HIV Epidemiology in the Prairies

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  • Why was there a dramatic increase in the rate of HIV in 2008?
  • The term epidemic can be applied to any disease or health-related condition that occurs in clear Excess of normal expectancy. Define these terms: epidemic , pandemic , endemic , morbidity , mortality . 
  • The term epidemic can be applied to any disease or health-related condition that occurs in clear Excess of normal expectancy.
  • Another point to remember is that looking at the years in which people tested HIV positive does not tell you when they were infected - the test itself may come many years after infection occurred. And when looking at HIV reports, it's important to keep in mind that there might be more than one reason for trends in the data. An increase in diagnoses might not mean that more people are becoming infected with HIV than in previous years - it might mean, instead, that HIV testing has become more easily available than in recent years, or that stigmatisation of people living with HIV has declined, so more people are willing to be tested.
  • analogous - similar
  • A competing pathogenic hypothesis at the time was that HIV was caused by environmental toxins, such as "poppers.“ In terms of characteristics (such as age, gender, race, etc), HIV reports are not necessarily entirely representative of all HIV infections because some groups of people may be more likely to be tested than others. It is worth remembering this limitation when interpreting reported statistics by exposure category in particular. Reports from the most recent years are usually affected by reporting delays
  • With reported diagnoses, each number indicates an actual positive result for a person's HIV test. This method of looking at an epidemic can give an extremely clear picture in terms of real people who have been affected by the virus, especially when looking at smaller areas. However, it is often not a reliable way of assessing wider trends because many people living with HIV have never taken an HIV test, and not all diagnoses are reported.
  • If data collection is different across the province, community, or nation, can we compare. Can we compare if populations are different? Who should we compare our data too? And for what reason?
  • Because the next swan you see may not be white.
  • Why or why not?
  • 3. Everyday behaviors and experiences often provide useful analogies and examples for the kinds of thinking used in epidemiology. Think of an instance when you tried to figure out why something in your everyday life (e.g., a computer program, illness or clinical experience, automobile, etc.) was not working the way it was supposed to. How did you proceed? What steps did you follow to figure out the problem? What observations did you note? Did you try altering settings and observe changes? How successful were your observations? 4. Describe three attributes of public health problems that make them particularly difficult to study in terms of cause and effect. http://www.sjsu.edu/faculty/gerstman/eks/Lab_The_Epidemiologic_Tradition.pdf
  • How has surveillance and data been used to change programs at provincial or national levels? Do targeted interventions work or do targeted interventions further stigmatize key populations? What about general messages in the media? Most messages in the media report HIV in relation to IDU, Aboriginal, prostitutes, ...
  • So, when HIV prevalence is reported for Aboriginals in Saskatchewan, what does this mean? In most cases, HIV prevalence cannot be accurately determined from reported cases because many infections are undiagnosed or unreported. The best estimates are mainly based on the results of surveys of large groups of people. How many HIV tests are performed in SK per year? How does this compare to other provinces as far as prevalence is concerned? We most likely would have to dig deeper.
  • What goes into the numerator of an incidence proportion?  No. of disease onsets.  What goes into the denominator of an incidence proportion? Size of cohort at risk  Why do denominators of incidence proportions exclude those who are not at risk? Because they do not have the potential to develop the disease.
  • prevalence count population size None; prevalences are proportions, and proportions are unit-free “dimensionless” numbers. It considers both new and old cases and involves no follow-up of individuals (also see Table 6.2, p. 135). Prevalence will increase over time.
  • What is the prevalence in SK? Double the national average? Prevalence versus the number of infections versus incidence. Prevalence rate refers to the percentage of a country’s whole population infected with a disease. The number of infections can either be the total number, or expressed in 100,000s, ie: 5 per 100,000 people. Incidence refers to the number of new cases of a disease in a population over a specific period of time, usually annually.
