Saskatchewan struggles to stem highest HIV rate in Canada as cases rise across the country

A woman in Saskatoon was recently admitted to hospital with severe complications related to HIV. She was diagnosed with a rare and life-threatening viral infection, called progressive multifocal leukoencephalopathy, that was eating away at her brain’s white matter.

The patient was homeless and struggling with substance use. She was also experiencing active psychosis and paralysis on the left side of her body. Despite her complex medical condition, she was discharged in the middle of the night to a shelter with no open beds. She ended up wandering the streets with no shoes and no jacket in the extreme cold.

It was an outreach team run by Sanctum Care Group – the HIV-AIDS Response Team (HART) – that came to her aid. (HART, which is called into hospitals to support patients, was creating a discharge plan for the patient at the initial hospital but were not told of her release.)

Only through Sanctum’s connections to infectious disease physicians in the city were they able to get the woman readmitted to another hospital. She was provided treatment, including antiretroviral therapy, but her condition continued to deteriorate. HART tracked down her family so that they could say goodbye.

“She died knowing someone cared about her, wasn’t going to leave her alone, paralyzed and confused to fend for herself. She died with dignity,” said Katelyn Roberts, Sanctum co-founder and executive director, who shared the patient’s story. The woman passed away in hospital last week.

Care providers and medical experts in the province have long raised the alarm about growing rates of HIV, but they have been unable to curtail the disease’s spread. Saskatchewan has the highest diagnosis rate of any province or territory at 19.4 new infections per 100,000 people – more than three times the national average in 2023.

Compounding challenges of mental health, substance use, racism, violence, poverty and housing affordability are increasing the complexity of care, transmission rates, co-morbidities, co-infections and instances of early death among people with HIV, according to a report released this week by the Saskatchewan Infectious Disease Care Network.

Canada is behind many other developed nations in addressing HIV rates despite significant advancements to prevent, test and treat the virus. The latest data from the Public Health Agency of Canada, released on Friday, shows 2,434 new cases of HIV were diagnosed in 2023, an increase of 35 per cent from the year prior.

The issue has grown worse with the “post-pandemic explosion” of drug use and homelessness, said Satchan Takaya, division head for infectious diseases at the University of Saskatchewan. “With the numbers escalating exponentially, we can’t keep up,” she said. “We just don’t have the capacity in the health system.”

She sees the approaching World AIDS Day, which has taken place annually on Dec. 1 since 1988, as a reminder that there is still much work to do. Too many people are unaware that this crisis is on their doorstep, she said, affecting the most vulnerable in their communities. Indigenous people in Saskatchewan are disproportionately affected.

HIV care programs in Saskatoon, the province’s largest city, have been disconnected and – through no fault of their own – fight one another to obtain funding from the same pool of money, Dr. Takaya said.

Sanctum, which opened in 2015 as a HIV hospice and transitional care home, has since expanded to support high-risk individuals through a prenatal home called Sanctum 1.5 for women who are at risk of having their infant apprehended at birth. It also has a prenatal outreach team and transitional housing for graduates of Sanctum 1.5.

Getting individuals to take HIV medications routinely is a consistent challenge because of the stresses of their everyday life, Ms. Roberts said. But Sanctum programs, which provide stability for this population, have proven successful in reducing homelessness and substance use among its clients, in addition to treating HIV. But their waitlists continue to grow.

The report released this week followed a two-year review of Saskatoon’s HIV care services and identified a path forward for change. It outlines the need for greater investments to support the expansion of HIV programs; better data-sharing and co-ordination between program providers; training to advance culturally competent and trauma-informed care; and audits to determine adequate funding based on patient load and the complexity.

The creation of a provincial HIV program and hiring of an HIV care co-ordinator, who would liaise across care sites and manage referrals, are among the 11 recommendations. The evaluation is clear, Dr. Takaya said, adding that now action needs to follow.