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Guidelines aimed at improving HIV-prevention access too narrow: report

A year ago CMAJ, the journal of the Canadian Medical Association, published guidelines for health-care providers trying to determine who might be an appropriate candidate for pre-exposure prophylaxis (PrEP), the daily use of antiretroviral medications by people who are at high risk of HIV infection, before and after potential exposure. The guidelines recommend PrEP for men who have sex with men, transgender women and heterosexual couples when one partner is HIV positive.

As a result, doctors may hesitate to prescribe the regimen to other patients, even if there are behavioral, clinical and social factors that are known contributors to HIV risk, such as having condomless sex with multiple partners or intravenous drug use, according to an editorial published Thursday in the Canadian Journal of Human Sexuality. This is especially true for women and people of colour, whose lives are not fully understood by the guidelines’ experts, says LaRon Nelson, a public health nurse, research chair at the Ontario HIV Treatment Network and lead author of the report.

“We should create guidelines that are consistent with the way people live their lives – however complex that may be – and not how doctors think people should act,” he said. “People know they should share their sexual history and HIV status with their doctors and sexual partners, but the reality is that they do not. That’s why the guidelines should be based on behaviour and the patients’ clinical history and not their sexual orientation or the HIV status of their partner.”

Darrell Tan, an infectious diseases physician at St. Michael’s Hospital in Toronto and the author of the CMA guidelines, says his team took a strictly evidence-based approach when drafting the recommendations, but they are not meant to exclude any patient if they are a good candidate for PrEP.

“The guidelines are intended as just guidelines. They’re not a strict set of criteria against which every single person needs to be strictly evaluated. They’re intended to give broad, overarching guidance to clinicians,” Dr. Tan said.

However, some HIV specialists say too many family doctors are still reluctant to prescribe the daily regimen of life-saving drugs.

“Often what we hear from clients is that their doctors outright refuse to prescribe PrEP to them because of a lack of knowledge or they try to pass them off to an HIV specialist,” said Alex Urquhart, a program co-ordinator and PrEP expert for the AIDS Committee of Toronto. “Unfortunately, the process of getting prescribed PrEP can often feel like trying to win a court case.”

Timothy Matheson, a doctor in Nova Scotia who has cared for hundreds of HIV patients, explains that health-care providers are more inclined to turn to the guidelines for advice because PrEP, which Health Canada only approved for use in 2016, is still relatively foreign to them.

“Not many physicians have as much experience with PrEP or have a large population of patients with HIV,” he said.

In the past year, SaskatchewanManitoba and Nova Scotia have all seen a spike in new HIV cases among Indigenous people, attributed to intravenous drug use and heterosexual transmission.

Dr. Matheson says PrEP should be an option for anybody who may be at risk for an HIV infection. “The fact that someone is gay should not push that person in the direction of having PrEP more than a straight person. It really should come down to the behaviour and the risk factors,” he said.

In the United States, a federal task force released a statement this week calling for PrEP to be recommended for all women who recently had a sexually transmitted infection.

However, even with more inclusive guidelines, there are still barriers preventing people from accessing PrEP.

Dawn K. Smith, a medical officer for the U.S. Centers for Disease Control and Prevention who created the American PrEP guidelines, said “special efforts are needed to increase PrEP access [in the United States] among people of colour, who disproportionately face limited access to health care, low financial resources to pay for health care, and discrimination, which can all hinder people from obtaining PrEP as an HIV prevention service.

“With no vaccine or cure, prevention of HIV is paramount,” she said.



Multiple vials of naloxone now required to resuscitate Metro Vancouver opioid users

On the worst days, ambulances have been dispatched to as many as 135 overdoses across B.C. in a 24-hour period. Public health experts are expecting between 1,400 and 1,500 deaths in 2018, similar to 2017.

Chief provincial health officer Dr. Bonnie Henry said even the free, Take Home Naloxone program kits are now being distributed with three vials since toxic street drugs require more intense antidotes — as many as six to 10 doses in the most challenging cases, according to ambulance paramedics.

