Author: Samira Prasad

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

Dr. Nav Persaud, MAP scientist and Chair of the National Pharmacare Committee of Experts, wrote this op-ed for the Toronto Star framing national pharmacare as a necessary nation-building project.

Dr. Tara Kiran, family physician and MAP scientist, spoke to Global News about a study that suggests Ontarians without a family doctor are at higher risk of death.

“You end up going for a lot of your care to walk-in clinics or emergency departments, and those settings are actually designed to just deal with an immediate issue,” Dr. Kiran said. “They don’t provide ongoing follow-up, and it’s not really their job to manage chronic conditions over time.”

Hayley Thompson of Ontario’s Drug Checking Community, spoke to the CBC about powerful drugs used primarily by veterinarians to sedate animals increasingly showing up in Toronto’s unregulated drug supply.

MAP director and scientist Dr. Stephen Hwang, spoke to CBC News in Thunder Bay for a story about a possible state of emergency over homelessness in the community. Housing advocates and Indigenous leaders in Thunder Bay, Ont., have been calling on the city to declare a state of emergency over homelessness, while city staff are pushing for a humanitarian crisis to be declared, instead.

Dr. Sean Rourke spoke with The Canadian Press about a new oral, at-home HIV test that delivers results in as little as 20 minutes. The test has been used in the U.S. for well over a decade is finally coming to Canada. Rourke said his team at St. Mike’s will start taking orders in the coming weeks from health providers, front-line agencies and hopefully, governments.

“This is the gap that we’ve been missing to reach the people who need it the most,” Rourke said, speaking about communities that are at increased risk as a result of health inequities.

This piece was also published on Global News.

TORONTO – REACH Nexus, based at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital (Unity Health Toronto), has partnered with three Black-led community health organizations to launch a new study aimed at improving access to the HIV prevention medication PrEP (pre-exposure prophylaxis) for African, Caribbean, and Black communities in the Greater Toronto Area.

The study, called the Safe Steps Model, is being conducted by REACH along with TAIBU Community Health Centre (TAIBU CHC), the Black Coalition for AIDS Prevention (Black CAP), and Africans in Partnership Against AIDS (APAA), along with other clinical and social service providers. Together, these organizations provide culturally safe care and wellness programming for Black communities across the GTA.

Dr. Wale Ajiboye, adjunct scientist with REACH Nexus, and project lead for Safe Steps, said the study team is using community engagement and culturally responsive care to tackle longstanding barriers to PrEP access, including stigma, limited service access, and anti-Black racism in the health system.

“The Safe Steps Model is culturally responsive, grounded in protection motivation and self-determination theory, and designed to address key individual and systemic barriers to using HIV prevention tools,” said Dr. Ajiboye. “This study has the potential to significantly expand prevention efforts and improve health outcomes for those at risk.”

The study is now enrolling participants to address individual, social, and structural barriers to HIV prevention. It emphasizes client independence, relationship-building, and access to essential resources, like social services, that help address the underlying social determinants of health and support people in meeting their HIV prevention goals.

PrEP—taken orally or as an injectable—prevents HIV acquisition and is a central strategy in Canada’s goal of reaching zero new HIV infections by 2030. Yet uptake remains low among African, Caribbean, and Black communities. In Ontario, Black residents represent 5.5% of the population but accounted for 25% of new HIV diagnoses in 2020 (Ontario HIV Surveillance Initiative). Ongoing medical mistrust, rooted in systemic racism, continues to limit access to care.

“TAIBU is excited to lead this important study that aims to create a more equitable and accessible path to HIV prevention and help dismantle the barriers created by anti-Black racism,” said Liben Gebremikael, Chief Executive Officer of TAIBU CHC. “Everyone, regardless of their background, should have what they need to protect their health.”

The study aims to reduce these disparities by supporting informed, equitable access to HIV prevention while addressing broader social determinants of health.

“Our collaboration with the Safe Steps Project reinforces APAA’s longstanding commitment to community-based leadership in the HIV response,” said APAA executive director Fanta Ongoiba.

“Together, we are building stronger pathways to care that respect the lived experiences, voices, and priorities of ACB communities.”

A recent study co-led by researchers at St. Michael’s Hospital found that Black men were 66% less likely than white men to be aware of PrEP. Among participants in rural areas, Black men were also about 60% less likely to be using PrEP compared to white men.

The findings underscored the urgent need for targeted, culturally relevant interventions to ensure equitable access to HIV prevention across Canada.

“Black CAP is proud to partner on the Safe Steps Program to expand HIV prevention access in our communities. Culturally grounded, community-led approaches like the Safe Steps Program are essential to reducing new infections and ensuring Black individuals can make informed, empowered decisions about their health,” said Elizabeth Mutinda, Executive Director of Black CAP.

About REACH Nexus

REACH Nexus is a national research group working to end HIV, Hepatitis C, and other STBBIs in Canada. A part of the MAP at St. Michael’s Hospital, REACH focuses on reaching the undiagnosed, scaling up testing, improving access to prevention (PrEP and PEP), connecting people to care, and ending stigma. It partners with people living with HIV, service providers, community organizations, public health, industry, and policymakers.

About TAIBU Community Health Centre

TAIBU, meaning “Be in Good Health” in Kiswahili, is a community health centre serving Black-identifying residents of the Greater Toronto Area. TAIBU offers primary care, health promotion, and disease prevention services in a culturally affirming environment tailored to address the needs of marginalized populations facing systemic health barriers.

About Black CAP

Since 1989, Black CAP has supported Black, African and Caribbean communities in Toronto affected by or at risk of HIV and STIs. As Canada’s largest Black-focused AIDS service organization, it provides culturally relevant prevention, outreach and support services. Facing stigma and systemic barriers, Black CAP relies on donors and volunteers to continue its work.

