’.”

The court stipulated that the health minister must weigh any decision to grant an exemption to the CDSA by considering the “evidence, if any, on the impact of such a facility on crime rates, the local conditions indicating a need for such a supervised injection site, the regulatory structure in place to support the facility, the resources available to support its maintenance, and expressions of community support or opposition.”

This leaves health advocates in the unenviable position of having to garner support for each proposed facility, for a project that has been exhaustively shown to be effective and necessary.

In a sense, the court decision has determined that an enormous amount of energy will be put into proving something that’s already been proven, over and over.

If this reality discourages Dalton, he hides it well. There’s a more worrisome reality that drives him.

“People are dying on the streets and HIV is spreading,” he says. “By treating people like human beings, by treating them with dignity and giving them options, they will be a lot more likely to live productive lives and possibly go to treatment.”

“With the amount of commitment and progress that’s been made through Insite and globally for safe injection sites, and with the already existing support in Ottawa, we can push through.”

– Erin

(Please note- this piece has references to rape and violence)

I have growing admiration for Elizabeth Smart. Here’s a young woman who was kidnapped and raped on an ongoing basis during her entrapment. Her captors were discovered, and she returned to a “free” life- never free from those experiences, though. She talked about them earlier this week at John Hopkins University in a human trafficking and sexual violence forum. She made some amazing points about shame and power.    

The most common question she says she’s asked is “Why didn’t you try to run away?” She talked about the judgment attached to this question and how it further violates people who are raped or abused. Women face this all the time in a world of misogynistic violence, from sexual harassment to rape and murder. No one observing from the outside can know how power exists in a relationship. To those who want to ask a victim “Why?” Elizabeth responds, “We weren’t in [the] situation, we don’t know the circumstances. We don’t have a right to ask that question.”

Her words echo what so any of women with HIV face- What did you do to deserve HIV? It must have been something nasty and you must be nasty too, the line of judgment goes. Evelyn, one of our founding members, used to speak a lot at high schools about HIV awareness and safer sex education. She never told people how she became infected, because she felt people would take her specific situation and tell themselves it could never apply to them. Doreen Millman, who helped open Vancouver’s International AIDS Conference in 1996, said if someone asks her how she became infected, her response is “It just doesn’t matter.” Get on with support and care was her message.

In addition to letting go of judgment, Elizabeth also talked about the damage done by the abstinence-based sex education she had growing up. The message she received was “Sex was something that only happened between a husband and wife who loved each other.” After the first assault, and the many that followed, she said her soul “was crushed” and she doubted anyone could want her because if she were to follow the teaching she’d received, she was no better than a used piece of gum. That kind of education, she says, makes it too easy to feel you are worthless, and to feel great shame. That must change.

Her work now is to push for education.  “If I had been taught in school early on… perhaps I would have been a bit more prepared… We can’t start young enough in educating children.” She acknowledged that parents are reluctant because of their faith, their fears, their belief they can keep their children nearby and safe. But that isn’t always possible. And because of that, “People need choices, skills, permission.” They need to know that no matter what happens “You always have value.”

That is such a vital message.

- Janet

Ah.

That sigh of relief and contentment marks the end of our annual SpringBoard conference, a lovely afternoon of insightful speakers, thoughtful participants, and lots of cake.

The keynote presentation focused on HIV and refugee and immigrant health, a topic made more urgent by the recent government cuts to refugee health coverage. Dr. Mary Kestler from Oak Tree Clinic described how the changes in immigration laws and refugee health coverage have caused confusion, inefficiencies, and anxiety for refugees as well as health and social service workers. (Those refugees claiming status from within Canada are the ones affected by the changes, not those approved as refugees by the government before they arrive). The refugee claim process is already confusing, demanding, and difficult, and now many refugees are made ineligible for health coverage of any kind.

Before June 2012, all refugees had expanded health coverage. But now there is no mental health coverage—and we’re talking about people who have experienced severe violence and trauma—no vision care coverage, no prenatal care coverage. Even medications aren’t covered, except for communicable diseases.

