The Province of Saskatchewan Should have Declared a State of Emergency (2016)
In 2016, public health professionals in Saskatchewan declared that increased rates of HIV infection across the province merited a state of emergency (1). Declaring a state of emergency would allocate resources towards addressing this specific situation, and lay the groundwork for addressing it long-term.
Dr. Denise Worker, Saskatchewan’s deputy chief medical health officer at the time, responded that a state of emergency could not be declared, because it did not exist in the province’s public health vocabulary (2). This, it turns out, is untrue. In 2020, the Saskatchewan government declared a state of Emergency in response to the COVID 19 Pandemic (3).
Why didn’t Saskatchewan declare a state of emergency in 2016?
While Saskatchewan’s rates of HIV infection are 11 times higher than the national average, 69% of new infections occur among Indigenous and Metis Peoples (4). The most common method of transmission is by IV drug use (1), and Indigenous women are, above everyone, the most likely to contract HIV (5).
IV drug use can be a way to cope with the ongoing lived reality of colonialism (5). Mental illness, loss of culture and identity, systemic racism, high rates of poverty, homelessness, food scarcity, and lack of access to education are all physical manifestations of colonization within Indigenous communities (5).
Saskatchewan’s disproportionate rates of HIV stems from social determinants of health that are directly caused by the ongoing effects of settler colonialism (5).
Many issues (like homelessness or food insecurity) may be more pressing to an individual than seeking treatment for their illness (5).
Systemic racism within the healthcare system creates a steep barrier to accessing HIV services (4).
Antiretroviral Therapy is prohibitively expensive in Saskatchewan, so even if someone were to seek out treatment, endemic poverty may prevent them from accessing it (2). This contributes to higher viral loads within Indigenous communities.
The government will not provide funding for harm reduction facilities in Saskatchewan (7), even though it would effectively reduce rates of HIV transmission and overdose.
HIV services are only available on 7 out of 80 Indigenous communities in Saskatchewan (2).
Stigma around HIV is still high in many Indigenous communities (4), and is a significant barrier to seeking out HIV services or knowing ones’ status (4).
It is important to put emphasis on the structurally imposed nature of these risk factors, not the way they may manifest as individual risk behaviours. (5) Structural risk factors need to be addressed on a systemic level, and culturally specific services need to be provided, free of cost, to individuals who need them.
The Saskatchewan government did not declare a state of emergency in 2016, in response to high rates of HIV, because its framework of care for its Indigenous population is one of neglect. Without full recognition of its direct contribution to provincially rising rates of HIV, Saskatchewan (and every province in Canada) will continue to blame Indigenous Peoples for their own misfortune, while being the very force that causes it.
bibliography
- Vogel, Lauren. “HIV In Saskatchewan merits Urgent Response.” CMAJ, vol. 187, no.11, 2015, pp 793–794.
- Vogel, Lauren. “Saskatchewan Won’t Declare State of Emergency.” CMAJ, vol. 188, no.16, 2016, pp 1071–1072.
- “COVID-19: Saskatchewan Declares State of Emergency, Imposes Additional Measures to Protect Saskatchewan Residents.” Provincial Government Website of Saskatchewan, 18 March 2020 https://www.saskatchewan.ca/government/news-and-media/2020/march/18/covid-19-state-of-emergency. Access 23 March, 2021.
- Hatala, Andrew R. et al. “Being and Becoming a Helper: Illness Disclosure and Identity Transformations among Indigenous People Living With HIV or AIDS in Saskatoon, Saskatchewan.” Qualitative Health Research, vol. 28, no.7, 2018, pp 1099–1111.
- Cessna, Andrea Page. “The Boom Province: A Syndemic Approach to the HIV/AIDS Explosion among Aboriginal Persons in Urban Saskatchewan.” University of Saskatchewan Undergraduate Research Journal, vol. 1, no.1, 2014, pp 15–20.
- Van der Meulen et al. “On Point: Recommendations for Prison-Based Needle and Syringe Programs in Canada.” Prison Health Now, 2016. (pp 5)
- Taylor, Stephanie. “Saskatchewan’s first drug site still to open without provincial funding.” National Post Website, 16 June 2020. https://nationalpost.com/pmn/news-pmn/canada-news-pmn/saskatchewan-government-denies-funding-for-first-supervised-consumption-site. Access 23 March 2021.