The rate of HIV-AIDS in Saskatchewan, particularly in First Nations communities, is so high that the province should declare a public-health state of emergency.
That's the view of a group of doctors in the province who, on Monday, are issuing a cri de coeur for action.
The ad hoc coalition, led by Dr. Ryan Meili of the West Side Community Clinic in Saskatoon, is comprised mostly of physicians who provide front-line HIV care, but they have some chilling data to justify sounding the alarm.
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The HIV infection rate in Saskatchewan is 13.8 per 100,000 population, almost double the national average of 7.8 per 100,000.
But the provincewide numbers hide the real problem: On reserves, the infection rate is 64 per 100,000.
Yet, even that number is misleading, and likely an underestimate, because there is very little testing done on First Nations.
Where systemic HIV testing is carried out, the story that emerges is even more troubling.
On the Ahtahkakoop First Nation, for example, 60 of 1,700 residents tested positive for HIV, a staggering rate of 3,500 per 100,000 population.
To put that number in perspective, consider that it is higher than the HIV infection rate in Nigeria.
Since the early days of the epidemic, HIV-AIDS has spread principally through unprotected sex, particularly among men who have sex with men. But, increasingly, the virus is being spread through intravenous drug use, which is a scourge in many impoverished First Nations.
Despite its dismal statistics, Ahtahkakoop First Nation is actually one of the few good news stories because the community is tackling the issue head-on: It has implemented universal testing, opened a needle exchange and hired a nurse who specializes in infectious-disease care.
In many other indigenous communities, there are no prevention programs, no treatment and no care to speak of. But there is a lot of stigma.
Like all infectious diseases, HIV preys on people who live in poverty and in dismal conditions, such as those that are commonplace on reserves.
Over the past decade, there have been 1,515 cases of HIV-AIDS recorded in Saskatchewan, and 1,075 were in people who identified as indigenous.
That's 71 per cent – in a province were roughly 20 per cent of the population is indigenous.
It would be wrong, however, to dismiss Saskatchewan's HIV problem as merely another "Indian problem," or as the responsibility of the federal government, not the province.
The provincial numbers over all point to a broader problem.
Last year, there were 158 HIV cases reported in Saskatchewan, up sharply from 112 in 2014.
Yet, almost everywhere else in the world, infection rates are falling, and death rates are falling even faster thanks to earlier and better treatment.
But in Saskatchewan, once again, the HIV-AIDS death rate is 3.1 per 100,000, four times the national average of 0.7 per cent.
Most troubling of all may be the fact that, last year, three babies were born HIV-positive in Saskatchewan, even though mother-to-child transmission is entirely preventable.
Despite it all, Saskatchewan doesn't even have an AIDS strategy. They did, but it expired in 2014. The indifference is shocking and shortsighted, especially when you consider that each new HIV infection costs the health system about half a million dollars.
Twenty years ago, when HIV-AIDS was much more top of mind in public policy, and more present in the headlines, British Columbia declared a state of emergency.
Since then, the province has gone on to be a world leader, with innovations such as supervised injection, universal testing and the treatment-as-prevention philosophy.
Saskatchewan has an abysmal record on HIV-AIDS, but it can, like B.C., turn it around.
If it takes the declaration of a public health emergency to do so, so be it.
André Picard