Author: Emily Holton

By Sean Rourke and Bill Flanagan

THE GLOBE AND MAIL

Imagine having easy access to a home self-test for COVID-19. With instant results, you’d be able to make informed decisions about your health and decide whether you should stay in or go to work. Research teams around the world are devoting resources to making this a reality, in the hopes of helping to stop the months-old pandemic in its tracks. In the meantime, many Canadian jurisdictions are offering medically administered swab tests with quick turnaround times in accessible ways.

But this inspiring efficiency is in sharp contrast to how the HIV epidemic has been handled in Canada, where the rate of new HIV infections continues to rise – even as the numbers consistently decline in countries such as the United States, the United Kingdom, Australia and Japan.

The difference: Canada has not yet approved or implemented a full range of HIV testing options, including self-testing; we have not yet ensured linkage to care for all; and universal and free access to treatment is not consistently available across our country.

About 15 per cent of people living with HIV in Canada are undiagnosed: They have HIV but do not know it because they have not been tested. There is also a significant proportion of people who are diagnosed with HIV but are not in care. Recent estimates from the U.S. Centers for Disease Control indicate that about 80 per cent of new HIV infections result from gaps in testing and treatment.

This suggests that if more Canadians had access to home self-tests, and were then provided with effective treatment – which can allow people with HIV to live almost normal lifespans, and in almost all cases can entirely suppress the virus so that there is no risk of transmitting it to sexual partners – the reduction in spread could in effect end the HIV epidemic in this country.

Black, Indigenous and other racialized people make up about half of Toronto’s population, but 83 per cent of the city’s COVID-19 cases says MAP scientist Dr. Andrew Pinto.

In the below interview, he spoke with CTV News about how systemic racism has affected racialized populations during the pandemic.

What good are Ontario’s many health services if patients get lost in a maze of telephone numbers and waiting lists trying to access them? That was the dilemma the Toronto health region began tackling ten years ago, when it started introducing centralized intake services to act as a single point of entry for patients or doctors navigating Ontario’s complex healthcare system. A patient could call one of several centralized access lines to find a service that meets their needs, such as programs for senior’s supports, mental health and addictions, or diabetes services. Or, their family doctor can use it to refer them to that service.

Now a new study is exploring how well it works.

The study, published in Healthcare Policy, looked at how often family doctors are using central intake services and also whether family doctors were more likely to be aware of the program if they worked in an inter-professional team setting like a Family Health Team or Community Health Centre.

The study, which surveyed nearly 250 primary care physicians in Toronto, found that most family doctors are not aware of the centralized intake services available in the city. This creates a barrier between patients and the help they need. We spoke with Dr. Tara Kiran, family physician at St. Michael’s Hospital Academic Family Health Team and lead author of the study, about how the findings could improve the system.

“Health information is actually an extension of our sacred kin lines – of the blood and genetic memory that’s held in our DNA. It’s an observation about our health that’s rooted in blood memory. That’s a huge and awesome resource. We can use this to plan and develop thriving communities.”

Prof. Janet Smylie sees a change in the conversation about systemic racism.

The recently appointed Tier 1 Canada Research Chair in Health believes she is the first Indigenous person with kin and land ties to what is now known as Canada. She hopes to use the platform to advance the conversation even further.

“First Peoples in Canada receive second class healthcare services that for the greater part have been designed using non-Indigenous models and approaches,” says Smylie, a University of Toronto professor at the Dalla Lana School of Public Health and the Department of Family and Community Medicine at the Faculty of Medicine.

She is pleased about the award but prepared for the work ahead, which blends her medical and research background. From health care to research, it is all “relational.”

“I have the privilege and opportunity to develop those relationships with patients and carry that into my public health research and in Indigenous communities. Relationality, from my perspective, as a Métis woman is foundational to Indigenous social systems. The key, in my mind, is to never underestimate how important those relationships are,” she says.

“Thinking about developmental impact and mental health impact has to be in the same equation as the potential harm of COVID,” said Dr. Sloane Freeman, MAP scientist and lead pediatrician for the Model Schools Pediatric Health Initiative at St. Michael’s Hospital.

SickKids has released new proposed guidelines for reopening schools in Ontario come September, including recommendations like staggered lunch times, no large assemblies, and mandatory masks for older students.

The document, which was released Wednesday in collaboration with doctors from across the province, builds on COVID-19 recommendations the organization first released last month. It suggests various health and safety protocols for schools that take a student’s age and developmental considerations into account.

CBC News has learned Ontario Education Minister Stephen Lecce will unveil the province’s plans for the upcoming school year on Thursday.

The group says it is recommending the use of masks for high school students, with consideration for middle school students, whenever physical distancing can’t be maintained. Around 61 per cent of the authors agreed masks shouldn’t be required for elementary school kids.

By Dr. Tara Kiran

Summer in Canada has brought fewer new COVID-19 infections and an economy that is slowly reopening. But even as many Canadians are breathing a collective sigh of relief, health-care leaders are preparing for a winter unlike any that has come before.

