Bill C-398 defeated

By Aaron Wherry - Wednesday, November 28, 2012 at 8:04 PM - 0 Comments

A sufficient number of Conservatives voted against Bill C-398 tonight to defeat the private members’ bill that was intended to make it easier to send generic medicine to developing countries.

A previous version of the bill passed the House in March 2011, but failed to pass in the Senate—Tony Clement set out the government’s objections in a memo to Senators—before the government was defeated in the House. Seven Conservatives voted in favour this evening, but 14 who had supported the bill previously voted against it.

NDP MP Helene Laverdiere’s statement on the bill’s defeat is here. Pat Martin reports that Paul Dewar was unimpressed with the government side.

Paul Dewar to MP across aisle after CPC defeats Drugs for Africa bill, “what church do you go to? Got a confessional? You’re gonna need it.”

The Globe editorial board made the case for the bill earlier this week. UNICEF Canada is disappointed.

Can mass HIV testing really end AIDS?

By Julia Belluz - Thursday, August 2, 2012 at 2:20 PM - 0 Comments

Dr. Julio Montaner, Director of the British Columbia Centre for Excellence in HIV/AIDS. (Darryl Dyck/CP)

“And if we can stop the transmission, we can stop the disease.”—Dr. Julio Montaner, director of B.C.’s Centre for Excellence in HIV/AIDS, July 19, 2012

At first glance, it seemed wasteful, almost insanely so. After the international AIDS conference in Washington, D.C., last week, health officials from B.C. were trumpeting mass population screening for HIV in their province, and eventually, beyond. According to the media reports, if we could get everyone who has ever been sexually active tested (on a volunteer, not mandatory, basis) it could mean “the beginning of the end” of AIDS.

Of course, there was much overselling in the media—with headlines like: “B.C. aims to end HIV/AIDS with widespread testing“ and “B.C. launches massive program to wipe out HIV/AIDS.” But this screen-everybody approach also seemed dubious from a public health viewpoint. Given the well-known problems associated with over-testing, over-screening, and over-diagnosis in other areas of medicine—from PSA testing to pap smears—why try the catch-all method with HIV? What about the traumas related to false positives and the sheer monetary cost of such an encompassing plan? Plus, Canada doesn’t have a high prevalence of HIV/AIDS. Why would we adopt mass screening for a disease that mainly impacts marginalised or hard-to-reach groups that probably wouldn’t be captured anyway? Science-ish called Dr. Julio Montaner, one of the leading proponents of the program, to find out more.

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Should we make surgeons get tested for HIV, hep B and hep C?

By Julia Belluz - Thursday, July 19, 2012 at 9:00 AM - 0 Comments

Petr Josek/Reuters

When patients go into the hospital for a surgery, it’s next to a miracle they ever leave the building unscathed. It’s not that hospital administrators and health professionals don’t do their best to protect patients—they do. But with the incredible complexity of surgeries and modern hospital systems, the intricate pathways of care, there are infinite possibilities for things to go wrong.

In the media, we tend to focus on the risks related to hospital-acquired infections or the wild pre-checklist days. But there’s another danger that isn’t talked about much outside of medical circles: getting a blood-borne infection, such as HIV, hep C and hep B, from your health-care provider.

Precautions are taken at every turn to make sure diseases aren’t transmitted from doctor or nurse to patient—and vice versa. And the risk of transmission is remote. Extremely, utterly, almost infinitesimally remote. To give you a sense, according to the U.S. Centers for Disease Control, the occupational risk of infection with hep C after a needlestick injury or cut is less than two per cent. That’s somewhere between the risks related to HIV (less than one per cent) and hepatitis B (six to 30 per cent, though surgeons working today would be vaccinated for hep B).

In Canada there have been no documented cases of physicians transmitting hep C or HIV to patients since modern antiviral therapies came on the scene to treat blood-borne pathogens and doctors started implementing what’s known as “universal precautions”—or  avoiding contact with patients’ bodily fluids by using gloves, gowns and masks. There has been one reported case of hep B transmission, but it occurred before antivirals and universal precautions. Worldwide, the documented number of health-care worker to patient transmissions of blood-borne infections since 1991 has been “exceedingly low.”

