Pictured above: Dr. Sean B. Rourke (left), a scientist with St. Michael’s MAP Centre for Urban Health Solutions, and Two Spirit Elder Albert McLeod attend a meeting for the Ayaangwaamiziwin Centre in April 2024. (right) a test for HIV/syphilis is performed as part of a community testing event.

Nearly one year after launching, more than 2,000 people have been enrolled in the Ayaangwaamiziwin Centre—a groundbreaking public health intervention tackling the soaring rates of HIV and syphilis across the Prairies and northern Territories.

Community and mobile testing across Saskatchewan, Alberta, and more recently Manitoba has identified +150 cases of syphilis and over 60 cases of HIV. People who tested positive received immediate treatment or were connected to culturally safe care and further preventative treatment.

Launched in March 2025, the Ayaangwaamiziwin Centre is a historic initiative, co-led with Indigenous communities designed to test, treat, and connect more than 11,500 people to trauma-informed, culturally grounded care. Working with community partners, including frontline health and harm reduction agencies, the Centre is currently operating at locations in the Prairies, with additional sites set to launch soon in Yukon, the Northwest Territories (N.W.T.), and Nunavut. Named after an Ojibwe word meaning “carefulness and preparedness,” the initiative is co-led by Dr. Sean B. Rourke, Director of REACH Nexus at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital in Toronto.

“People are engaged and fascinated by this project. They love that they will be able to receive their results right then and there, at the same appointment rather than waiting days to receive results,” said Kristine Cockwill, an outreach worker with the Northreach Society, a harm reduction agency in Grand Prairie Alberta.

The Centre is aimed at helping people from Indigenous or remote communities who are often underserved by traditional healthcare systems. The model meets people where they are—whether in remote northern First Nations, urban shelters, or street encampments.

“Many people in these communities do not have a phone or any means of communication, making relaying positive cases back to the client challenging,” Cockwill said. “Rapid testing allows us to treat a positive syphilis case while the client is there and present for testing.”

A public health emergency

The Centre’s work comes at a critical moment. From 2020-2023, Canada has seen a roughly 85 per cent increase in new HIV diagnoses. In Saskatchewan and Manitoba, rates are three times the national average.

Each new HIV case carries an estimated $1.44 million in lifetime healthcare costs—totaling $2.1 billion for new cases in 2021 alone, an 11 per cent rise from a decade earlier (University of Alberta Institute for Health Economics).

Syphilis rates are also climbing at an alarming pace, nearly doubling between 2018 and 2023, from 6,371 to 12,135 cases.

Most devastating is the rise in congenital syphilis—passed from mother to baby during pregnancy. Once nearly eradicated in Canada, cases have surged by nearly 600 per cent, resulting in miscarriages, stillbirths, and infant deaths.

“The rise in congenital syphilis is a public health crisis—entirely preventable and entirely solvable,” said Dr. Rourke. “No baby in Canada should be born with this infection. With the right tools, testing, and care in the hands of those who need it most, we can end this.”

A coordinated national response

These numbers are more than statistics, they are a call to action.

The Centre is a bold, united response to the twin public health crises of syphilis and HIV with over 25 partners including:

• Public Health North Zone, Alberta Health Services in High Level, Alberta
• StreetWorks and Radius Community Health and Healing in Edmonton, Alberta
• Northreach Society in Grande Prairie, Alberta
• Wellness Wheel Medical Clinic and All Nations Hope Network in Regina, Saskatchewan
• Northern Inter-Tribal Health Authority in Prince Albert and northern Saskatchewan
• Ka Ni Kanichihk and Siloam Mission in Winnipeg, Manitoba
• One Yukon Coalition and Kwanlin Dün First Nation in Whitehorse, Yukon
• Chief Public Health Officers in Northwest Territories and Nunavut

These partnerships follow a “Two-Eyed Seeing” approach—blending Indigenous and Western knowledge systems.

“HIV and syphilis aren’t just statistics—they are public health emergencies tearing through communities,” said Dr. Rourke. “Every test, every diagnosis, every person we connect to care brings us closer to ending this crisis. We must act boldly, urgently, and together.”

The Centre is also preparing to deploy GeneXpert machines in clinics and mobile units to speed up diagnoses and provide rapid (even that day) treatment and referrals immediately. These machines can provide confirmatory testing in just under an hour and are a vital tool in remote communities where access to traditional labs is limited. It provides fast, accurate diagnoses on the spot, helping to connect people to treatment and culturally safe care.

A crisis decades in the making

The surge in sexually transmitted and blood-borne infections (STBBIs) in Indigenous communities is rooted in decades of systemic neglect, shaped by colonization, residential schools, intergenerational trauma, and ongoing structural racism.

“Indigenous-led, trauma-informed, and culturally safe care is essential to reducing STBBIs in First Nations, Inuit, and Métis communities,” said Dr. Tom Wong, Chief Medical Officer of Public Health at ISC.

“Everyone in Canada has the right to access health services and to thrive. But for many, that isn’t happening.”

Overcrowded housing, food insecurity, stigma, and discrimination all contribute to persistent health disparities and hinder care.

A human-centered approach

At its core, the Ayaangwaamiziwin Centre is about people, many of whom have been let down by existing systems.

Kristine Cockwill shared how she is able to reach individuals lost to follow-up—people who tested positive but never received care due to homelessness or legal issues.

“We identified a positive syphilis case at a community testing event using this point-of-care device and were able to treat the client immediately,” Cockwill said. “This was someone who likely wouldn’t have made it into an office and would have been very difficult to reach again. Being able to provide care on the spot was incredibly impactful.”

Building a new model of care

In March 2024, over 100 stakeholders—Indigenous leaders, Elders, health workers, and people with lived experience—gathered in Winnipeg to co-create community-driven solutions. Elder Albert McLeod introduced the group to the word Ayaangwaamiziwin, shared by Ojibwe Language Specialist Roger Roulette. The concept, “carefulness and preparedness, “now guides the entire initiative.

With deep partnerships, knowledge sharing, and a non-judgmental approach, the Centre shows what public health can look like when rooted in culture, dignity, safety and equity.

Over the next 3 years, the Centre will continue to expand, partnering with more frontline agencies and individuals with lived experience to reach those left behind by conventional healthcare.

“The Ayaangwaamiziwin Centre is a powerful shift in how we reach and honour Indigenous peoples and all those impacted by HIV, STBBIs, and systemic barriers,” said Albert McLeod.

“For too long, people have faced trauma, racism, and neglect in the health system. This Centre offers a new path—one rooted in dignity, healing, and self-determination. It’s about restoring trust, creating choice, and giving people the power to reclaim their health, their voice, and their future.”

By Andrew Russell