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Canada's Lagging HIV/AIDS Policy Should Make You See Red

We need more courageous action at all levels of government to address the structural drivers of HIV/AIDS.

12/11/2017 16:43 EST | Updated 12/11/2017 17:03 EST

We are seeing red.

This month, as World AIDS Day came around, we found ourselves getting angry.

The red ribbon has long been a potent symbol of HIV/AIDS activism, signifying anger at the bureaucratic red tape that, in the 1980s, delayed release of life-saving treatmentsto people living with HIV/AIDS. Treatment access and effectiveness have since improved for some living with HIV/AIDS, at least in Canada; the global majority still has unconscionably limited access to HIV/AIDS medication.

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So why are we still angry? Why are we still "seeing red?" We're angry because social inequity, stigma and the HIV vulnerability that they produce have not disappeared. The HIV response continues to be characterized as much by policy failure as by limited, incremental improvements.

Sure, there's been policy progress. The 2015 election halted Prime Minister Stephen Harper's hard-right turn in many HIV-related policy fields, including the longstanding war on supervised injection sites, which have been clearly shown to prevent HIV transmission. We applaud the belated federal shift toward evidence-based drug consumption policies.

Still, we are angry. First, we're angered by the continued criminalization of HIV non-disclosure. Canada is exceptionally aggressive in prosecuting people for not disclosing their HIV status prior to consensual sex. People living with HIV/AIDS have been charged at alarming rates using sexual assault law, normally reserved for crimes of sexual violence, even where no HIV transmission occurred.

Poverty-related risk, plus stigma and exclusion, equal vastly higher HIV rates among structurally marginalized groups.

We were encouraged by the Ontario government's World AIDS Day announcement that the province will stop criminally prosecuting HIV non-disclosure where there's no realistic chance of HIV transmission — a move that came only after extensive pressure from HIV/AIDS activists and community groups.

But we remain disappointed by Canada's slow progress in revising these regressive, outdated laws. They ignore the science demonstrating HIV transmission is unlikely when people are on treatment; they fail to recognize the dangers some people, particularly women, may face when disclosing their HIV status; and they have disproportionately targeted racialized and Indigenous people.

This brings us to what angers us most: HIV/AIDS rates are still far higher in marginalized communities in Canada, including Indigenous, racialized and LGBTQ+ populations. It is no coincidence that these are also populations more likely to face intersecting forms of marginalization and discrimination, including poverty, colonization, racism, sexism, homophobia and transphobia — forces collectively referred to as the "structural drivers" of HIV.

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The causal links between structural drivers and HIV vulnerability are complex, but the evidence, in the form of HIV/AIDS statistics, is overwhelmingly clear: poverty-related risk, plus stigma and exclusion, equal vastly higher HIV rates among structurally marginalized groups.

As a specific example, HIV rates are at least 2.7 times higher in Indigenous populations than in the Canadian population as a whole. This reflects much larger policy and political failures on the part of the Canadian state. Indigenous scholars have long called for strengths-based approaches to Indigenous health, and for the state to cede real control of health and other programming to Indigenous communities. But from the Missing and Murdered Indigenous Women and Girls inquiry to pipelines to health services, Canada is still failing to engage with Indigenous communities on an equal, nation-to-nation basis.

To make real progress in addressing HIV/AIDS, we need bold, creative policy interventions.

Indigenous sovereignty may seem far removed from HIV/AIDS policy, but this is precisely the point. HIV transmission via shared needles can be reduced in part through the relatively simple policy "fix" of needle exchanges and supervised injection sites, particularly where these are part of a more comprehensive harm reduction strategy; the prosecution of HIV non-disclosure can be addressed through specific changes to criminal law. To address the structural drivers of HIV, there is no single, simple policy change; more fundamental and far-reaching change is required.

To make real progress in addressing HIV/AIDS, we need bold, creative policy interventions focused not on "vulnerable" individuals but on the discriminatory social and economic environments that produce this vulnerability. These policies might include guaranteed basic income strategies, mandatory school-based supports for LGBTQ+ youth (currently under attack by Alberta's official opposition leader Jason Kenney's United Conservative Party), and significant new funding for strengths-based, culturally grounded programs led by and for Indigenous people living with HIV/AIDS to suggest only a few.

We need more courageous policy action at all levels of government to address the structural drivers of HIV/AIDS. Seeing red remains crucial if we are to confront this epidemic in ways that reflect a deep commitment to progressive social policies and social change.

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