Article by Kyla Trkulja

Graphic design by Amy Assabgui

It is estimated that about 65,000 Canadians are living with Human Immunodeficiency Virus (HIV).¹ Thankfully, advances in treatment, increased awareness about preventative measures, and efforts to combat stigma have both improved the prognosis of people with the virus and slowed its transmission across Canada. The goal of bringing an end to this virus as a widespread threat is possible by the year 2030—although we can get there sooner if we increase access to HIV testing and connect people to care.²

A major barrier to this is reaching the 10% of those living with HIV who do not know that they are infected.³ While this may seem like a minority of the population, lack of diagnosis is a key driver of the HIV epidemic. Since these individuals are not receiving treatment, they can still transmit the virus through unprotected sex and sharing of drug injection equipment. Increasing access to diagnostic testing is a major strategy in Canada’s plan to end HIV. Once diagnosed, individuals can get access to life-saving antiretroviral therapy, which allows patients to live long, healthy lives.³ What’s even more incredible is that individuals on antiviral medications who achieve viral suppression, when HIV can no longer be detected in their blood, are no longer infectious. This means they cannot transmit the virus to others, making this a huge public health advancement in ending the spread of HIV.

Dr. Sean Rourke, a clinical neuropsychologist and scientist with the MAP Centre of Urban Health Solutions at St. Michael’s Hospital and Unity Health Toronto, has played an important role in Canada’s efforts to increase access to HIV testing and ensuring those with the virus can live normal lives. After completing his PhD in clinical neuropsychology at the University of California San Diego, he was given the opportunity to open an HIV neurobehavioural clinic in Toronto at St. Michael’s Hospital—the first neuropsychology clinic in Canada for HIV-related cognitive concerns. 

“[The brain] is just like any other organ in the body; it’s affected by HIV mainly because of inflammatory processes,” Dr. Rourke explains. As such, his clinic aims to better understand why some patients with HIV develop a mild brain injury while others don’t, whether this injury is due to HIV or other conditions, how this injury affects wellbeing and everyday functioning, and how to treat it. This clinic has tested thousands of people and both improved the quality of life of individuals with HIV and increased knowledge on how HIV affects the brain. 

Dr. Rourke also strives to increase accessibility to HIV testing by filling in gaps in the health system across the country. He analyzes the needs of communities throughout Canada and determines how they can best be addressed. Dr. Rourke’s goal is to reach individuals who are undiagnosed so they can “know their status” and make decisions about going for treatment. He achieves this by increasing HIV awareness, addressing the barriers that can cause stigma, and connecting individuals to free testing and treatment. 

“I’m trying to bridge the health, public health, and community sectors together,” Dr. Rourke says. “We can end HIV in Canada—we have everything we need. It’s just that we’re not doing the things that we need to do to get there.” 

Dr. Rourke led efforts in getting Canada’s first self-test for HIV approved, and launched the “I’m Ready to Know” research program (www.readytoknow.ca) featuring Canada’s Chief Public Health Officer, Dr. Theresa Tam, on June 2^nd, 2021. Individuals across Canada can now download the ‘I’m Ready, Test’ app that gives them the ability to order free HIV self-test kits and get connected to care anywhere in Canada. They can also book an appointment with a peer navigator online to support them with the testing and linkages to care. In the just over a year since launching, over 10,000 HIV self-test kits have been accessed across the country.

In order to reach populations that may not have smartphones or a permanent home address, Dr. Rourke is also launching a new program called ‘Our Healthbox’, which allows individuals to access free HIV self-tests and harm-reduction supplies including clean needles and naloxone through dispensing machines in the community. The goal of these machines is to provide low-barrier access to a collection of products that are urgently needed while encouraging people to take care of themselves, and reduce harm without the risk of shame or stigma. The ‘Our Healthbox’ machines will be all over the country starting in the Summer of 2022, including remote and First Nations communities, so people can get, as Dr. Rourke describes, “what they need for their health in ways that works for them where they live.” 

While the dispensing machines will improve access to HIV self-tests and minimize the discomfort of asking for a test from a doctor, Dr. Rourke is also working to combat the stigma that serves as a barrier to HIV testing and access to health services. He is involved in a program called “The Positive Effect” (www.positiveeffect.org), a fact-based, lived experience movement powered by people living with HIV and the communities that support them. Their work is focusing on ending HIV stigma once and for all by teaching people about the misconceptions and misinformation about HIV to reduce fear. “Most of the time, people who stigmatize simply do not have the right information—they need to know more about HIV and have the right language to engage respectfully in the conversation” Dr. Rourke explains. “If everybody did that a little bit more, the world would be a lot better.” He remains optimistic that with the right tools, individuals and society can learn to broaden their mindsets. This, combined with increased access to testing and treatment, is having a direct impact on ending the HIV epidemic in this lifetime.

References:

1. Public Health Agency of Canada. (2022, July 12). Government of Canada. Canada.ca. Retrieved July 12, 2022, from https://www.canada.ca/en/public-health/services/publications/diseases-conditions/hiv-canada-people-living-with-hiv-new-infections-2020.html
2. Lima VD, Brumme ZL, Brumme C, et al. The Impact of Treatment as Prevention on the HIV Epidemic in British Columbia, Canada. Curr HIV/AIDS Rep. 2020 Apr;17(2):77-87. doi: 10.1007/s11904-020-00482-6. 
3. Public Health Agency of Canada. (2022, July 11). Government of Canada. Canada.ca. Retrieved July 12, 2022, from https://www.canada.ca/en/public-health/services/publications/diseases-conditions/canada-progress-towards-global-hiv-targets-90-90-90-2020.html