Every winter is difficult for hospitals in Canada, which are often over-full and under-resourced. But this year, a potential surge of COVID-19 cases could put further stress on an already stretched system.

Better publicly funded homecare needs to be part of our strategy to prepare for what may be our worst winter yet.

We’ve known for a long time that homecare needs to be improved. In Ontario alone, there have been several expert reports in the last few years calling for homecare reforms and two successive governments have made changes to homecare governance. Yet, problems remain.

In 2018, I led a study asking patients and caregivers from across Ontario about the challenges they faced when transitioning from hospital to home. Again and again, the same answer came up: patients just simply don’t get enough homecare to meet their needs.

THE TORONTO STAR

THE GOAL: Improving the health and well-being of people experiencing marginalization during the pandemic by evaluating programs that support these populations, and figuring out how to make these services more effective.

THE TEAM: A group of 35 scientists, as well as community partners and people with lived experience of marginalization; the principal investigators are based at MAP Centre for Urban Health Solutions at St. Michael’s Hospital in Toronto.

THE TIMELINE: The project, which received funding from the University of Toronto COVID-19 Action Initiative, U of T’s faculty of medicine and the St. Michael’s Hospital Foundation, launched in May. It has a budget of $450,000 and is slated to run for a year. The first phase, which will evaluate six programs that support marginalized populations, is underway now.

When the pandemic hit, and COVID-19 infiltrated Toronto’s shelter system, the city set up isolation centres in hotels, where those experiencing homelessness can safety self-isolate and recover.

But how well are these sites working? Are there any unintended harms? What can be done to improve them?

These are among the questions that a team of scientists and community partners is probing as part of a collaborative and urgent effort to improve the lives of those on the margins, who have been hit hardest by the pandemic.

“What we’ve learned during the past few months is that the current context within the pandemic often makes people who are already marginalized even more marginalized,” said Dr. Michelle Firestone, a scientist at MAP Centre for Urban Health Solutions, which is leading the project.

“It exacerbates a lot of the pre-existing or systemic issues a lot of communities face.”

Dr. Ahmed Bayoumi, a scientist at MAP and Firestone’s co-principal investigator of the project, said it grew out of the need to “think broadly about how the pandemic response, in particular, was having an effect on the lives of people in the communities we work with.”

“We recognize that COVID is going to be with us for a while — certainly for the rest of this year and into next year,” he said. “We’re looking at programs that have been initiated … to try and learn from that, in terms of how can we move forward to both improve current responses but also inform future responses.”

Four prestigious Canada Research Chair titles have been awarded to MAP scientists, as part of Canada’s commitment to recognize and invest in some of the world’s most accomplished and promising researchers.

MAP is now home to six Canada Research Chairs in total: new chairholders Drs. Janet Smylie, Ann Burchell, Sharmistha Mishra and Darrell Tan, as well as current Canada Research Chairs Drs. Patricia O’Campo and Nav Persaud.

The chairs announced this month focus on solutions to understand and address anti-Indigenous racism in health services, eliminate barriers to accessing sexually transmitted disease services, improve HIV-prevention strategies, and better understand the spread of disease.

Learn more about the chairholders and their outstanding work below.

A new initiative sponsored by the CIHR Centre for REACH 3.0 and the Canadian Foundation for AIDS Research (CANFAR), and led by MAP scientist Dr. Sean Rourke, seeks to end the stigma that inhibits Canada’s progress to reaching its goal to end the HIV epidemic by 2025.

The Positive Effect – collaboratively designed by scientists, medical experts, community leaders and people with living with HIV in Canada – begins online at positiveeffect.org. The initiative will connect the lived experience of those both managing and preventing HIV with facts and evidence to correct the misinformation and fear that underlies and perpetuates stigma.

The positiveeffect.org will promote authentic, ongoing and high-energy engagement across Canada of those dedicated to wiping out HIV stigma, which impedes testing, prevention efforts, and contributes to further health inequities across communities. 

“The Positive Effect is much more than a website – it is about shifting mindsets and enriching lives,” said Dr. Rourke. “It is a movement to end HIV stigma by linking facts and evidence of how stigma can affect people to their core, with stories of lived experience where people navigate through challenging circumstances and vulnerability with courage, resilience and growth.

“We know stigma interferes with HIV prevention and deters people from getting tested regularly and knowing their status – this is one of the reasons why ending HIV stigma is so critical. HIV stigma arises out of fear, lack of knowledge, and prejudices, and that’s why we created The Positive Effect. We want to inspire and support people to think differently about HIV by appreciating real stories that they otherwise may never hear about – through these experiences, we will shift mindsets.”

Quick Facts

• One in five people living with HIV are denied health services because of stigma and discrimination.
• 9,090 Canadians live with HIV and don’t know it.
• 10,340 people diagnosed with HIV aren’t in care and accessing life-saving treatment.
• Reducing HIV stigma is central to ending the HIV epidemic in Canada and will mean less barriers for people to know their status and receive treatment or preventative care.

Learn More

Visit the Positive Effect website

Read the backgrounder