  • The first thing to understand is that the crime rate is not the same as the actual number of crimes. Crime rates are the result of crimes reported to police. Since most people don't report crimes, the official rates provided by the FBI in the Uniform Crime Reports are always less than the actual crime rate. Additionally, the UCR crime rates only reflect 8 different crimes: 1)Homicide 2) Robbery 3) Rape 4) Burglary 5) Aggravated Assault 6) Larceny/theft 7) Motor vehicle theft 8) Arson. Since the UCR, which is where crime rate data is collected from, doesn't report on other crimes, there could be all sorts of other crime going on over and above these 8 "index crimes" even if these are going down. However, once the police are aware of a crime, they prepare a report to go to the FBI for the annual UCR. The police can tweak how they report crimes to make their crime rate look higher or lower. For example, Burglary can be reported as just that, or the police can choose to code the incident as a trespass and a theft, which would make the burglary rate look lower. Also, police agencies are not required to actually send these reports to the FBI either, so this can have an impact on the overall crime rate. One final thing to keep in mind is that comparing crime rates at a local level can be rather deceptive unless you look at the hard numbers. For example, if a city has no murders one year and then 2 the next, the rate would have increased by 200% although 2 murders is hardly a crime wave. The types of crimes the police focus on can also change how crime statistics look. If the crime rate is based on crimes known to the police, more proactive enforcement on a particular category of crime or in a specific crime-prone area will make the reported numbers increase even if the actual true number of crimes has not. The rate goes up because of police action, but only because they are taking more reports and making more arrests. Other government agencies, such as the Bureau of Justice Statistics, also collects crime data and reports on crime rates involving crime categories not included in the UCR results. Drug crime is a good example of this. If the police suddenly crack down on drugs in an area, the number of police generated reports on drug offenses will increase, as will the reported crime rate. If they reduce enforcement efforts, the rate will go down even if the actual amount of crime doesn't. To truly understand crime statistics, you have to look at rates, hard numbers, the population of the reporting jurisdiction, the arrest and clearance rates, and consider that the numbers are influenced by a wide variety of factors, which always make the number lower than the actual number of crimes that take place in society since the police can't possibly be aware of all crimes.
  • http://www.sjsu.edu/faculty/gerstman/eks/
  • – both sexes
  • Article???? Statistics???? Are we being realistic????
  • Does Saskatchewan have population based data? objectives of conducting a population-based HIV prevalence survey could include: :to obtain national and subnational estimates of HIV prevalence and demographic variation in HIV prevalence in the general population; :to provide information on HIV prevalence that can be used to calibrate, validate and improve the use of HIV sentinel surveillance data among pregnant women attending antenatal clinics; :to identify risk factors that predispose the general population and subpopulations to HIV infection; :to link the risk factors with biological measures and to assess the associations between the two; and :to assess the extent to which current interventions are accessible to the general population, including their impact on the population.
  • What happens in Saskatchewan?
  • What do ASO’s NGO’s want? Is lack of housing, residential schools, being aboriginal, related to HIV? How?
  • Training would improve reporting on HIV/AIDS
  • HIV Epidemiology in the Prairies

    1. 1. GREG RIEHL, R.N., SASKATCHEWAN HIV HCV NURSING ED ORG Epidemiology in the Prairies: Spotlight on Saskatchewan
    2. 2. HIV is a great story. <ul><li>It pushes all the news buttons: it is a health emergency, it has a human face, it has elements of science, medicine, religion, it has deep grief and moments of extreme joy. </li></ul><ul><li>It often has enemies: governments, the church, religious bodies, the fraudsters and snake-oil salesmen. </li></ul><ul><li>It has heroes: the people living with HIV, community groups and NGOs fighting on the frontline of the epidemic, the scientists and researchers working for new treatments, a vaccine, a cure, and the doctors and nurses caring for the sick and dying. </li></ul><ul><li>It is clear that HIV and AIDS is more than a disease that infects individuals. </li></ul><ul><li>It is a social, economic and, in some countries, security crisis. </li></ul>