Henry said contrary to some perceptions, it’s not that opioid drugs are becoming “resistant” to naloxone, it’s that many drug users are using not only more toxic opioids drugs like carfentanil but in multiple combinations with other drugs. Moreover, the current reality of the overdose crisis is such that users are taking drugs for which naloxone has no effect to revive them, she said. That includes cocaine, speed and GHB.

Dr. Bonnie Henry, Provincial Medical Health Officer JONATHAN HAYWARD / THE CANADIAN PRESS

“It’s a sad state of affairs,” Henry said.

“Some of the drugs are so toxic, and drug users are also taking opioids with sedatives like Valium, alcohol or Xanax. So yes, we’re seeing that many people require several doses,” Henry said, adding that hospital emergency departments are also requiring higher doses of naloxone in intravenous drips to save lives.

“What we’re seeing is these potent toxic drugs, even the smallest amounts cause respiratory depression, cause people to stop breathing. So we may be getting naloxone in but we may need more and more, for longer periods of time because it (naloxone) wears off quickly.”

There are an estimated 55,000 individuals in B.C. who have opioid use disorders.

Joe Acker, director of clinical practice for B.C. Emergency Health Services, said in 2017, ambulance paramedics responded to 23,400 overdoses and the number in 2018 will, in all likelihood, exceed that. (The overall number of overdoses in B.C. would be greater because the figure provided by Acker does not include overdoses attended by other emergency personnel or those not attended by such professionals).

Acker said naloxone was administered in about a quarter of cases and he acknowledged that some drug users react with anger when they are revived with naloxone because it not only “ruins their high” but can also cause nasty withdrawal symptoms.

At times, oxygen may be used instead of naloxone to prevent those effects. Paramedics are no longer required to take drug users to a hospital once they have been revived as long as their assessments show that the client is stable.

Acker said some drug users seek out the most concentrated drugs like carfentanil while others are unsuspecting. Paramedics have observed that welfare cheque days are often the busiest and most lethal.

On the worst days, ambulances have been dispatched to as many as 135 overdoses across B.C. in a 24-hour period. Public health experts are expecting between 1,400 and 1,500 deaths in 2018, similar to 2017.

While paramedics and health professionals use safety-engineered retractable needles to avoid contracting infectious diseases from those to whom they are administering drugs, Henry said public health officials have not changed their minds about distributing such needles to drug users.

The issue of used needles being discarded on city streets and parks where unsuspecting children, adults and pets can step on them came up repeatedly during the civic election campaign. Needles that retract as soon as they are used are a harm reduction strategy in some jurisdictions but Henry said they have been ruled out here because they are harder for injection drug users to handle.

Acker said BCEHS does respond to citizens reporting accidental needle-pokes on streets and in parks but he couldn’t provide a number reflecting the frequency of such calls. Henry said while such cases would be traumatizing to individuals, in B.C. there has never been a case of transmission of HIV or other serious infections caused by such incidents.

Discarded needles seen on Vancouver streets or in parks will be collected if citizens call a hotline at 604-657-6561.

Dr. Patricia Daly, medical health officer, Vancouver Coastal Health



In her presentation on the opioid overdose crisis last week to city council, Vancouver Coastal Health chief medical officer Dr. Patricia Daly said overdose prevention sites and take-home naloxone kits were saving lives; the B.C. Centre for Disease Control estimates thousands of deaths over the last two years have been prevented because of the measures.

Daly said more than 300 people have died from overdoses in Vancouver so far this year, similar to the number at this point last year.

While Canadian life expectancies are rising, in B.C., they have dropped because of opioid overdoses. Last year, drug overdoses led to more deaths than suicides, homicides and motor vehicle accidents combined.



Know your status: World AIDS Day 2018

The theme of World AIDS Day 2018 is “know your status.” To mark the occasion, we at ISRCTN have compiled some of the most exciting clinical trials aiming to improve HIV testing rates.