About APAA

Africans in Partnership Against AIDS (APAA), is a community-based, Canadian non-profit charitable AIDS service organization serving African communities in the greater Toronto area. Established in 1993, APAA has supported members of the African community in response to the increased need for those living with HIV/AIDS.

REACH Nexus Media Contact:

Andrew Russell
Senior Communications Specialist, REACH Nexus
andrew.russell@unityhealth.to
Phone: 416-268-7642

MAP director and scientist Dr. Stephen Hwang, spoke to CBC News about the health risk of frostbite during the recent cold snap. “Sometimes, people who are at risk don’t realize it because they’ve got to the point where their digits are becoming numb,” he told reporters. “So really, watching out for others who might be at risk and providing them with assistance is really important.”

In this article from The New York Times, the author dives into the research surrounding the Housing First method, citing research lead by several MAP scientists and researchers. Using examples from Toronto, Massachusetts and California, this article looks at where Housing First shines and what the limitations are.

Op-ed by Dr. Benita Hosseini & Dr. Andrew Pinto for Healthy Debate

When the next pandemic arrives (and it will!) Canada will once again face urgent questions: Which treatments work? For whom? At what dose? And how quickly should we act?

During the COVID pandemic, we had to answer these questions without a reliable way to rapidly test outpatient treatments in community settings. Instead, we relied heavily on data from pharmaceutical-sponsored studies that often left significant ambiguity about how well a therapy would work in general populations. That uncertainty shaped billion-dollar procurement decisions and left health-care providers without clear guidance.

We now have an opportunity to change this.

A ready-to-run adaptive platform trial that stays in place to evaluate multiple treatments as soon as a threat emerges could ensure that Canada is no longer caught unprepared or dependent on evidence from elsewhere. This type of platform trial would be permanent, “always on” infrastructure to rapidly assess multiple treatments in real-world settings.

The Paxlovid story is a telling example. Canada purchased large quantities based on early trial data sponsored by the manufacturer. Those trials, while important, did not reflect the realities of outpatient care in Canada, where patients had different levels of vaccination, comorbidities and health-system access. It later became clear, only after additional data were released by the manufacturer, that the benefits were smaller than initially expected, especially for lower-risk groups.

This is not about criticizing any one trial. It is about recognizing that Canada had no mechanism to answer these questions for itself, quickly and independently. Without a rapid way to evaluate effectiveness in our own communities, governments had to make decisions with wide uncertainty and limited local data.

That vulnerability is still with us today.

Canada faces two structural challenges during health emergencies:

1- We do not have a rapid method to evaluate outpatient treatments. Most people with acute respiratory infections, whether COVID, flu, RSV or a future pathogen, are treated in primary care and emergency departments, not hospitals. Yet our research infrastructure has traditionally focused on acute care settings. This leaves us unable to quickly test therapies where they matter most.

2- We rebuild research infrastructure from scratch every time. Each new pandemic or emerging infection requires new teams, contracts, ethics approvals, data capture systems and protocols. This delays the start of trial by weeks or months; the exact period when governments are making critical decisions about what to purchase and how to deploy it.

The result?

Canada ends up making high-stakes clinical and procurement choices with limited local evidence. That is a fundamental vulnerability.

A ready-to-run platform trial can address this gap. The platform does not shut down between pandemics, it stays active, even at low intensity. When a new virus emerges or new therapy becomes available, enrolment can ramp up immediately, avoiding delays that come from reinventing the wheel.

It can test more than one treatment at a time. Instead of running separate trials, an adaptive platform can evaluate several therapies in parallel under one master protocol. This reduces cost, improves efficiency and accelerates decision making.

The adaptive platform evolves as evidence evolves; it allows ineffective treatments to be dropped and promising ones to be added. The trial adapts to changing variants, patient needs and scientific priorities.

Major international trials (such as RECOVERY and PANORAMIC in the United Kingdom and REMAP-CAP globally) showed how quickly adaptive platforms can produce reliable answers.

The next pandemic will not begin in hospitals. It will begin in walk-in clinics, family practices, urgent care centres and emergency departments. That is where clinicians see the earliest cases, and where early treatment decisions shape outcomes.

Evaluating treatments in these settings matters because:

1- Effectiveness varies based on timing of treatment and patient characteristics.

2- Many high-risk groups, including people facing economic insecurity, newcomers, and those without access to regular primary care, receive care in outpatient settings.

3- Early treatment can prevent hospital admissions and reduce pressure on emergency rooms.

Early steps are already underway. TreatResp (adapted from CanTreatCOVID, one of the largest outpatient trials conducted in Canada with 800 participants) offers an initial demonstration of how this model can work in community settings. But efforts like this will only reach their potential if they are treated as national infrastructure rather than short-term projects.

A standing trial embedded in community settings strengthens the entire system, not just hospitals. It also supports more responsible public spending. A standing platform would give decision-makers early signals about which drugs are effective, which groups benefit most and rapid data to support or revise guidelines.

In other words: better data, fewer costly mistakes.

There is growing recognition across health systems that preparedness cannot focus solely on stockpiles, vaccines or hospital surge plans. We also need the capacity to generate evidence, rapidly, locally and independently.

The window to build this is open today. Once the sense of urgency fades, it will be much harder to create sustained funding and political support. If we want to avoid repeating the uncertainty of the last pandemic, we need to act now.

Conflict of interest disclosure: Dr. Andrew Pinto is the Principal Investigator for CanTreatCOVID and TreatResp. Dr. Benita Hosseini is the co-Principal Investigator for CanTreatCOVID and TreatResp.