    3. 3. Why is everyone talking about Saskatchewan <ul><li>What is so unique about the epidemiology of this province? </li></ul><ul><li>How can these numbers help or hinder communities, agencies and, most importantly, people in the Prairies living with HIV. </li></ul>
    4. 4. We will not be doing this . . . <ul><li>DEFF = 1 + ( m – 1)r </li></ul><ul><li>r = sc2/(s2 + sc2) </li></ul>
    5. 5. Epidemiology <ul><li>epi = upon; demos = the people; ology = to speak of (to study) </li></ul><ul><li>Definitions vary but each definition seems to include reference to: </li></ul><ul><ul><li>  &quot;the study of,&quot; </li></ul></ul><ul><ul><li>&quot;disease and health-related conditions,&quot; and </li></ul></ul><ul><ul><li>&quot;populations and groups.&quot;  </li></ul></ul>
    6. 6. Statistics <ul><li>Epidemiologic statistics are mere estimates of the parameters they wish to estimate. </li></ul>
    7. 7. Epidemic <ul><li>The term epidemic is used when HIV and AIDS are widespread in a community. </li></ul><ul><li>The term epidemic can be applied to any disease or health-related condition that occurs in clear ______________ of normal expectancy. </li></ul>
    8. 8. Does Saskatchewan have an HIV epidemic? <ul><li>In order to understand the many epidemics of HIV that are spreading around the world, and the AIDS epidemics which follow in their footsteps, it is necessary to look at certain figures. </li></ul><ul><li>The figures we need include: </li></ul><ul><ul><li>the number of people living with HIV (the HIV prevalence), </li></ul></ul><ul><ul><li>the number of new infections (the HIV incidence), and </li></ul></ul><ul><ul><li>the number of people who have died of AIDS. </li></ul></ul>
    9. 9. <ul><li>Because HIV is mostly transmitted via unprotected sex, a society’s myths, taboos and societal norms can often cloud debate on the disease and prevent accurate information getting into the public domain. </li></ul><ul><li>HIV/AIDS media guide </li></ul><ul><ul><li>IFJ media guide and research report on the media's reporting of HIV/AIDS http://www.ifj.org/assets/docs/117/252/83d8475-9cb28fc.pdf </li></ul></ul>
    10. 10. Fast facts <ul><li>Less than 20 per cent of people at risk of contracting HIV have access to preventative measures such as condoms. </li></ul><ul><li>UNAIDS estimates that at best, only one person in ten in Africa and one in seven in Asia in need of antiretroviral treatment were receiving it. </li></ul><ul><li>More than 600 people contract HIV every hour. </li></ul><ul><li>Women account for nearly 50 per cent of all HIV/AIDS cases. </li></ul>
    11. 11. What is Infection? <ul><li>Infection = biologic agent living and replicating within host </li></ul><ul><li>Infectious disease = infection accompanies by pathology Infection ≠ disease! </li></ul><ul><li>Viruses (submicroscopic; incapable of multiplication outside of host) </li></ul>05/19/10 Pathos
    12. 12. Analogy <ul><li>Before the HIV was discovered, epidemiologists noticed that AIDS and Hepatitis B had analogous risk groups, suggesting similar types of agents and transmission </li></ul>
    13. 13. Analogy <ul><li>Early in the AIDS epidemic, before HIV was discovered (circa 1983), epidemiologists realized groups at high risk of HIV groups shared characteristics with groups at high risk of Hepatitis B. </li></ul><ul><li>This suggested the diseases were spread by similar mechanisms. </li></ul><ul><li>What data do we collect and why? </li></ul><ul><ul><li>Age, gender, risk factor, ethnicity, etc. </li></ul></ul>
    14. 14. What does the public think is happening? <ul><li>Where does the public get their information? </li></ul><ul><li>Where does the media get their information? </li></ul>
    15. 15. Do we all collect the same data? <ul><li>There are two main types of national HIV and AIDS statistics: </li></ul><ul><li>Reports of actual cases tell us the minimum number of people who are affected, but are of limited use if many cases go unreported. </li></ul><ul><li>Estimates based on surveys give the proportion of people living with HIV, as well as other statistics, according to certain assumptions. </li></ul>
    16. 16. Where do we collect data in SK?
    17. 17. The Problem of Induction <ul><li>Why can you never prove that all swans are white? </li></ul><ul><li>Will all IDU’s get HIV? HCV? </li></ul>
    18. 18. Who do we collect data from? And what do we do with the information?
    19. 19. Do we treat all communicable diseases the same?