HIV (human immunodeficiency virus) is a virus transmitted through blood, semen, and breast milk which destroys infected white blood cells and weakens a person’s immune system. Left untreated, a HIV infection can develop into AIDS (acquired immunodeficiency syndrome) and a person can become vulnerable to severe illnesses like tuberculosis and pneumonia.

Currently, 36.9 million people worldwide are living with HIV but 40% of them are unaware of their HIV status. In honor of World AIDS Day on December 1st, join the ISRCTN team as we discuss clinical trials trying to help more people know their status.

Fishermen were used to encourage HIV testing within their community in Uganda
Faintsmoke via Wikimedia Commons

Word of mouth

recent trial in Uganda used peer recommendations to increase HIV testing rates by training fishermen how to use HIV self-testing kits and encourage other men to self-test. Of those approached by the fishermen, 82.6% agreed to self-test and 87.6% of those who agreed used the kits immediately.

similar trial in Malawi is using women attending antenatal clinics to encourage men to test for HIV. While the full trial is ongoing, participants in preliminary interviews were accepting of using women to deliver self-testing kits to their partners. Participants thought this would provide men with privacy and confidentiality, would not require them to miss work, and would allow men to be the first to know their HIV status.

Peer networks are a promising way to improve HIV testing rates— but what role can digital networks play in helping people know their status?

Online outreach

An ongoing study in England and Wales is using social networking websites and mobile phone apps to promote self-testing among men who have sex with men (MSM). SELPHI is studying whether offering free self-testing kits to participants increases HIV testing rates with some men being offered delivery of a self-test kit every three months to encourage regular testing. It is hoped that offering free HIV self-testing kits online will increase rates of confirmed HIV diagnosis and access to treatment.

Another study with MSM is trying to improve HIV testing rates and condom usage with HIV-prevention videos. The HeHe Talks study in Hong Kong is testing whether presenting information in a story, rather than a teaching, format using first-hand stories will be more effective at reducing HIV-risk behaviors and promoting HIV testing.

50% of participants with access to a postal STI kit (which test for HIV) took an STI test compared with 26.6% of participants given details of in-person testing.

Many services are reaching out to men online to encourage HIV testing
StockSnap via Pixabay

The type of website service used to encourage sexually transmitted infection (STI) testing was recently tested in a study of two London boroughs. Participants aged 16–30 were given access to websites which either offered postal STI kits or detailed local sexual health clinics offering in-person STI testing. Within 6 weeks, 50% of participants with access to a postal STI kit took an STI test compared with 26.6% of participants given details of in-person testing.

The internet is a convenient way to encourage and facilitate HIV testing, however integrating HIV testing into community services can be a useful way to reach people who may not have internet access.

Package deals

study in Derbyshire integrated HIV testing into a substance misuse service to study whether HIV testing methods affect testing rates. Young people attending the service were offered an oral swab test for HIV within the service or a blood test at a sexual health clinic.

HIV testing can be integrated into other services for children
Paul Chenoweth ND, MPH, Global Immunization Division

Whereas all participants offered an oral swab took the test, only 18.5% of participants who were offered the blood test took it.

The Mphatlalatsane project in Lesotho is integrating HIV testing into a package of interventions for caregivers of children aged 1–5 years old in rural areas. This ongoing study is delivering group sessions on child development, nutrition, hygiene, HIV, and child literacy. It is hoped that participation in the program will increase rates of HIV testing and treatment, as well as improve child growth and cognitive and language development.


To ensure more people know their HIV status, the importance of testing, prevention, and treatment must be more widely known and taking the test needs to be easy, convenient, and private.

35 million people are thought to have died of HIV/AIDS since the beginning of the epidemic and the loss of earnings globally due to AIDS in 2020 is projected to be $7.2 billion. Knowing your status is the first step towards receiving treatment and eventual viral suppression.

You now know what researchers are doing to help other people know their HIV status. Why not find out your own?

