A doctor's plea for a safe consumption site for Kenora as it deals with spike in HIV/AIDS

More cases of HIV/AIDS have been reported in Kenora, Ont., in the last 12 months than in the last eight years, and a doctor practising in the community says a safe consumption site is needed to help address the issue.

In 2022, the Northwestern Health Unit (NWHU) reported nine confirmed cases of HIV/AIDS in the northwestern Ontario city. In the previous eight years, there were only eight confirmed cases, according to NWHU data. 

Dr. Jonny Grek says that number may be much higher — he's seen 15 new cases reported in the past nine months, and said the health unit's data lags behind what he's seeing at the ground level. 

"Our numbers are from the street point-of-care testing, which are then followed up with a lab confirmed test — and so far, there have been no false positives on the point-of-care testing," Grek told CBC News in an interview. 

The NWHU's medical officer of health, Dr. Young Hoon, doesn't dispute Grek's numbers, but said the NWHU must follow provincial standards for reporting cases and cannot rely on preliminary testing or other clinical information to confirm them.

Grek practises family medicine at Kenora's Paterson Medical Centre, and provides outreach and street medicine through the Sunset Country Family Health Team. He's seen a lot of struggle on Kenora's streets since he came to the area 4½ years ago.

The attitude and the feel on the streets here is one of, I would say, despair on top of despair.- Dr. Jonny Grek

"The attitude and the feel on the streets here is one of, I would say, despair on top of despair," he said.

He works closely with people who may be more vulnerable to viruses, including those who use drugs, are homeless or underhoused, or work in the sex trade.

Being a street doctor means Grek literally meets people where they're at. Sometimes, they may feel more comfortable doing a consultation at the homeless shelter or the Kenora Fellowship Centre.

HIV (human immunodeficiency virus) attacks the immune system, or its ability to fight off disease. Left untreated, HIV can lead to AIDS (acquired immunodeficiency syndrome), which can be controlled through various treatments. 

In Ontario in 2020, it's estimated over 22,000 people were living with HIV, according to the Ontario HIV Epidemiology and Surveillance Initiative.

The virus is primarily spread through bodily fluids including blood and semen. Young Hoon said unprotected sex, and sharing needles or drug preparation equipment are the most common ways people contract HIV/AIDS.

Officials in Kenora recently held an emergency council meeting where members of the public shared their concerns regarding public safety in the downtown area. 

Grek, who was at the meeting, said there was a collective agreement that conversations about these issues need to be had — but there was also a lot of anger and resentment about the situation.

He said he would like to see more empathy toward people who use drugs, rather than judgment and fear of them.

Safe consumption sites

As part of addressing the opioid crisis, there have been calls for safe consumption sites — where people are legally allowed to bring drugs for use in a clean, safe environment, and may also receive addiction support from health-care workers.

In Ontario, there are 24 safe consumption sites. But the closest one to Kenora is Path 525, at 525 Simpson St. in Thunder Bay, Ont.

In the latter half of 2022, the NWHU worked with LBCG Consulting for Impact Inc. to conduct a supervised consumption services feasibility study. The study looked at whether supervised consumption services are needed in Kenora, Dryden, Fort Frances and Sioux Lookout, and what form they might take.

"The main goal is to prevent [opioid] overdoses, but it does have the ability to increase access to the clean needles and drug preparation equipment, and that of course would reduce the spread of HIV," said Young Hoon.

The NWHU is currently reviewing drafts of the report, with hopes of finalizing and publishing the results in February.

In Grek's view, a safe consumption site "would mean everything" for Kenora.

"We're past the point here where we can stop people from using drugs. We are way past the point of being able to control or stabilize even the unsafe … the toxic supply of drugs that are in the market at the moment," he said. "But what we're not past the point of is showing that people who use drugs are human beings." 

And when — not if — Kenora recognizes this is the right approach, he said, it must be more than "just a drop-in space where you go and use drugs and then you leave."

He encourages people to challenge their perspectives by having open conversations, like the one held at last week's Kenora council meeting.

"We all get healthier when we learn more, especially if it means that we're just a bit more open minded to people," he said.

Ramping up testing, prevention programs

Anyone who believes they're at risk of getting HIV/AIDS can receive a blood test by reaching out to their primary health-care provider, or going to a community health centre, primary care or outreach clinic. Some NWHU offices also offer testing, said Young Hoon.

Young Hoon emphasized that conversations with health-care practitioners are confidential.

"Many years ago, when less was known and there [were] less treatment options for HIV, the diagnosis of it did feel like it could be a death sentence, but it's not that way anymore," she said. "Early detection and treatment of HIV means that people with HIV can live with it for a very, very long time and live with it in a healthy way."

But treatment must start as soon as possible.

Testing helps prevent spread of HIV, as does access to clean needles and barrier protection like condoms during sex. A list of needle distribution sites can be found on the NWHU's website. Many clinics also give out condoms for free.

Making these services accessible to vulnerable populations — people who are underhoused or affected by poverty — is critical, Young Hoon said.

The health unit is closely monitoring HIV/AIDS case numbers to see what additional actions may be needed.