    20. 20. Surveillance <ul><li>Obtaining an estimate of the number of people infected with HIV in a country or region is important for the purpose of evaluation, programme planning and advocacy. </li></ul><ul><li>Estimates are usually obtained from surveillance systems, but because HIV epidemics develop differently in different countries, different surveillance systems are required (UNAIDS/WHO </li></ul><ul><ul><li>(UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, 2000). </li></ul></ul><ul><ul><li>http://data.unaids.org/pub/manual/2005/20050101_gs_guidemeasuringpopulation_en.pdf </li></ul></ul>
    21. 21. Surveillance <ul><li>In all epidemic states, surveillance systems aim to provide information that will increase and improve the response to the HIV epidemic. </li></ul><ul><li>In countries where HIV is uncommon, biomedical surveillance and behavioural data can provide an early warning of a possible epidemic. </li></ul><ul><ul><li>(UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, 2000). </li></ul></ul><ul><ul><li>http://data.unaids.org/pub/manual/2005/20050101_gs_guidemeasuringpopulation_en.pdf </li></ul></ul>
    22. 22. Surveillance <ul><li>Where HIV is concentrated in subgroups with high-risk behaviour, surveillance can provide valuable information for designing focused interventions. </li></ul><ul><li>In generalized epidemics , sentinel HIV surveillance among the general population can provide essential information for planning care and support and for indicating the success of the current response </li></ul><ul><ul><li>(UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, 2000). </li></ul></ul><ul><ul><li>http://data.unaids.org/pub/manual/2005/20050101_gs_guidemeasuringpopulation_en.pdf </li></ul></ul>
    23. 23. Surveillance <ul><li>Most sentinel surveillance systems have limited geographical coverage, especially in smaller and more remote rural areas. </li></ul><ul><li>Can an event or condition ever be said to have a single cause? </li></ul>
    24. 24. Population-based survey to measure HIV prevalence <ul><li>Countries that do not have existing population-based surveys to which HIV testing can be added have to design and conduct new seroprevalence surveys. </li></ul><ul><li>Do we need to do surveys, or more research in Saskatchewan? </li></ul>
    25. 25. Population-based survey to measure HIV prevalence <ul><li>The primary objective of a population-based HIV prevalence survey is typically to obtain: </li></ul><ul><ul><li>Accurate HIV prevalence estimates </li></ul></ul><ul><ul><li>Information on risk factors related to HIV infection </li></ul></ul><ul><ul><li>To inform the design, implementation and evaluation of the response to the HIV/AIDS crisis or epidemic. </li></ul></ul><ul><li>Do provincial reports in Saskatchewan and Canada meet this criteria? </li></ul>
    26. 26. Prevalence <ul><li>'HIV prevalence' is given as a percentage of a population. </li></ul><ul><li>If a thousand truck drivers, for example, are tested for HIV and 30 of them are found to be positive, then the results of a study might say that HIV prevalence amongst truck drivers is 3%. </li></ul>
    27. 27. Prevalence? <ul><li>A prevalence count includes all cases (old and new). An incidence count includes only recent onsets (i.e., onsets that occurred during the period of observation). </li></ul><ul><li>Perception of risk often differs from reality. Identify factors that shape misapprehensions of risk. </li></ul><ul><ul><li>Factors that shape misapprehensions about risks include: (a) fear (b) lack of control (c) media attention (d) the inability to deal with numerical information </li></ul></ul>
    28. 28. Prevalence? <ul><li>What goes into the numerator of a prevalence calculation?  </li></ul><ul><li>What goes into the denominator of prevalence? </li></ul><ul><li>What units are associated with prevalence estimates? </li></ul><ul><li>List ways in which prevalence differs from incidence. </li></ul><ul><li>If the rate of a disease remains constant, but the death rate of the disease decreases (through improved treatment), what happens to its prevalence of the condition over time? </li></ul>