Author: Deborah Kendall


Only 50% of people with HIV seek treatment and here’s why, says AIDS council

KUALA LUMPUR: Approximately 100,000 Malaysians are affected by HIV/AIDS but almost half of them fail to seek treatment due to shame and fear of social stigma despite government initiatives to provide free medication, according to an AIDS body under the health ministry.

The Malaysian AIDS Council (MAC) said some were also in denial or resigned to what they believed to be fate.

“A lot of them probably think they’re going to die anyway, so they don’t bother. Many of them are drug users who might not have stable jobs, and some of them are homeless.

“When you put all the factors together, that’s where you get the 50% of those who don’t get treatment,” MAC president Bakhtiar Talhah told FMT.

Although frontline treatment for HIV, which costs about RM400 a month, is given for free at government hospitals, Bakhtiar said MAC often came across people who refused to seek treatment at the closest medical centre. Instead, he said, they preferred to travel to hospitals further away to avoid running into people they knew.

“There’s still a lot of stigma and discrimination that people with HIV in Malaysia face.”

There are currently some 3,300 reported cases of HIV infections a year, down from 6,000 to 7,000 a decade ago.

The majority of the 3,300 cases were sexually transmitted, although Bakhtiar said the spread of HIV in Malaysia was initially driven by drug use.

“Sex was never the main factor in Malaysia,” he said. “We had a very unique case of the HIV pandemic.”

With initiatives such as needle exchange programmes, which provide drug addicts with clean needles, the number of cases involving HIV infection through needle-sharing dropped by 90%, he said.

Bakhtiar said through MAC’s work on the ground, it had discovered that the urban population was generally more open to HIV/AIDS-related issues than those in rural areas.

“But at the same time, we have been surprised by the acceptance of certain initiatives by those in rural areas,” he added.

“For example, drug use is probably more rampant in rural areas, plantations and fishing communities. But we found that because the family or community lanes are very strong in those areas, they actually support our initiatives.”

Asean deputy secretary-general for the Asean Socio-Cultural Community Kung Phoak meanwhile told FMT he was optimistic about the overall HIV rates in the region.

He said there had been great progress in the area and a drop in the number of people affected by HIV/AIDS.

Bakhtiar, however, was less confident.

“If you’re looking at absolute numbers, we have been able to get the number of infections down,” he said.

“But compared to what other regions have done and how they have performed, we are way behind.”

He told FMT that Asia was in fact the worst performing region in this matter, below Latin America and Africa.

“We have to ask why. What is it that they are doing which we are not? In that sense, there’s still so much for us to do.”

Author: Ainaa Aiman


Advocacy fashion show for HIV-Aids awareness

AS PART of the celebration of the World Aids Day, medical practitioners, counselors and volunteers of HIV-Aids (human immunodeficiency virus-acquired immunodeficiency syndrome) converged for the Night of Advocates in the Red Carpet Runway Advocacy Fashion Show last Tuesday, November 20.

Spearheaded by Tingug-CDO Inc., a non-government organization that promotes the protection of human rights among homosexual, bisexual, and transgender, the event was held at the activity center of Centrio Ayala Mall where 130 doctors, midwives, nurses, counselors and volunteers from all over Northern Mindanao participated and walked the red carpet in their work clothes, showing their support to people who are living with HIV-Aids.

“We would like to make known and shout to the public na: ‘Hey these are the people working for the advocacy.’ Because they are definitely working the advocacy,” Reynante Namocatcat of Tingug-CDO Inc. said.

Apart from the fashion show, the event also comprised with testimonials from persons who are living with HIV-Aids, a bid to make the public aware of it and to slowly diminish the stigma and discrimination.

“Because as of now, when you talk about HIV and Aids, naa pa ang self-discrimination, naa pa tong denial and unacceptance. So, we are trying to shout out to the general public that: ‘Hey, this is not actually the [time for] discrimination anymore, this is the need of time to respond,’” Namocatcat said.

“We need to let the people wake up and just informing them that there is a need to respond. By way of attending learning group sessions, and submitting ourselves for testing so that we will know our status,” he added.