Mary gave an example of a patient with HIV who can access coverage for antiretrovirals, but can’t access medication to save her vision, which is threatened because of the HIV.

The confusion over health coverage has even led doctors to turn away patients.

“Haven’t refugees already suffered enough?” asked Mary.

One note of hope comes from the BC health ministry, which has indicated that HIV+ refugee claimants will be able to access health coverage for up to nine months. We’ll have to wait and see what happens with this development.

Patience Nyoni from the Afro-Canadian Positive Network of BC expounded on the struggles of refugees, explaining that they are already dealing with many challenges, and on top of that they now have no health coverage.

Getting an HIV test and learning their status can be a heavy load to bear. For refugee women, the challenges can be multiplied: trying to take care of their HIV health while taking care of their children, while also dealing with stigma and isolation, can be overwhelming. Patience described how support for refugee women with HIV is vital in combating isolation and depression, and she expressed her appreciation for the connections she has made through Positive Women’s Network.

Through the recently formed Afro-Canadian Positive Network, Patience is working to provide support for Afro-identified folks experiencing the impacts of HIV, loneliness, trauma, and culture shock. As she said, a lot of migrants from Africa are missing their families while also dealing with HIV and trying to navigate complicated systems here in Canada.

The discussion made apparent that creating an underclass of people in Canada by undercutting refugee health coverage is dangerous, unjust, and doesn’t benefit anyone. Here’s another idea: actual equality, in the form of expanded health care coverage for everyone.

– Erin

The “Breast is best” mantra has become the chant pregnant women and new mothers hear, and it’s no surprise- breast milk is amazing stuff. Breastfeeding helps build a child’s immune system, develop healthy gut flora, and prevent allergies, obesity, asthma and SIDS.  It also boosts a baby’s brain power. But as we learn more about how breastfeeding contributes to infant and child development, women who can’t or are advised not to breastfeed for medical reasons can be profoundly affected. A couple of pieces I read last week brought the issue up again.  

HIV and Breastfeeding- No

HIV is present in breast milk, so women with HIV who live in areas where clean water supplies are available are advised to formula feed to avoid transmission risk. This can be complicated for women with pressure from surrounding friends, family, or social norms that they will breastfeed. This tension was presented in a study of women of African descent living in the UK. It was shared recently at the British HIV Association conference.

Twenty-three women with HIV (pregnant or new moms) took part in a study to discuss their feelings about breastfeeding. Having been raised with the expectations that mothers breastfeed, they felt that breastfeeding was “an essential aspect of being a woman and a mother.”  Roger Pebody’s coverage of the study also noted that these feelings were echoed by women in a Canadian study last year.

For women who haven’t disclosed to people in her circles, fear of discrimination and judgment loom large. The pressure to breastfeed could feel enormous. Women in this situation reported they often isolated themselves and their babies.

HIV and Breastfeeding- Yes

Pebody’s piece also reported on confusing health education women receive. Breast IS best for women with HIV when there are no dependable clean water supplies. In these situations, the risk of water-borne illness to babies outweighs the risk of HIV transmission from breast milk, and positive moms are advised to breastfeed exclusively.   There should be no use of formula at all (using both breast milk and formula is called mixed feeding). On top of putting an infant at risk for water-borne infections, formula can cause inflammation in an infant’s gut, which can open the way for HIV infection.

http://www.southsudanmedicaljournal.com/archive/2009-05/feeding-infants-whose-mothers-are-hiv-positive.html

Another piece breastfeeding women need to know about is weaning. It looks like transmission risk is more about how a woman weans than when. A study of 958 women http://www.iasociety.org/Default.aspx?pageId=5&elementId=15161  showed that levels of HIV in their breast milk increased when they weaned abruptly when their babies were four months. In women who continued to breastfeed, those who did so exclusively had lower levels of HIV in their milk than the women who didn’t exclusively breast feed. This research indicates the benefits of exclusive breastfeeding past four months of age, and reinforces the importance of good health support and education for women.

http://natap.org/2013/HIV/SciTranslMed2013Kuhn181ra51.pdf

It’s a lively time of year here at Positive Women’s Network. An Aboriginal women’s retreat a couple of weekends ago, a workshop on HIV and menopause yesterday, and now we’re abuzz as our annual SpringBoard health conference approaches (register now! for details click here). In between we showed up at the Canadian Association for HIV Research (CAHR) conference, which was held in Vancouver this year. We had two poster presentations, the first on the development of our Pocket Guide on Aging for Women Living with HIV, and the second on shifting HIV service models. To get a better look at the posters, just click on them.