    29. 29. Prevalence <ul><li>In a country with a low-level or concentrated epidemic (where high levels of infection are found only in specific groups), the national estimate of HIV prevalence is mainly based on data collected from populations most at risk - usually sex workers, injecting drug users or men who have sex with men - and on estimates of the sizes of the populations at high risk and at low risk. </li></ul><ul><li>Better understanding of the nature of an HIV epidemic allows better prevalence estimates to be produced. This is why, each year when a new set of estimates is brought out, the figures for previous years may change. </li></ul>
    30. 30. Prevalence <ul><li>Point prevalence = prevalence at a particular point in time </li></ul><ul><li>Period prevalence = prevalence over a period of time </li></ul><ul><li>Interpretation A: proportion with condition </li></ul><ul><li>Interpretation B: probability a person selected at random will have the condition </li></ul>(c) B. Gerstman Chapter 6
    31. 31. Incidence <ul><li>'HIV incidence' is the number of new HIV infections in the population during a certain time period. </li></ul><ul><li>People who were infected before that time period are not included in the total, even if they are still alive. </li></ul>
    32. 32. True or False? <ul><li>Changes in HIV incidence statistics can give an idea of whether prevention strategies are being successful in reducing the number of new infections. </li></ul><ul><li>A society that shows regularly declining incidence figures is one that is experiencing fewer and fewer new infections, which is certainly desirable. </li></ul>
    33. 33. Denominators (c) B. Gerstman Chapter 6 Denominators: reflection of population size
    34. 34. Numerators & Denominators <ul><li>“ Rates” are composed of numerators and denominators </li></ul><ul><li>Numerator  case count </li></ul><ul><ul><li>Incidence count  onsets </li></ul></ul><ul><ul><li>Prevalence count  old + new cases </li></ul></ul><ul><li>Denominators  reflection of population size </li></ul>(c) B. Gerstman Chapter 6
    35. 35. Saskatchewan population
    36. 36. Saskatchewan populations
    37. 37. “ Rate” Gerstman Chapter 2 Loosely, the “rate” of an event is the number of events divided by population size
    38. 38. NEP <ul><li>The problem with insisting on one-for-one exchange is that research shows that this can restrict access to clean needles and therefore increase infection rates. </li></ul><ul><li>Do needle-exchange programs really work? </li></ul>
    39. 39. Key Terms <ul><li>Morbidity = related to disease or disability </li></ul><ul><li>Mortality = related to death </li></ul><ul><li>Endemic = normal occurrence of a condition </li></ul><ul><li>Epidemic = much greater than normal occurrence of a condition </li></ul><ul><li>Pandemic = an epidemic on multiple continents </li></ul><ul><li>Incidence = rate or risk of developing a condition </li></ul><ul><li>Prevalence = proportion of population with a condition </li></ul>Gerstman Chapter 1
    40. 40. HIV Morbidity <ul><li>In 2008, 173 laboratory-confirmed HIV cases were reported compared to 127 in 2007, </li></ul><ul><li>101 in 2006 and 80 in 2005 (an increase of 36% from 2007). There was a total of 707 </li></ul><ul><li>HIV infected individuals identified in the 10 years, 1999 to 2008. </li></ul>
    41. 41. Prenatal statistics <ul><li>In generalized epidemics, HIV testing among pregnant women is considered a good proxy for prevalence in the general population. </li></ul><ul><li>In countries with low levels of HIV prevalence, strategically placed sentinel sites can provide an early warning for the start of an epidemic. </li></ul><ul><li>Antenatal clinic surveillance does not provide information about HIV prevalence in men. </li></ul>