Yet, provincial medical regulators in Canada are targeting blood-borne pathogens in surgeons. The College of Physicians and Surgeons of Ontario just introduced a new policy that asks surgeons—and those who assist in surgery—to report if they have been tested for the blood-borne pathogens hep B, hep C, and HIV in the last year.

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Supreme Court hears HIV transmission trial

By Richard Warnica - Wednesday, February 8, 2012 at 10:23 AM - 0 Comments

The Supreme Court will hear arguments on Wednesday in two cases that examine the line between sexual non-disclosure and aggravated assault.

At issue is whether people who know they have HIV or AIDS have a legal duty to disclose their condition before having sex and whether they should be criminally charged if they don’t, regardless of transmission.

The hearing marks the first time the high court has addressed the question since 1998, when, in a landmark decision, it ruled that non-disclosure represents “a significant risk of serious bodily harm” to the exposed.

Advocates for the HIV positive argue that medical advances have since substantially reduced the risks of transmission and that the current law, as applied, only adds to the stigma of living with the disease. (Read a good, if slightly muddled, summary of that argument here. For the opposite view, check out Wednesday’s Globe and Mail editorial on the topic)

For Roger

By Aaron Wherry - Thursday, December 1, 2011 at 2:46 PM - 1 Comment

NDP MP Glenn Thibeault reflects on his brother, Roger, who died 20 years ago of AIDS.

For World AIDS Day, Thibeault is hoping to bring the experiences he learned from his brother to Parliament. “I hope I can bring the message that our job’s not done yet, that we still need to bring forward awareness, we still need to work harder on research, we still need to work harder on making sure that society understands that on World AIDS Day, it’s affecting everyone,” Thibeault says. “The sad thing that I see in some instances, coming from different parts of the country, there’s still the stigma that this is still a gay disease. It’s not.”

Insite: ‘Too early to tell’ if it works?

By Julia Belluz - Thursday, November 17, 2011 at 3:56 PM - 14 Comments

“I think it’s just too early to tell.”—Ontario health minister Deb Matthews on whether she opposes safe-injection sites, 11/02/2011

In the 1990s, Vancouver was Canada’s capital of drug-related crime and home to the fastest-growing AIDS epidemic in North America. Back then, drug users injecting were a common sight in the city’s Downtown Eastside. They were doing so against the backdrop of a changing HIV epidemic in Canada, with the concentration of the disease shifting from men who have sex with men to addicts sharing needles.

Thus, the city on Canada’s west coast was a fitting locale for Insite, the first safe-injection site on the continent. Allowing people to use pre-obtained drugs under medical supervision could potentially reduce the harms associated with this type of drug use—namely, the risk of overdose and infectious diseases such as HIV and hepatitis C.

Insite fell into the category of what health policy wonks call “harm reduction,” or policies and programs implemented to reduce the adverse health, social and economic consequences of illegal drugs (and other high-risk activities). International health organizations—such as the WHO and UNAIDS—believe in harm-reduction interventions, and endorse them as a key part of a global HIV-prevention strategy. Continue…

The police blotter

By Emma Teitel - Wednesday, September 28, 2011 at 12:10 PM - 0 Comments

British Columbia: RCMP arrested a 65-year-old Surrey man for allegedly selling homemade “moonshine” to walk-up customers from the basement window of his home, as well as operating an illegal still containing approximately 200 gallons of illegally distilled spirits in various stages of fermentation.The homemade booze was found in a trailer at the rear of the property.

Alberta: An Edmonton man wanted for an offence committed in June has been arrested and charged with assault causing bodily harm. The 25-year-old allegedly boarded a public bus inebriated on June 3 and sucker-punched the driver when asked to refrain from singing. The attack was recorded and uploaded onto the Internet, where public tips eventually helped police identify the man.