Janet, our communications coordinator, received appreciative feedback about our development of resources aimed at women who are aging with HIV. Our pocket guide has an audience not only in BC, but across the country!

The bold title of this poster provoked a lot of thoughtful response. Support worker Melissa said, “I had a couple people say to me that the topic we chose was very relevant and current and important and that their organization was thinking about the same questions.” Support coordinator Bronwyn reported that she “had some really good discussions with people about the integrated model, particularly around integrating hep C work into the work that AIDS service organizations currently do.” Service model decisions are a hot topic these days!

– Erin

Good morning! I am off to my first full day at CAHR today. I will be tweeting (watch #CAHR2013) about what I’m attending and sharing others’ tweets as well. Super excited to be going- I love this conference. 

Yesterday afternoon I met with Jolene Donatelli from the Canadian Treatment Action Council to talk about Positive Sex, a new workshop model for folks wondering how to disclose their HIV status. This format uses theatre games to work through people’s questions and anxieties. As a former high school theatre geek, I’m all over the idea. (I tell my kids I lived Glee, which is true. Minus the slurpies in the face).  I love the idea of people building  a foundation of disclosure experience through this workshop. Jolene, Bronwyn (Support Program Coordinator here at PWN) and I talked about how we might bring these workshops to BC.

Last night the conference opened with the Mark Wainberg Lecture given by Dr. Liviana Calzavara. “Refocussing Our Efforts: The Unspoken Structural Factors that Shape HIV Research” was the title, and her address was interesting. Her goals were to look at the historical context of the Canadian epidemic and talk about “unspoken structural forces shaping how and what research is done.” What struck me in particular was the concept of research based on individuals vs. society- in other words the social determinants of health. Calzavara suggested that too much research has focussed on the individual (physical factors) and not enough on the very influential social constructs and influences that put people at risk for HIV. I totally agree that more needs to be done on this.

Today I’ll be cheering for colleagues Bronwyn, Melissa, et al (Bronwyn’s pictured above) as they present their poster that examines the potential integration of Hepatitis C support and education into HIV organizations. Drop by and say hi between 2 and 3 PM- Poster 212. Tomorrow I’ll be in the Poster Exhibit area with my poster on our Pocket Guide on Aging for Women Living with HIV. That’s number 227, and I’ll be around from 2-3.

If you’ve got your iPhone on the go, you can download a conference app to keep you up to speed on program details, conference layout and more.  Alas, I’m an Android gal, so I’ll be using the old-fashioned paper kind.

See you there!

- Janet

Photo: Sneak peak of Bronwyn with her poster.

A girlfriend remarked to me the other day that one of the reasons she loves a mutual male pal of ours is that “he was practicing enthusiastic consent before it was cool.” Has enthusiastic consent made it into the ranks of cool? I’m not sure about this—but I like the idea.

Maybe my friend is right, at least in part. Enthusiastic consent seems to have been a hot topic in certain circles in March, as several excellent pieces wound their way through social media and onto my screen. Here are five worth looking at.

Practicing enthusiastic consent
Given that most writers on enthusiastic consent are either long-winded or esoteric, I guess it’s difficult to explain the concept concisely. That makes this easy-to-understand piece all the more impressive. Remember: enthusiastic consent is all about communication.

Un-Memorizing the “Silence is Sexy” Date Script
Women are expected to “just say no” during sex when they want their partners to stop, but what if instead they were given more opportunities to say yes? Allowing women to have agency and express what they want is sexier than treating them as silent partners.