    42. 42. Cause <ul><li>Definition of “cause” </li></ul><ul><li>Any event, act, or condition preceding disease or illness without which disease would not have occurred or would have occurred at a later time </li></ul><ul><li>Disease results from the cumulative effects of multiple causes acting together (causal interaction) </li></ul>
    43. 43. Cause <ul><li>Definition of “cause” </li></ul><ul><li>Necessary cause = found in all cases </li></ul><ul><li>Contributing cause = needed in some cases </li></ul><ul><li>Sufficient cause = the constellation of necessary & contributing causes that make disease inevitable in an individual </li></ul>
    44. 44. Confounding <ul><li>A distortion brought about by extraneous variables </li></ul><ul><li>From the Latin meaning “to mix together” </li></ul><ul><li>The effects of the exposure gets mixed with the effects of extraneous determinants </li></ul>05/19/10
    45. 45. Properties of a Confounding Variable <ul><li>Associated with the exposure </li></ul><ul><li>An independent risk factor </li></ul><ul><li>Not in causal pathway </li></ul>05/19/10
    46. 46. Challenge the government: ask the hard questions <ul><li>What is the government doing to prevent the spread of HIV? </li></ul><ul><li>What is it doing to help those already infected? </li></ul><ul><li>Does it have a program to provide antiretroviral treatments and drugs for opportunistic infections for people with HIV? </li></ul><ul><li>Does it involve people with HIV, along with scientists, researchers, doctors, nurses and community groups in the development of its HIV Strategy? Does it even have a strategy? Is the Strategy an actual Strategy? </li></ul><ul><li>How much money does it devote to HIV? What about sexually transmitted infections, which are often a precursor to HIV? What about NEP? </li></ul><ul><li>Does it promote the use of condoms and encourage safer sex campaigns that accurately reflect the reality of people’s sexual lives? </li></ul>
    47. 47. HIV STRATEGY FOR SASKATCHEWAN 2010 - 2013 <ul><li>A COMPREHENSIVE STRATEGY IS REQUIRED TO REDUCE THE RAPID INCREASE OF NEW CASES OF HIV IN SASKATCHEWAN AND TO IMPROVE THE QUALITY OF LIFE FOR HIV-POSITIVE PEOPLE </li></ul><ul><li>http://www.health.gov.sk.ca/adx/aspx/adxGetMedia.aspx?DocID=3ffeca87-ac63-4b67-87a1-c09abf14434b&MediaID=3775&Filename=hiv-strategy-exec-summary-2010.pdf&l=English </li></ul>
    48. 48. HIV STRATEGY FOR SASKATCHEWAN 2010 - 2013 <ul><li>Executive Summary </li></ul><ul><li>Saskatchewan has seen a significant increase in new cases of HIV since 2003 and currently has the highest rates in Canada at twice the national average. (20.8 vs 9.3/100,000) The epidemiology of HIV in Saskatchewan is different than the rest of Canada, with new HIV cases associated predominantly with injection drug use (75%) with First Nations and Métis women under age 30 accounting for a disproportionate number of those cases. </li></ul><ul><li>http://www.health.gov.sk.ca/adx/aspx/adxGetMedia.aspx?DocID=3ffeca87-ac63-4b67-87a1-c09abf14434b&MediaID=3775&Filename=hiv-strategy-exec-summary-2010.pdf&l=English </li></ul>
    49. 49. Tips for journalists and for people who read their articles... <ul><li>Common stereotypes </li></ul><ul><li>It is often thought, wrongly, that only “bad” people get HIV – </li></ul><ul><li>those who have sex with multiple partners, or are injecting </li></ul><ul><li>drug users or sex workers. Another misconception is that if </li></ul><ul><li>someone is in a group that has high rates of HIV – such as </li></ul><ul><li>injecting drug users or sex workers – that he or she is or will </li></ul><ul><li>be infected. It is important to remember that it is not the </li></ul><ul><li>group that someone belongs to that makes them vulnerable </li></ul><ul><li>to HIV infection, but their behaviour and the social or </li></ul><ul><li>economic circumstances that may have contributed to it. </li></ul><ul><li>Journalists should steer clear of making value judgements on </li></ul><ul><li>how someone contracted HIV and instead report on how it </li></ul><ul><li>affects them, their community, their work and their family. </li></ul>