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Good news, bad news: July 28-August 4

By macleans.ca - Wednesday, August 10, 2011 at 9:10 AM - 2 Comments

Good news

Tom Williams/Roll Call/Getty Images

Declaring war on war criminals

For years, the federal government stubbornly refused to release the names and faces of suspected war criminals hiding in Canada—for fear of violating their privacy. But after renewed pressure from the media, Stephen Harper’s Conservatives finally relented, posting mug shots of 30 wanted war criminals online. The result? Six of those fugitives are behind bars, two have been deported, and the rest are no doubt scrambling for cover. In this country, privacy should never trump justice.

Hard-headed

More than two-thirds of British doctors believe bicycle helmets should not be mandatory, and that forcing riders to wear them may prompt some people to give up biking altogether (and relinquish the obvious health benefits). But that surprising conclusion, contained in the latest issue of the British Medical Journal, doesn’t jibe with the Canadian experience. According to a study conducted here, the number of cyclists suffering serious head injuries is down nearly 30 per cent over the past decade, largely because children are now wearing helmets when they pedal.

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Newsmakers: July 14-21

By Nancy MacDonald, Cigdem Iltan, Emma Teitel, Alex Ballingall and Richard Foot - Tuesday, July 26, 2011 at 10:50 AM - 1 Comment

Kevin Winter/American Idol

He speeds for good deeds

When you imagine the record-holder for the fastest bicycle trip across Canada, you’re probably not picturing somebody’s grandpa. But as of this week, the title belongs to Winnipeg’s Arvid Loewen, proud grandfather of three. The 54-year-old, who has raised more than $1.5 million for Kenyan orphans by cycling, pedalled close to 500 km per day. After 13 days, six hours and 13 minutes, Loewen rolled into downtown Halifax, beating the previous record by more than three hours. In other speeding news this week, David Weber’s attempt to save his unborn baby was rewarded with a huge ticket and a licence suspension. The 32-year-old was driving in rural Manitoba with his wife Genevieve when she went into labour. Complications during her first birth meant natural labour could endanger future babies. Panicked, David hit speeds of up to 170 km/h to get to a hospital. But the RCMP pulled him over twice, earning him $1,000 in fines. “What would have happened if something happened to my wife, or my baby?” David told the Winnipeg Free Press. “It’s like there’s no compassion anymore.” Baby Anabela was born healthy via emergency C-section.

Shaq to work

It was a good week for retired athletes embroiled in controversy. Shaquille O’Neal was absolved of involvement in a titillating story about a group of gangsters who allegedly kidnapped, pistol-whipped and robbed a man claiming to be in possession of a Shaq sex tape. Court officials deemed the big man wasn’t involved in the incident. Shaq also inked a multi-year deal with broadcaster TNT. He’ll join Charles Barkley, Kenny Smith and Ernie Johnston on the network’s Inside the NBA program. Then there’s former baseball star Roger Clemens. After being charged with lying to Congress about steroid use, the former Yankee had his trial thrown out after the prosecution submitted evidence that violated a pretrial agreement. Judge Reggie Watson said afterwards a “first-year law student” wouldn’t have made the same mistake. Talk about dodging a knock-down pitch.

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HIV deaths in China cut 60 per cent in 7 years

By macleans.ca - Thursday, May 19, 2011 at 12:17 PM - 4 Comments

Improved access to HIV drugs in China has reduced deaths by more than 60 per cent in seven years, although more still needs to be done to improve access, researchers say in the Lancet Infectious Diseases journal. The country introduced free anti-retroviral drugs in 2003, and reached more than 60 per cent of patients by 2009, the BBC reports, although some groups could use better access, including men, the elderly, migrants, intravenous drug users, and those who’ve caught HIV through sexual contact.

BBC News

Are all these people soft on crime?

By Aaron Wherry - Tuesday, February 8, 2011 at 11:47 AM - 31 Comments

Two weeks ago, a group representing 11 religious denominations expressed its objections to the government’s justice program. Now, it’s a group of 500 health professionals that is registering its concern.

“We, the undersigned, are concerned that the federal government is pursuing significant amendments to federal drug legislation, through Bill S-10, which are not scientifically grounded and which research demonstrates may actually contribute to health and social harms in our communities,” the health professionals say in the letter.

They say there is no evidence that mandatory minimum sentences will reduce drug use or deter crime, that the sentences would have a disproportionately negative impact on young people and members of Canada’s aboriginal communities, and that they would have a negative impact on public health and HIV rates.