The event, according to Namocatcat, is also to encourage the public to submit for voluntary counseling and testing, saying that there is a need for people to know and understand their status.

“By knowing our status, we will be able to mitigate ourselves from having multiple sex partners,” Namocatcat said.

On December 1, in time for World Aids Day celebration, Tingug-CDO Inc. has organized another event to be held in Limketkai Mall.

The event will consist of a mass, lectures on HIV-Aids and human rights issues.


Push to test for hepatitis C in Richmond

London Drugs joins other community organizations offering testing for the curable liver-targeting virus

Richmondites will have one more option to find out if they have hepatitis C starting Monday as London Drugs joins other community organizations offering testing for the curable liver-targeting virus.

London Drugs rolled out in-pharmacy hepatitis C testing at some of its Lower Mainland locations earlier this fall, and on Nov. 19 will begin offering it at its Ironwood location.

“We want to provide a convenient way for people to access care,” said Jane Xia, manager of special pharmacy services.

The test involves a quick finger-prick, and 20 minutes later the pharmacist can read the patient their results and connect them with a physician if it looks like they’re producing hepatitis C antibodies.

Hepatitis C is a virus that targets the liver, and there is no vaccine for it (unlike hepatitis A and B). If left untreated, it can cause liver damage and even liver failure. The province estimates 73,000 people in B.C. are living with the virus, and one in four don’t know they have it.

But the good news is there’s effective treatment available. In March, B.C. followed Ontario to extend public coverage of hepatitis C medication to anyone diagnosed with the virus. Previously, people who didn’t have drug plans would have had to pay $45,000-$50,000 for a round of treatment. The province would fund it in certain cases, but only if there was advanced liver damage.

At London Drugs the tests cost $24, a fee which covers the testing kit itself, Xia said.

The pharmacy is the latest option available for getting tested for hepatitis C, but community organizations around the Lower Mainland have been pushing to get baby boomers and people from immigrant communities tested since the beginning of the year, with grants from Gilead and the Public Health Agency of Canada.

Hepatitis C testing
Public health workers with the Vancouver Infections Diseases Centre visit a language class in Richmond to administer free cheek-swab tests for hepatitis C and HIV. Photo: Richmond News/Megan Devlin


They’re paying particular attention to people in immigrant communities, since hepatitis C is considered endemic (greater than two per cent prevalence) in much of the world outside North America, and people may immigrate to Canada without knowing they have the virus.

Gigi Lo, with SUCCESS Richmond, heads the language and settlement organization’s hepatitis C testing program.

““We do find that it still carries a bit of stigma,” Lo said. But after listening to education seminars on the virus, she says students become more open and receptive to getting tested.

On Oct. 26, public health workers set up a testing station outside a SUCCESS language class, and students lined up to get the inside of their cheeks swabbed for signs of hepatitis C and HIV antibodies.

Yi Wang and his wife JianHua Wang both got tested.

“Why get tested? Because it’s safe and convenient,” Yi said.

The tests through the SUCCESS outreach program are free of charge, and a physician on-site can connect people with care should they test positive.

One 23-year-old who got treated for hepatitis C last year is urging others to know their status, since now it’s fairly easy to get cured.

“It’s just so important to be, like, proactive with your own health,” said Kamal G., who didn’t want her full name used to keep her medical history private.

She was diagnosed with the virus when she was 12 years old, but didn’t get treated sooner because she was young and her liver appeared healthy.

She isn’t sure how she got it, but once she tested positive, her mother was also tested and found she had the virus. She knows her dad received a blood transfusion in India, and wonders if improperly sterilized equipment could have exposed him to the virus.

Kamal lives in Surrey and graduated with a BSc. from UBC earlier this year, and wants people to know that having the virus hasn’t kept her from achieving her goals. Although, now that it’s been cleared from her system, she says it’s a “psychological relief” to know that it won’t get worse.

Author: Megan Devlin



On Friday, Nov. 16, ETSU’s Community of Scholars will host their first presentation at the Millennium Centre on both ongoing and proposed HIV and AIDS research.