A Letter To My Son About Consent
Watching parents cry over their son as the Steubenville rape verdict came down prompted this mother to write a letter to her son. “The horrible truth is that as long as parents anywhere allow their boys to think that their wants are more important than other people’s rights this will continue to happen,” she says, explaining to her son that “making sure the sex you are involved in always involves complete consent will be the best gift you can give your future self.” Now that’s motherly love.

On Preventing My Son From Becoming A Rapist
Another mother contemplates how to raise her young son to be a good human being amid “the very loud messages coming from our current rape culture.” She’s got a solid plan: the article ends with a list of actions she will take as a mother to help her son develop. One of my favourites: “I will not let him push other kids around, because, fuck you – it isn’t ‘just kids figuring shit out’. It is mean and aggressive. Equally, I will not let your kid push my son around.” Don’t you wish everyone had a rad mama like that?

The Healthy Sex Talk: Teaching Kids Consent, Ages 1-21
More concrete actions for parents to develop children who understand and practice consent, arranged by age group: 1 to 5 years, 5 to 12 years, and teens and young adults. It’s not too early to start.

– Erin

I realize you hear a lot from Erin and me here, on Facebook and Twitter.  While we work behind the scenes, there’s a great team doing the frontline work with our HIV+ members. Melissa is on the Support team, and she’s one of the first people a newly diagnosed woman might meet at PWN. I asked her a couple of questions about her work in general and about the one-to-one connections with members.

-    Janet

What is Your Work at PWN?

I started here as a UBC social work practicum student in 2005 and have worked in various roles since.  These days I wear 2 hats: support worker and retreat coordinator.  As a support worker, I help women with HIV and their families. This includes advocacy, information and referrals – whatever women feel they need.

I also oversee the drop-in and food bank in consultation with other support staff (I work with a fabulous team!). I co-facilitate peer support training, a program we run every spring, and I work in partnership with the Pacific AIDS Network to support members involved with the Positive Leadership Development Institute. In my role as retreat coordinator, I plan, organize, coordinate and implement 2-3 different types of retreats per year. We have wellness retreats and skill development weekends as well as Aboriginal women’s retreats.

What’s It Like for A Newly Diagnosed Woman Coming In?

I’m so glad when newly diagnosed women decide to connect with us because it takes a lot of courage to reach out for support.  When I meet a new woman, I tell her that she is not alone- that’s important. Also that our membership is made up of a big and diverse group of women living with HIV across BC.

Women can and do lead long healthy lives with HIV.  I want a newly diagnosed woman to know she deserves support and that I am here to offer support, information, resources, advocacy and connections to other positive women.

What Do You Think Makes Women Hesitant About Coming In?

For a lot of women, just actually “stepping” through the door is incredibly hard. (Valerie wrote a great piece on this.)   There’s so much stigma and discrimination around HIV. There are concerns about safety and confidentiality, there’s fear about HIV disclosure, there’s fear about being judged or disrespected.

To walk in to an organization that specializes in supporting women living with HIV can be scary, intimidating, and overwhelming- it’s walking into the “unknown.”  It takes a huge leap of faith and a lot of courage to take that first step.  For most women, once they do come in, see our drop in space, meet with me or another support worker, and have a cup of tea and chat, their fear of the “unknown” slowly disappears.

And it’s not just about a woman’s own fears. For women with controlling or abusive partners, getting here has added layers if her boyfriend or partner could say she can’t. Then there are women from small communities within the city where everyone knows everyone else. They worry they’ll be recognized if they come in.  These are realities for lots of women, so that’s why we stick with “meeting women where they’re at.” Women get to decide what works for them. Sometimes our main connection is over the phone.

What Would You  Like Women Out there to Know?

We strive for a space where women who walk through our doors feel safe, supported and heard.  Some women say PWN is like their “second home.” It’s a great place to connect with other women, find out about resources and get support… oh, and we like to laugh a lot and have some fun, too!

Photo: IstockPhoto

Think people arrested for drug possession are violent kingpins? Think harsher sentences for drug dealers make neighbourhoods safer or stem the trade? Think the justice system is based on fairness?

Director Eugene Jarecki’s The House I Live In is an impressively comprehensive documentary that spurs a rethinking of the history of the War on Drugs and its effects on communities in the United States. The film screened earlier this month at the Vancity Theatre.