    50. 50. HIV is a great story. <ul><li>It pushes all the news buttons: it is a health emergency, it has a human face, it has elements of science, medicine, religion, it has deep grief and moments of extreme joy. </li></ul><ul><li>It often has enemies: governments, the church, religious bodies, the fraudsters and snake-oil salesmen. </li></ul><ul><li>It has heroes: the people living with HIV, community groups and NGOs fighting on the frontline of the epidemic, the scientists and researchers working for new treatments, a vaccine, a cure, and the doctors and nurses caring for the sick and dying. </li></ul><ul><li>It is clear that HIV and AIDS is more than a disease that infects individuals. </li></ul><ul><li>It is a social, economic and, in some countries, security crisis. </li></ul>
    51. 51. HIV STRATEGY FOR SASKATCHEWAN 2010 - 2013 <ul><li>Surveillance </li></ul><ul><li>The Goals </li></ul><ul><li>Earlier detection of cases </li></ul><ul><li>Decrease in number of new cases (within 4 to 5 years) </li></ul><ul><li>A decrease in the number of sexually transmitted infections </li></ul><ul><li>The Plan </li></ul><ul><li>Increased access to testing </li></ul><ul><li>Increased understanding of the at-risk groups </li></ul><ul><li>Improved information and communication at all levels </li></ul><ul><li>http://www.health.gov.sk.ca/adx/aspx/adxGetMedia.aspx?DocID=3ffeca87-ac63-4b67-87a1-c09abf14434b&MediaID=3775&Filename=hiv-strategy-exec-summary-2010.pdf&l=English </li></ul>
    52. 52. HIV STRATEGY FOR SASKATCHEWAN 2010 - 2013 <ul><li>Clinical Management </li></ul><ul><li>The Goals </li></ul><ul><li>Increased quality of life for HIV patients </li></ul><ul><li>Increased proportion of HIV-positive pregnant women receiving pre- and post-natal care </li></ul><ul><li>Decreased number of HIV patients progressing rapidly to AIDS </li></ul><ul><li>Decrease hospital admissions for HIV-related illnesses </li></ul><ul><li>Zero perinatal transmission </li></ul><ul><li>The Plan </li></ul><ul><li>Adopting a non-discriminatory patient first approach with cross-disciplinary teams </li></ul><ul><li>Focused learning opportunities for all health care providers </li></ul><ul><li>Best practice plans and protocols in place for enhanced clinical management </li></ul><ul><li>http://www.health.gov.sk.ca/adx/aspx/adxGetMedia.aspx?DocID=3ffeca87-ac63-4b67-87a1-c09abf14434b&MediaID=3775&Filename=hiv-strategy-exec-summary-2010.pdf&l=English </li></ul>
    53. 53. HIV STRATEGY FOR SASKATCHEWAN 2010 - 2013 <ul><li>Prevention and Harm Reduction </li></ul><ul><li>The Goals </li></ul><ul><li>Increased access to holistic centers focusing on prevention and well-being </li></ul><ul><li>Fixed and mobile locations offering mix of services including health and social services </li></ul><ul><li>Decrease in transmission of blood-borne viruses and sexually transmitted diseases </li></ul><ul><li>Reduction of injection drug use </li></ul><ul><li>The Plan </li></ul><ul><li>Review of medical/nursing curriculums for substance abuse and chemical dependency </li></ul><ul><li>Establish prevention and wellbeing centers with expanded access to needle exchange programs and other harm reduction measures to promote and encourage safe behaviors </li></ul><ul><li>Expand addictions prevention and treatment </li></ul><ul><li>Incorporate mental health and addictions programming into holistic center approach </li></ul><ul><li>http://www.health.gov.sk.ca/adx/aspx/adxGetMedia.aspx?DocID=3ffeca87-ac63-4b67-87a1-c09abf14434b&MediaID=3775&Filename=hiv-strategy-exec-summary-2010.pdf&l=English </li></ul>