This new forum was founded by Dr. Ken Phillips, associate dean of research for the College of Nursing, and endorsed by Dr. W. Andrew Clark, associate dean for research in the College of Clinical and Rehabilitative Health Sciences. The forum was created to call attention to research that is being done by several Academic Health Sciences Center colleges: The Quillen College of Medicine, the Gatton College of Pharmacy, the College of Nursing, the College of Public Health and the College of Clinical and Rehabilitative Health Sciences.

For their first presentation, the event will be divided into two segments.

The first segment will include Dr. Jonathan Moorman, professor of medicine and section chief for Infectious Diseases at the Quillen Veterans Affairs Medical Center. He will discuss his “Translational Research in HIV/AIDS.”

The last segment of the presentation will include grant recipients from ETSU’s Center of Excellence in Inflammation, Infectious Diseases and Immunity. The grant recipients will be showing their proposed research concepts in HIV and AIDS.

“Many people do not realize how much ETSU research helps to improve life for community members and our region,” said Dr. W. Andrew Clark. “The reason we are starting with Dr. Moorman is that he is a great example of how translation research can have a dramatic impact on medically impacted people that live in our region.”

The event will begin at 9 a.m. and is free and open to the public. Faculty and members of the Tri-Cities community are encouraged to attend.

“Our initial concept is to have one seminar per semester to get started and see if there is an interest in the university and community to attend these events,” said Clark.


Community of Scholars hosts HIV and AIDS presentation

Medication dominates Canadian health-care spending, according to new CIHI reports

Spending on prescription and over-the-counter drugs in Canada is rising faster than spending on hospitals or doctors, according to the latest official snapshot of how health-care dollars are allocated across the country.

The total amount that individual Canadians, private insurers and governments pay for medications is expected to grow by 4.2 per cent this year, an increase driven in part by wider use of brand-name drugs that cost more than $10,000 a year.

By comparison, total spending on hospital care and physicians is expected to increase by 4 per cent and 3.1 per cent, respectively, in 2018.

In a new report published on Tuesday, the Canadian Institute for Health Information (CIHI) said the over all growth in health-care spending in Canada in 2018, which is anticipated to be 4.2 per cent, is slightly higher than in the lean years after the 2009 recession, but lower than in the prosperous decade that preceded the crash.

Total health-care spending from all sources – public and private – is expected to top $253-billion this year. That works out to $6,839 for each Canadian, or the equivalent of 11.3 per cent of GDP, CIHI said.

“It’s a little bit steady-as-she-goes for national health expenditures,” Michael Hunt, the director of spending, primary care and strategic initiatives at CIHI, the official clearinghouse for national health-care statistics, said in an interview. “We’ve been looking at the 4-per-cent economic growth reflected in health-spending growth as well. It’s the magic 4 per cent.”

However, Mr. Hunt added that CIHI is keeping a close eye on prescription drugs as one area where spending could spike in coming years.

Health expenditure forecast for 2018, by use of funds

Percentage of health spending 28.3% 15.7% 15.1%
Spending per person $1,933 $1,074 $1,032
Growth per person 3.0% 3.2% 2.2%


CIHI explored some of the reasons for concern in a separate report, also released on Tuesday, on what government-sponsored drug plans doled out for prescription drugs in 2017. (Public drug plans vary from province to province, but most provide some coverage for seniors, social-assistance recipients and patients with extremely high drug bills.)

“By historical standards, this growth in drug spending is not that huge. It’s fairly normal,” said Michael Law, a University of British Columbia professor who holds a Canada Research Chair in Access to Medicines. “But what you can see in here are the signs of what’s coming.”

For example, the CIHI report on prescription drugs found that the proportion of government spending on patients whose medications cost more than $10,000 a year increased to 36.6 per cent in 2017, up from 34.5 per cent in 2016.

The report also pointed out that Canada has been slow to embrace biosimilars, the cheaper near-copies of biologic drugs. Biologics, which are manufactured in living cells rather than synthesized from chemicals like conventional pills, tend to be expensive: Three of the top-10 classes of drugs in terms of government spending are biologics.