Until the late 19th and early 20th centuries, many drugs now considered dangerous and criminal were freely available and used by all classes. The outlawing of certain drugs took root not in science, but in racism. Governments banned drugs associated with minority groups as a way to indirectly attack those groups. Why was opium prohibited in California? Because that’s where Chinese migrants were. Cocaine laws in the South? Those were targeted at black people. Marijuana laws? Those were meant to make life hard for Mexicans.

Drug laws continue to have a racial impact. The 20th century saw what has been dubbed the Great Migration, as African Americans fled the brutality of the segregationist Jim Crow laws established after the abolition of slavery. They moved from the southern states to cities in the north like Detroit, Chicago, Baltimore, Pittsburgh, and New York. “White flight” to the suburbs followed, enhancing the demographic shift in these urban centres. African Americans were relegated to the most rundown neighbourhoods and faced persistent institutional discrimination. Policy makers redlined inner-city neighbourhoods, and banks denied mortgages to black families. The National Housing Act of 1934 ostensibly supported American home ownership, but it was really designed for white Americans: the Federal Housing Administration refused to approve mortgages in black neighbourhoods.

Faced with no economic prospects, many inner-city residents have done the only thing they can: they’ve turned to the prohibited economy. David Simon, former Baltimore reporter and creator of television show The Wire, explains in the film that “going to sell drugs on the corner is the rational choice of people going to work for the only functioning company in a company town.” Differential drug penalties are particularly vicious towards African Americans: Sellers of crack cocaine tend to be black (although cocaine usage is proportionate among racial groups), and mandatory minimum sentences for possessing and selling crack cocaine are much more severe than for powder cocaine.

The hard question is this: Is mass incarceration an extension of the slavery and Jim Crow legacy? Right now there are more black men in prison, on probation, or on parole than were enslaved in 1850. Most people sent to prison for drug possession are non-violent offenders, caught with small amounts of prohibited substances. Mothers become single parents, children are orphaned. Future prospects are sealed off, as convicted felons are “denied the right to vote, automatically excluded from juries and legally discriminated against in employment, housing, access to education and public benefits, much like their parents or grandparents,” writes Nsenga Burton.

Government policies and institutional discrimination have entrenched poverty in inner-city neighbourhoods; drug laws have criminalized the only economic means available to people; black males are fed into an ever expanding prison industrial complex that profits from their exploitation; families and communities are under siege; children are growing up without fathers.

Near the end of The House I Live In, Simon comes to a wholly unpalatable conclusion, but it’s hard to dispute given the impacts of the United States’ longest-running war: “The drug war is a holocaust in slow motion.”

For those of us in Canada, there’s a harder question yet: Is anything similar happening in our own backyard? Many Canadians like to think that slavery and mass incarceration are uniquely American issues, but given the recent report from the country’s correctional investigator on the soaring rates of Aboriginal people in prison, it is increasingly impossible to deny that some of what happens in Canada closely resembles other phenomena we look upon in horror.

Aboriginal people are currently being shuttled into jail at a rate that should leave you bathed in sweat. While they comprise 4% of the country’s population, they make up nearly 1 out of every 4 prisoners; for women it’s closer to 1 out of 3. If those numbers aren’t enough to paint a devastating national self-portrait, try a comparison to the global leader in incarceration, our big bad neighbour to the south: The US imprisonment rate is 730 per 100,000 people; in Canada it’s 140 per 100,000; for Aboriginal people in Canada, it’s a sky-high 910 per 100,000 people.

Leading up to this era of incarceration were explicit government policies to assimilate Aboriginal people, or “kill the Indian in the child.” The reserve and pass system (which inspired the South African government’s apartheid system), the Indian Act, residential schools—all were mechanisms to destroy Aboriginal identity and clear the land of indigenous inhabitants, paving the way for access to resources and national and capitalist expansion.

Until just over 50 years ago, Aboriginal people could only gain the right to vote if they agreed to give up their treaty and status rights—few were willing to renounce their identity to be enfranchised under a colonial state. Only in 1960 did the government allow all Aboriginal people the right to vote.

