BY NORM TOLLINSKY
The HIV AIDS program for northeastern Ontario couldn’t have been more appropriately named. Dubbed HAVEN, short for HIV AIDS Extended Network, the Sudbury-based interprofessional team has saved hundreds of lives during the 20 years it has been in operation.
Several things have changed since the program was established.
“When I started 17 years ago, we were following about 65 patients,” said Dr. Roger Sandre, medical director of the HAVEN program. “Today we’re following 225 active cases.
“This is a reflection of two things. The spread of HIV has not stopped. There continues to be new cases, particularly among intravenous drug users. The second reason is that patients who are in our care are doing exceptionally well. Treatment has made a huge impact on their lives with the result that they aren’t dying of HIV-related problems and they’re not developing AIDS. Our patients are growing older, we follow them longer and, at the same time, we continue to see new infections.”
The demographic profile of HIV patients has changed over the 20 years, said Sandre, an infectious disease specialist. Today, the HAVEN program is treating more women, more Aboriginals and more intravenous drug users.
More women are contracting HIV because of sexual relations with HIV-infected drug users, said Judy Latendre-Paquette, co-ordinator of the HAVEN program.
“Twenty years ago, we were seeing a lot of men who were having sex with men. We’re still seeing some of that, but now it’s mostly women.”
Treatments for HIV have also changed.
“At the beginning, we were using one drug, AZT,” noted Sandre. “Now, we have 20 to 25 drugs on the list and they’re used in various combinations. They’re highly effective, they’re becoming increasingly simple to use and they’re less toxic.
Drugs
“The drugs disrupt the way the virus replicates and different drugs disrupt the replication at different stages,” he explained.
The cost of drug therapy is steep, averaging $2,500 a month, but the Ontario Disability Support Program covers the cost for most patients.
“If you fall into a crack where you don’t have a drug plan and you’re working, there’s the Trillium Drug Plan,” said Latendre-Paquette. “Only two per cent of patients are covered by private drug plans because most patients don’t have full-time jobs.”
Testing for HIV is much more sophisticated than in the past.
“We measure their CD4 cell counts to assess their immune system, we measure how much virus is in their blood and we do drug resistant testing to measure an individual patient’s virus against the drugs that are available,” said Sandre. “This way, we can choose the drugs that will work for an individual patient.”
It’s estimated that 30 per cent of people infected with HIV are walking around without even knowing it.
“Most patients at the beginning will not know by any clinical signs that they have the disease,” said Sandre. “They’ll be completely asymptomatic, so it’s a silent disease. You can have it for many years, not know it and continue to spread it.”
This makes testing critical for those who are at risk, including intravenous drug users and people having sex with multiple partners.
HIV-infected patients who aren’t diagnosed through testing eventually manifest symptoms such as weight loss, fevers, sweats and diarrhea.
“The message we need to convey to family physicians is to test patients who are at risk,” said Sandre. “Multiple sex partners, intravenous dug use, snorting drugs with shared straws and crack pipe smoking with shared pipes are all risks. These patients need to be tested for HIV and Hepatitis B and C, all of which are blood borne diseases. Don’t wait until they have symptoms.”
One more change the HAVEN program has seen is that there are more HIV-infected women having babies.
Twenty years ago, the chance of spreading HIV to a newborn was about 25 per cent.
“Today, if a mother goes on treatment during her pregnancy and gets good follow-up care, the chance of spreading it to the infant is well under one per cent, so we can prevent almost all vertical transmissions,” said Sandre. “This is why HIV testing is done in all pregnancies.”
The program cares for HIV patients from across northeastern Ontario. Patients are followed up at the HAVEN clinic on the ground floor of the newly renamed Health Sciences North hospital in Sudbury once every three to six months.
Interdisciplinary team
The interdisciplinary team includes nurses, a social worker, a dietitian and a pharmacist.
Years ago, said social worker Linda Mansfield-Smith, HIV patients were dying and needed end-of-life support. Now that they’re living longer, they need income support, addiction and mental health support and help with housing.
“If you’re living with an addiction or you’re homeless, or looking for your next meal or fix, you don’t look after your health very much, so our staff and our partner agencies try very hard to make it easier for people to make their way to our doors for treatment.”
