Contextualize public health data behind increased HIV cases in Alberta, says nursing researcher

World AIDS Day is Dec. 1, a chance to raise awareness of HIV and AIDS and their associated stigma. Exploring new approaches in HIV prevention and mitigating stigma, as well as finding ways to provide better care and support services for people living with HIV in Canada has been part of Dr. Aniela dela Cruz’s work for over 20 years. She has more than 25 years of professional experience in public health, health policy, and health and program evaluation research. In her career, Aniela has worked with Alberta communities, provincial and federal governments, and non-government organizations focusing on areas of public health such as the social determinants, infectious disease prevention and support, and health and social inequities.

I’ve worked in the areas of HIV prevention, care, and support since 2001 and over the course of my career in public health, I have seen the seasons in HIV work change and circle back again. Recently, the province of Alberta reported a 73 per cent increase of HIV cases in 2023, compared to the previous year. Furthermore, the most common exposure category in 2023 for both male and female cases was ‘Acquired out of country.’ 

Reading the latest data in our province brought up a range of responses for me – worry, disappointment, urgency, anger, sadness, but certainly not defeat. The use of this type of data compelled me to write this open letter to reflect on the current data and to continue the work with my colleagues in communities across Canada.  

While it is easy to conclude that immigration plays a role and to direct attention to people migrating and settling in Canada, it is critical to understand the broader social determinants behind the most recent Alberta data on HIV. 

• HIV cases rising in Alberta (CBC, October 2024)  

When HIV first appeared in the world and in Canada, it was a significant public health concern. It was an epidemic; people were scared, and little was known about the diseases at that time. Mainstream media positioned HIV as something that solely affected men who had sex with men. However, over the last 30+ years, this has evolved. Thanks to the enduring collective work of clinicians and researchers, people living with HIV, people affected by HIV, and community-based organizations, effective medical treatment has been developed over nearly four decades.  

HIV has become a chronic condition if treated medically and appropriately, yet, seeing the most recent data in Alberta is concerning. It’s a stark reminder that important work remains to be done. 

We need to continue to understand HIV as a biomedical condition, but also with important psychosocial aspects and social determinants that cannot be excluded in the overall care, treatment and support of people living with HIV. 

HIV is not only a public health issue, but also a social issue. We know that HIV transmission is shaped by social determinants of health such as socioeconomic status, gender, legal status and ethnicity, to name a few. In the global, national and provincial context, we also know that access to HIV treatment and psychosocial support is also influenced by social determinants of health. We know clearly that stigma related to HIV is also a driving factor behind why people choose to not get tested for HIV, access HIV treatment or engage in ongoing psychosocial care for a socially stigmatizing condition.  

It is easy for the general public in Canada to show reactions that are over-simplified, indifferent or worse – inhuman – towards people living with HIV or other infectious diseases (remember SARS and Covid-19).  

Mainstream and social media is often filled with content targeting racialized immigrants for the health and social problems we see in Canadian society. To this, I urge Canadians to remember that there are people behind the public health data presented. 

When I think of the many women, men, gender-diverse individuals, transgender people, mothers, fathers, children of people living with HIV who I’ve met and worked with since 2001, I know that public health data often does not present the public with faces and the complex social determinants that influence HIV.  

Many cases ‘acquired out of country’ are linked to people who have lived, sometimes for decades, in refugee camps in HIV-endemic countries. These are people who have lived in social conditions that many Canadians can only imagine: political warfare, ethnic or religious warfare, violence towards women, children and men who identify as gay; women who are forced into the sex trade to earn money to pay for their children’s medication, resulting in HIV transmission; children who acquire HIV in-utero because of the lack of HIV care, treatment, and psychosocial support; the people who cannot access effective HIV treatment due to fear and stigma, and in many cases, death. I remember one individual who walked for days from one country to another because they were afraid of being ‘caught’ by pseudo government police for being gay and living with HIV.  

These are only some of the realities of people who migrate and settle in Canada, who live with HIV, ‘acquired out of country.’ There are many more stories. Not all are refugees, but many do share similar stories of being targeted for death due to their HIV-positive status, fear of being socially targeted and shame for HIV, lack of access to appropriate care and HIV treatment. 

Many Canadians are only able to imagine such violence and fear, as, generally speaking, we tend to enjoy a relatively peaceful, calm, stable and safe society. We must continue to show compassion for people in these predicaments and not be quick to judge people who live with HIV. 

What I have learned in the last few decades of my public health work is that racialized immigrants, living with HIV, who migrate to Canada want very much to become part of the Canadian social fabric. Many desire to work and to volunteer in Canadian communities and to apply their strengths and skills in Canada. However, many social factors prevent them from doing so including lengthy legal application processes to have permission to work in Canada, failing health and inability to access safe and affordable housing. Some become physically and holistically stable who work, volunteer, and participate meaningfully in Canadian society, often giving back to the country that has provided them with peace, safety, and access to appropriate medical care. 

In closing, public health data is effective in identifying patterns of infectious diseases to help develop appropriate interventions to manage such conditions. However, it is equally important to present the complexity of conditions such as HIV ‘acquired out of country.’ In this day and age, the general public is quick to take up data that is not contextualized and turn it into a narrative that promotes xenophobia, racism, and anti-immigration sentiments in Canadian society.