Lauren MacKenzie, MD, MPH, PhD

Manitoba HIV diagnoses up 130%: HIV program - Winnipeg | Globalnews.ca New HIV diagnoses in Manitoba have increased 130 per cent in two years, according to data from the Manitoba HIV Program.

Thank you to Iris Dyck @globalnews.ca.web.brid.gy for highlighting the HIV syndemic in Manitoba, our epidemiological research led by Dr. Zulma Rueda, and the work of the Manitoba HIV Program to support people living with HIV
globalnews.ca/news/1089671...

🎯Additional innovative and meaningful interventions are needed to address the convergence of houselessness, mental health, substance use, and socioeconomic factors driving the HIV syndemic in MB

🎯Health disparities in MB are shaped by structural and social determinants of health

🎯Indigenous Peoples in MB are disproportionately impacted due to the ongoing influences of colonization, structural racism, and intergenerational trauma

🎯At a population level, maximizing ART uptake for
HIV has been shown to prevent the transmission of HIV and decrease the incidence of new HIV diagnoses

🎯This concept is referred to as “Treatment as Prevention” or “TasP”

🎯PLWH who have undetectable viral loads do not sexually transmit HIV

🎯This concept is known as “U=U” or “Undetectable = Untransmittable

🎯 With advances in modern-day ART, HIV has evolved into a manageable chronic health condition

🎯Two fundamental goals of HIV care are to link people to ART & support them to reach and sustain an undetectable viral load

🎯This optimizes health for PLWH & eliminates onward sexual transmission

💊As of June 2024, Manitoba HIV Medications Program now covers most medications used for the prevention and
treatment of HIV, including:

💊pre-exposure prophylaxis
💊post-exposure prophylaxis
💊ART for people living with HIV

💊Until recently, PLWH were required to meet their Pharmacare deductible before HIV medications were covered by the province (unless they had drug coverage through EIA OR NIHB)

💊This was cost prohibitive for many PLWH and a barrier to HIV care

🏥This expands
the Program’s capacity for HIV care from 3 (Health Sciences Centre, Nine Circles Community Health
Centre and 7th Street Health Access Centre) to 5 provincial HIV care sites.

🏥The MB HIV Program is expanding options to access HIV care for people living with HIV in Northern MB and Winnipeg

🏥People newly diagnosed and living with HIV can now receive HIV care and primary care at the Thompson
Clinic in Thompson, MB & at the Aboriginal Health and Wellness Centre in Winnipeg

🎯In only the first few months of operating, PATHS has demonstrated significant success in linking people to
HIV care and supporting them to achieve viral suppression, with over 75% of PATHS clients on HIV treatment, and nearly half of PATHS clients achieving viral suppression

🎯The goal of PATHS is to:

🎯Provide wrap-around care with psychosocial supports to PLWH
🎯Offer & link to Indigenous led and culturally safe care
🎯Support PLWH to access and adhere to HIV treatment medication
🎯Support PLWH to transition to long term primary care services

🎯PATHS services are offered in non-traditional settings such as community spaces, agencies and drop-ins, shelters, encampments, residences, correctional settings, withdrawal management centers, hotels, parks & streets

🎯In July 2024, the MB HIV Program launched the “Program to Access Treatment for HIV and Support” (PATHS)

🎯PATHS delivers comprehensive services and offers intensive case management to people living
with HIV (PLWH) who are not linked to or retained in HIV care

📊There were 151 people referred to the MB HIV Program who have not been successfully linked to HIV
care

📊Only 66% of people referred to the MB HIV Program have a suppressed viral

🎯Innovative and meaningful efforts are needed to successfully engage & retain
people living with HIV in care

📊A total of 2,301 people have been diagnosed with HIV and referred to the MB HIV Program as of Nov. 8,
2024.

📊Many people diagnosed with HIV are linked to HIV care, but are not then successfully retained in HIV
care

Number of people newly diagnosed with HIV and referred to the MB HIV Program, 2021 – 2024

📈Between 2021 and 2023, there was a 130% increase in the # of people newly diagnosed with HIV & referred to the MB HIV Program

📈In 2023, the incidence of HIV in MB (26.4 HIV diagnoses/100,000 people) was >5 times higher than the incidence of HIV in Canada in 2022 (4.7 HIV diagnoses/100,000 people)

📃MB HIV Program Update for World AIDS Day 2024

🏥The MB HIV Program provides specialized care, treatment and support to >2,300 people living with HIV across MB

📈The incidence of new HIV diagnoses has increased yearly since 1985, but a sharp increase in new diagnoses was seen over the last 3 years

Because the below skeet went viral here, and people are arguing over it, I'm going to share some more info about it from a thread I did at the other place. I really need to just do an article about it but haven't done that yet. Until then, I hope readers find this thread useful. 🧵

🎯Ultimately though, a lack of stable housing is at the crux of many of these barriers to care, and a Housing First strategy is likely be the most impactful intervention possible

🎯PATHS delivers comprehensive services to and offers intensive case management to people living with HIV who are not connected to care

🎯Service is offered in non-traditional settings such as community spaces, agencies and drop-ins, shelters, encampments, correctional settings, parks and streets

🎯 Interventions should consider holistic, person-centered, and trauma-informed care options to address the barriers found in this research & appropriately serve PLHIV

🎯To this end, this year the Manitoba HIV Program developed & launched the “Program to Access Treatment for HIV and Support” (PATHS)

Facilitators to HIV care included:

✅Successfully stopping substance use
✅Perception of caring service providers particularly during HIV diagnosis
✅Welcoming healthcare environments
✅Social opportunities & integrated supports
✅Supportive social networks

Barriers to HIV care included:

⛔️Navigating the initial shock of receiving HIV diagnosis
⛔️Mental health challenges & inaccessible supports
⛔️Substance use
⛔️Violence
⛔️Discrimination by primary care service providers & social networks
⛔️Lack of preventative &
social supports
⛔️Lack of accessible housing

👤A total of 32 people living with HIV completed this study and over 70% of females and 50% of males reported severe and moderate sexual abuse among other traumatic childhood experiences.

📋This was a qualitative study, co-designed and co-led alongside people with lived experience and a research advisory committee

🏥Aimed to understand Manitobans living with HIV’s gendered and intersecting barriers and facilitators across the cascade of HIV care before and during the COVID-19 pandemic

📈As of 2023, the incidence of HIV in Manitoba has risen to 26.4 HIV diagnoses/100,000 people - over five times higher than the incidence of HIV in Canada in 2022 (4.7 HIV diagnoses/100,000 people).

📈In Manitoba between 2018 and 2021, the provincial incidence of HIV increased from 7.9 HIV diagnoses/100,000 people to 12.2 HIV diagnoses/100,000 people.

📊This was 3 times the Canadian national incidence, which in 2020 was 4 HIV diagnoses/100,000 people

🚨Published today, our paper:

📃”Gender and Intersecting Barriers and Facilitators to Access the
HIV Cascade of Care in Manitoba, Canada, Before and During
the COVID-19 Pandemic: A Qualitative Study”

🫶Led by Dr. Zulma Rueda & her incredible research team

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