At the top of that list is a class of drugs called tumour necrosis factor alpha inhibitors, or anti-TNF drugs, which treat autoimmune disorders such as rheumatoid arthritis, Crohn’s disease and ulcerative colitis.

In 2017, public drug plans spent more than $1.1-billion on anti-TNF drugs, including on infliximab, which is sold under the brand name Remicade, and etanercept, better known as Enbrel. The less-expensive biosimilar versions of both drugs accounted for only 1.4 per cent of spending on infliximab and etanercept last year.

“If we don’t figure out how to deal with biosimilars, we’re not going to experience the same thing that we have over the past decade where we saved a lot of money because a lot of drugs went generic,” Mr. Law said.

Savings from generic drugs have helped to offset the cost increases associated with the arrival of more high-priced drugs. A case in point: Public spending on the category of “other antidepressants,” fell by nearly 17 per cent from $235.9-million in 2016 to $196.4-million last year, largely because of the introduction of a generic version of one drug, duloxetine – better known as Cymbalta.

But Jordan Hunt, CIHI’s manager for pharmaceuticals, said drug spending shouldn’t be judged in isolation. “We need to think about health spending as a whole … a hep C drug might save the cost of a liver transplant,” he said, referring to an expensive new class of direct-acting antivirals that can clear hepatitis C infections in about three months.

On the whole, hospitals still gobble up more health-care dollars than any other part of the system – they are expected to account for 28.3 per cent of health spending in 2018. Prescription drugs, over-the-counter drugs and personal health supplies are next, accounting for 15.7 per cent of spending, followed by doctors at 15.1 per cent.

Most of the remainder is taken up by spending on long-term-care homes, home care, vision care, dental care and public-health initiatives.

In 2017, Canada spent more per person on health care than the average among the prosperous countries that make up the Organization for Economic Co-operation and Development, but much less than its neighbour to the south. The United States spent $12,865 a person on health care last year, more than twice the Canadian figure for the same year.


B.C. cities mark international Trans Day of Remembrance — some for the first time

Vancouver has held the annual event since 2002, Prince George is hosting its first vigil

In the past year, 369 trans and gender-diverse people were reportedly killed, according to the Trans Murder Monitoring project established in Europe. The annual Transgender Day of Remembrance honours them. (CBC)

Hundreds of transgender people around the world are killed every year simply for being trans. British Columbians are marking their deaths in an annual day of remembrance.

Some cities, like Prince Rupert, are officially recognizing Nov. 20 as the Trans Day of Remembrance for the first time.

“Now, more than ever, it’s important to show that there are communities around the world that do care and are making a difference,” said Ashley Wilson, who’s organizing a vigil at Prince Rupert’s city hall.

“Beyond that, there just aren’t a lot of LGBT that happens in Prince Rupert … we just don’t really have this visible group of people that does exist here.”

Ashley Wilson is organizing a vigil for Transgender Day of Remembrance at Prince Rupert’s city hall. (Carolina DeRyk/CBC)

Wilson transitioned three years ago.

“I’ve definitely found that [Prince George] is a fairly accepting community,” she said.

“But I just want to spread that message to anyone who is LGBT in the area, there are allies here and there are other people like you.”

‘It continues to happen locally’

Tami Starlight, founder of the Vancouver Trans Day of Remembrance, emphasized that discrimination and violence are not just a problem abroad— it happens at home in B.C. as well.

“Our goal is to point out that’s what has been happening around the world globally and that it continues to happen locally,” Starlight said.

Starlight started the first Vancouver version of the remembrance day in 2002.

Sixteen years later, several policy changes have been introduced — like B.C. recently recognizing a gender X on official documents and improving access to gender affirming surgery — but Starlight is still concerned about the direction of change.

Tami Starlight started Vancouver events for Trans Day of Remembrance 16 years ago. (Clare Hennig/CBC)


“The trans community seems to only be voiced through professional institutions and governmental institutions,” she said. “The grassroots, streetwise trans community doesn’t seem to have much of a voice.”