    54. 54. HIV STRATEGY FOR SASKATCHEWAN 2010 - 2013 <ul><li>Community Engagement and Education </li></ul><ul><li>The Goals </li></ul><ul><li>Reduce stigma and increase understanding of HIV among the residents of Saskatchewan </li></ul><ul><li>Increased support to HIV-positive people by their families and communities </li></ul><ul><li>Increased community and leadership engagement to address community related risk factors ie: adequate housing </li></ul><ul><li>The Plan </li></ul><ul><li>Engage elders of First Nations and Métis communities </li></ul><ul><li>Establish HIV positive peer to peer networks (positive teens, IDU’s, and HIV-positive mothers) </li></ul><ul><li>Public education on prevention and awareness of HIV </li></ul><ul><li>Targeted prevention treatment and healthy living for HIV-positive individuals </li></ul><ul><li>Strengthen prevention measures that protect children and youth. ie: KidsFirst programming focuses on areas such as home visiting, parent engagement, and mental health and addictions services </li></ul><ul><li>http://www.health.gov.sk.ca/adx/aspx/adxGetMedia.aspx?DocID=3ffeca87-ac63-4b67-87a1-c09abf14434b&MediaID=3775&Filename=hiv-strategy-exec-summary-2010.pdf&l=English </li></ul>
    55. 55. HIV STRATEGY FOR SASKATCHEWAN 2010 - 2013 <ul><li>The success of the strategy will mean that, over the next couple of years, we will see increased HIV rates due to increased testing and tracing. It is expected that the HIV rates will decline in years three or four as the intervention/prevention initiatives start showing effectiveness. </li></ul><ul><li>http://www.health.gov.sk.ca/adx/aspx/adxGetMedia.aspx?DocID=3ffeca87-ac63-4b67-87a1-c09abf14434b&MediaID=3775&Filename=hiv-strategy-exec-summary-2010.pdf&l=English </li></ul>
    56. 56. HIV STRATEGY FOR SASKATCHEWAN 2010 - 2013 <ul><li>The overarching goals of the Saskatchewan HIV Strategy are to: increase the rate of testing; ensure access to therapy and treatment; reduce the rate of new infections, including no new HIV-positive babies; increase quality of life and decrease discrimination. It is essential we have a sustainable plan that can adapt to meet a growing need. </li></ul><ul><li>http://www.health.gov.sk.ca/adx/aspx/adxGetMedia.aspx?DocID=3ffeca87-ac63-4b67-87a1-c09abf14434b&MediaID=3775&Filename=hiv-strategy-exec-summary-2010.pdf&l=English </li></ul>
    57. 57. Thank you <ul><li>[email_address] </li></ul><ul><li>Check slideshare.net for this presentation with references in the near future. </li></ul>
    58. 58. References <ul><li>Epidemiology Kept Simple: An Introduction to Traditional and Modern Epidemiology, 2nd Edition </li></ul><ul><ul><li>http://www.sjsu.edu/faculty/gerstman/eks/ (Awesome resource, loved it) </li></ul></ul><ul><li>HIV/AIDS media guide </li></ul><ul><ul><li>http://www.ifj.org/assets/docs/117/252/83d8475-9cb28fc.pdf </li></ul></ul><ul><li>HIV and AIDS In Saskatchewan </li></ul><ul><ul><li>http://www.health.gov.sk.ca/hiv-aids-annual-report-2008 </li></ul></ul><ul><li>HIV rise sparks warning: Recent jumps linked to usage of injected drugs </li></ul><ul><ul><li>http://www.thestarphoenix.com/health/rise%20sparks%20warning/2772120/story.html </li></ul></ul><ul><li>HIV STRATEGY FOR SASKATCHEWAN : 2010 - 2013 </li></ul><ul><ul><li>http://www.health.gov.sk.ca/Default.aspx?DN=3ffeca87-ac63-4b67-87a1-c09abf14434b&l=English </li></ul></ul><ul><li>Nightmare HIV scenario for Sask. First Nations unlikely: Health officer </li></ul><ul><ul><li>http://www.canada.com/health/Nightmare+scenario+Sask+First+Nations+unlikely+Health+officer/1924062/story.html </li></ul></ul><ul><li>Understanding the HIV and AIDS epidemics </li></ul><ul><ul><li>http://www.avert.org/statistics.htm </li></ul></ul><ul><li>Volunteers pick-up used needles in Regina neighbourhoods </li></ul><ul><ul><li>http://www.leaderpost.com/health/Volunteers+pick+used+needles+Regina+neighbourhoods/2774710/story.html </li></ul></ul><ul><li>WHEN PLAGUES END; NOTES ON THE TWILIGHT OF AN EPIDEMIC </li></ul><ul><ul><li>http://www.independent.co.uk/arts-entertainment/when-plagues-end-notes-on-the-twilight-of-an-epidemic-1278905.html </li></ul></ul>

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