Meanwhile, the New York Times looks at Insite, the safe injection site in Vancouver that the Harper government opposes.

How public health failed

By Larry Krotz - Monday, November 29, 2010 at 1:00 PM - 17 Comments

With an almost eight per cent infection rate, 60 per cent of government health spending in Kenya goes toward AIDS; John only recently began to practice safe sex | Marco Negri/Zuma/Keystone Press; Larry Krotz

John is something unusual in Kenya, a gay man who openly admits to both that and to being a sex worker. Homosexuality there has long been anathema, labelled by former president Moi as “foreign, not done by Kenyans.” Putting the lie to this, John every morning dabs on some Hugo Boss cologne, stops into an Internet café to check out a gay website for arriving tourists, then cruises the streets looking for business. But when we sat down and talked in Nairobi, John, who is 32 years old and asked not to be identified by his full name, admitted something astonishing: despite his high-risk occupation and the fact that AIDS has been around almost his entire life, he claimed not to know until last year that he could get HIV through sex with men. In Kenya, the HIV epidemic is overwhelmingly a heterosexual calamity. Eventually tested, he knows he is positive and, though he now uses condoms, for a long time he very likely spread the virus.

Astoundingly, a full generation after the arrival of AIDS, especially in that most hard-hit of regions, southern Africa, disinformation remains rife. As the 23rd World AIDS Day approaches on Dec. 1, what is similarly disturbing is that strategies needed to prevent the spread of this awful epidemic never came close to being effective. Statistics alone tell the tale. True, more and more people are on life-prolonging antiretroviral therapies (ART), something that mushroomed when costs dropped to $100 per year per patient with the arrival of generic drugs. Yet for every 100 people put on ART, southern Africa registers 250 new HIV infections.

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Playtime for proteins

By Jane Switzer - Thursday, September 9, 2010 at 2:40 PM - 0 Comments

When Mark Thompson plays his favourite video game, he’s focused on fighting HIV and Alzheimer’s rather than killing aliens or battling zombies. Thompson is one of the top players on Foldit, an online game created by researchers at the University of Washington that uses the brainpower of gamers to figure out how proteins fold into their three-dimensional configurations. A library assistant by trade, he tried Foldit after a friend on a gaming forum recommended it a year ago. “For the first six months, I still didn’t know anything about it,” he says. “I just knew what looked right to me, and what looked wrong. I went with that, and it seemed to work.”

But according to University of Washington computer scientist Zoran Popovi´c, non-scientists with a love of problem solving, like Thompson, are exactly the kind of players Foldit needs. Proteins carry out almost all of the body’s important functions, and incorrectly folded proteins are linked to everything from allergies to Alzheimer’s disease. Knowing how the long chains of amino acids that make up proteins fold into a particular shape directly affects their function. And that process is still puzzling to scientists.
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Idea alert

By Aaron Wherry - Friday, February 5, 2010 at 11:28 AM - 38 Comments

Keith Martin says there’s already a framework for addressing maternal and child health internationally. And, as luck would have it, he helped write it.

Last summer, at the pre-G8 Conference on International Health in Rome, parliamentarians from around the world developed a concrete work plan to reduce maternal mortality called, “Strategic Investments in Times of Crisis.” This was given to the G8 and G20 leaders at their meeting a few days later.

The plan called for strategic investments in people’s access to primary care: basic surgical facilities, medications, a full array of family planning options, diagnostics, adequate nutrition, clean water, power, and most importantly, trained health care workers. With these assets in place, most obstetrical complications could be treated, along with 80 per cent of the medical problems one encounters in the emergency departments of developing countries. This includes major killers like gastroenteritis, which causes 2.2 million deaths per year, pneumonia, 2.1 million, malaria, 2 million, and HIV/AIDS, which claims more than 2 million lives per year.

