The HIV Resurgence

“What it suggests is that the epidemic is expanding more broadly into the community,” says Maxwell, speaking with the brusque, forceful tone of a man who’s been on the front lines of the struggle against aids for many years. “You’re not a drug user, you’re not from an endemic country, you’re not a partner of any of those people, you’re not a man who has sex with men, you’re not a partner of a man who has sex with men. You have obviously been infected through sexual relations but you can’t pinpoint that a partner or something they’ve done would have increased their risk.” Indeed, the heterosexual component of the epidemic in Canada is so poorly understood by researchers that even finding a name for this category of infection is problematic: phac uses the cumbersome definition, “if heterosexual contact is the only risk factor reported and nothing is known about the hiv-related risk factor(s) associated with the partner.” Others use the contradictory category “heterosexual, no risk.”

What is clearly recognized by scientists and activists alike is that hiv/aids continues to be a disease of the poor and the marginalized in Canada, as it is everywhere in the world. Esther Tharao, co-chair of the African and Caribbean Council on hiv/aids in Ontario, asks simply: “If you look at the people who are infected by hiv in Canada, what does it tell you? Who are they? It’s men who have sex with men, it’s aboriginal people, it’s now black people, it’s IV-drug users, and it’s people who are homeless and living on the street. What do they have in common? They are people living on the margins of society.” Tharao, who is originally from Kenya, paints a picture of socially stigmatized young gay men driven to anonymous unsafe sex; African and Caribbean immigrant women who lack the support and resources to insist that their partners use condoms; or intravenous-drug users who have more pressing threats to their survival than a disease that might kill them in a decade. Her point about the most marginalized in society being the most afflicted is dramatically illustrated by the case of aboriginal Canadians. While aboriginals constitute just 6 percent of the population, they make up about 15 percent of those living with aids in provinces that report ethnicity in hiv/aids statistics to phac.

A decade after the introduction of lifesaving antiretroviral treatments, the medical and sociological research is clear: people who are poor or homeless or uneducated or living in a community where hiv infection is stigmatized are less likely to be tested for hiv and less likely to stay on the strict drug and monitoring regimes necessary to stave off the onset of aids. The result: in 2004, non-white Canadians accounted for 40 percent of all aids diagnoses. And yet, compared with many other diseases — those crossing class lines or those afflicting the middle and upper classes — scant attention is being paid to aids. “Marginalized people aren’t important,” says Binder, who is now co-chair of the federal Ministerial Council on hiv/aids. “That’s the reality.”

For activists like Binder and Tharao, this is both the crux of the problem and the link between the Canadian and global hiv/aids epidemics, between Africans mired in poverty and Canadians fighting the same virus in one of the richest countries in the world. With hiv infection still deeply stigmatized and with inequitable access to education, health care, and economic opportunities, hiv is free to spread among the most marginalized. Perhaps if the virus passes from the fringes of society to its heartier core we will be moved to tackle this scourge more aggressively at home and abroad. Until then, the epidemic marches on.