In the 1960s, Aboriginal people became over-represented in prisons. Their incarceration rates have climbed since then, jumping 43% in the last five years, according to the corrections investigator. These disproportionate numbers will be further exacerbated by the current government’s implementation of mandatory drug sentences, which eliminates judicial discretion in sentencing and guarantees that people will be sent to prison for minor offences. This actually goes against Section 718.2(e) of the Criminal Code, which says that courts must consider the circumstances of Aboriginal people and look for alternatives to prison in an effort to apply more culturally appropriate remedies and increase the chances of rehabilitation.

Despite all this, the correctional investigator’s report on the over-incarceration of Aboriginal people has elicited no concern from the governing party. The office of Canada’s minister of public safety said in a release that “the only identifiable group that our tough on crime agenda targets are criminals.”

I suppose that’s an easier story to tell. The good guys are simply going after the bad guys, the dealers, the pushers, the dregs of society. Best not to think about the effects of their incarceration on their mothers, their partners, their children, their grandchildren, their communities. Best not to think about just who these criminals actually are.

Those who really begin looking at the outcomes of criminalization might no longer settle for the easier story though. As the credits rolled for The House I Live In and I exited the Vancity Theatre, I heard someone behind me make a confession.

“I didn’t know the drug war was so much about race,” she said.

– Erin

Of course I was interested in the news out of CROI that presented the first case of a “functional cure” for HIV. Who wouldn’t be? If the baby girl in this case has truly been cured, what a gift that is for her and her family, and I wish them well.  

Follow-up to the Mississippi-born baby news has been more cautious than the breaking headlines . This one case, while amazing, isn’t going to change the world just yet. It has a place in AIDS history but we don’t know how significant a place. It’s not so different from Timothy Brown’s shift in HIV status, credited to a bone marrow transplant-  it’s very real for the individual, but not a reality for general treatment.

I’ve found myself thinking a lot about the baby’s mother, who didn’t find out her HIV status until she was in labour. I’m sure she’s going through her own struggles. TheBodyPro printed  a beautiful piece by Jim Merrell that had me and Erin nodding in agreement.  Jim said that this situation underlines a huge problem: why is it that a woman living in one of the wealthiest countries in the world got no prenatal care, and no HIV testing until she was about to give birth?

Why do some people get better healthcare than others? It can have to do with where you live, the money you take in (or don’t), your ability to eat, pay the rent, and pay for bus fare. It’s also influenced by how much schooling you got, whether you can read instructions about getting to a clinic or taking medication. It can have to do with little or no sex education, no condoms, limited or non-existent sexual health services. What Jim’s talking about is the social determinants of health, which create unequal access to health care and services.

“Health inequities are avoidable inequalities in health between groups of people within countries and between countries. These inequities arise from inequalities within and between societies. Social and economic conditions and their effects on people’s lives determine their risk of illness and the actions taken to prevent them becoming ill or treat illness when it occurs.”  Social Determinants of Health, Key Concepts

Whatever barriers there were for this mother to get healthcare when she was pregnant probably didn’t magically disappear after she gave birth, even though her baby was getting care. In giving a timeline to the story of the baby’s treatment, several articles refer to the mom and baby disappearing from care for several months “for reasons that are unknown.” I suspect there are many reasons, and they relate back to her access to care in the first place.

Did she have secure housing, food, and money? Was she getting support with her own HIV diagnosis, let alone her child’s? Was her own health and life stable enough to manage her child’s health and medications? Was she running out the door to a low-paying job that offered no time off for appointments? To a boss or to a lover, was it safe to explain why her child had so many appointments? HIV disclosure is huge, whether her own or her daughter’s or both. These are just a few possibilities for this woman whose life was changed forever when she got her diagnosis.

I’m hoping that those with power who know this woman are reaching out to make sure she gets healthcare and support. It’s the ethical thing to do, and she deserves it. She is but one woman who could benefit from accessible healthcare; I know there are millions. But right now, she’s on my mind.

- Janet

Photo: Istock Photo