Change and acceptance has to come from the community-level, she emphasized.

“We can have these protectors and bathroom markers changed and whatnot, but unless they are enforced and it becomes part of the active memory of the community, then they are just simply on paper,”  Starlight said.

Atley Jonas is the editor of the Victoria-based magazine XQQ Cross Queer Quarterly, (Submitted by Atley Jonas)

‘Cautiously optomistic’

Atley Jonas,the editor of the Victoria-based magazine XQQ Cross Queer Quarterly, agreed that recent legislative changes are a step in the right direction but not enough by themselves.

“We think that trans people are not being adequately listened to or perhaps they aren’t being acknowledged the way that they should,” Jonas said.

“We are hoping that [surgery funding change] is a positive step, and we don’t want to throw rain on something that could potentially benefit the community, so we are cautiously optimistic.”

Author: Clare Hennig 


HIV Risk Greatest During Follicular Phase of Menstrual Cycle

The follicular phase of the menstrual cycle may be the most vulnerable time for HIV-1 acquisition in women—not the luteal phase, as previously thought—according to the results of a new study published online October 31 in The Journal of Infectious Diseases.

“Our study showed that levels of the chemokine CCL2 were higher in the follicular phase and represented an accurate marker of that phase when controlled for multiple factors,” Keith Fowke, PhD, from the University of Manitoba, Winnipeg, Canada, the study’s principal investigator, shared in an interview with Contagion®.

HIV-1 infection is a public health issue that disproportionally affects women of reproductive age, wrote Genevieve Boily-Larouche, PhD, also from the University of Manitoba, and colleagues. They note that genital immune parameters are key factors that drive the sexual transmission of HIV in women.

Dr. Fowke explained that inflammation in the female reproductive tract is a known risk factor for HIV because it brings HIV target cells (CD4+ T cells) into the area. It is also known that the immune system varies throughout the menstrual cycle, he added. However, how this variation affects HIV susceptibility is not known.

With this in mind, the investigators conducted a longitudinal study to measure markers of inflammation and HIV target cells from the blood and genital tract of 37 women during the follicular and luteal phases of the menstrual cycle.

They found significant differences in the cervical concentrations of certain factors between the 2 phases of the cycle. In particular, the follicular phase was characterized by increased CCL2 levels, decreased interleukin 1α and interleukin 1β concentrations, and a significant rise in the proportion of CD4+ T cells that expressed CD69.

“The genital concentration of CCL2 was the best marker to distinguish the follicular from the luteal phase in univariate and multivariate analyses, and remained independent of elevated genital inflammation and bacterial vaginosis,” the authors wrote.

According to Dr. Fowke, the role of CCL2 is to attract immune cells to the genital tract, and so, it makes sense that the follicular phase also showed higher levels of CD4+ T cells with the activation/tissue retention marker CD69 on them.

“Because activated CD4+ T cells are highly susceptible to HIV infection, this study suggests that the follicular phase of the menstrual cycle, and not the luteal phase as previously thought, may be the phase of the menstrual cycle where HIV risk is greatest,” he noted.

Understanding how the menstrual cycle affects HIV risk is important when designing HIV prevention strategies, Dr. Fowke said. As well as helping to map out the cause and effect of how chemokine fluctuations affect HIV target cells during the menstrual cycle, this study could also help future studies by narrowing down all of the potential immune parameters that can be measured, to just a few key factors that help define menstrual cycle stage and assess HIV risk—namely CCL2, and CD69 on CD4+ T cells.

“Tracking these key factors will help other researchers determine the impact of their intervention on HIV risk,” Dr. Fowke said.

However, he also emphasized the need for follow-up studies to test the findings of this current study in different cohorts. “Studies testing the susceptibility of cells taken from different phases of the menstrual cycle to HIV infection in vitro, will help determine if cells from one phase are more likely to be infected by HIV,” Dr. Fowke concluded.