Insite, foresight, hindsight

By Colby Cosh - Tuesday, January 19, 2010 at 10:27 AM - 70 Comments

The B.C. Court of Appeal’s ruling on Vancouver’s Insite shooting gallery for heroin addicts makes for interesting reading. We are all so busy arguing over the merits of harm reduction, and the wisdom of the Harper government’s attempt to shut down the clinic, that it is easy to forget the big constitutional issue that was the chief concern of the court here. You would think that Canadian jurisprudence had developed a clear objective rule for settling even the trickiest “double aspect” issues, wherein both federal and provincial governments can claim that some crumb falls within their respective spheres of constitutional power.

You would, apparently, be wrong. Continue…

Was Jane Doe the bait?

By Charlie Gillis - Thursday, October 30, 2008 at 12:00 AM - 8 Comments

Her name is covered by a publication ban, but it waits on the witness list of Regina vs. Johnson Aziga like a ticking bomb. “Jane Doe” is the last woman known to have slept with Aziga, a man on trial in Hamilton, Ont., for allegedly killing two women and endangering the lives of nine others by knowingly exposing them to HIV. Sometime in the next few weeks, Doe is expected to take the stand as the Crown tries to pin first-degree murder on Aziga, in a prosecution that has been denounced by some AIDS advocates as an attempt to “criminalize” HIV.

It promises to be a dramatic moment, in part because Doe wants to do a lot more than put her ex-boyfriend behind bars. In January, the 34-year-old from Brantford, Ont., filed a civil suit against a raft of public officials and institutions, from Hamilton Public Health Services to the police officers who investigated Aziga for murder. In it, she accused them of negligence and breach of duty for sitting by as she walked headlong into the disease that will hasten the end of her life. The specifics of her claim are damning in the extreme: after seven years of keeping tabs on Aziga; after learning he was having unprotected sex with numerous women without disclosing he was HIV-positive; after obtaining court orders to stop him from doing so; after placing him under police surveillance for weeks during which she dated him, the authorities simply left her to become infected.

The allegations are not yet proven, and the city, the health unit and the police say they intend to defend themselves. Still, the case underscores how nearly 25 years after researchers identified the virus that causes AIDS, authorities seem no better fixed to stop someone who is recklessly spreading it before lives are needlessly lost. No less than 70 people have faced criminal charges in such cases since the early 1990s, according to statistics compiled by the Canadian HIV/AIDS Legal Network, most of them criminal negligence or sexual assault causing bodily harm. But the cops and prosecutors come into play only after public health officials throw up their hands, by which time others—sometimes several others—have been infected. In most provinces, public health officers have the prerogative to issue court-enforced behaviour orders, and even detain reckless individuals, notes Ryan Peck, executive director of the HIV & AIDS Legal Clinic of Ontario. “The powers are there,” he says. But at a time when authorities are hyper-aware of the stigmatization of AIDS, medical officers see court orders as a last resort. And quarantining HIV-positive people? Unheard of.

The Aziga case, in particular, unfolded as a slow-moving catastrophe. A Ugandan-born immigrant with a firm command of English, Aziga initially acted co-operatively with public health officials after being diagnosed with HIV in 1996, according to testimony heard at his criminal trial. He attended counselling sessions and kept his job as an analyst with the Ontario Attorney General’s Ministry. He appeared to understand his responsibilities under the law, agreeing to practise safe sex and to inform his partners of his HIV status.

When public health officials decided he was duping them is not yet clear: Doe’s $6-million civil claim alleges that “in or about the year 2000, [the public health service] determined that the defendant Aziga was engaging in an ongoing pattern of unprotected sexual intercourse with unsuspecting women,” and that several women in a number of communities had become infected. In October 2002, the health unit issued an administrative order under Section 22 of Ontario’s Health Protection and Promotion Act directing Aziga to wear a condom, disclose his status to sex partners and attend counselling. That month, in a phone conversation with a public health nurse, he acknowledged having unprotected sex with at least one woman without informing her of his HIV-positive status, his trial has heard. By the following April, testified Dr. Elizabeth Richardson, Hamilton’s chief medical officer of health, the department had a list of 20 names of HIV-positive women in the region who had named Aziga as a sex partner. Alarmed, officials went to court to obtain a stricter order—this time under Section 102 of the act—which would allow them to detain Aziga if he failed again to comply. But they never got around to exercising that power. Instead they called the police.