A version of this commentary appeared in Toronto Star, Ottawa Life and the Huffington Post
On World AIDS Day, we are seeing red.
The red ribbon has long been a potent symbol of HIV/AIDS activism, signifying anger at the bureaucratic red tape that, in the 1980s, delayed release of life-saving treatments to people living with HIV/AIDS. Treatment access and effectiveness have since improved for some living with HIV/AIDS (at least in Canada – the global majority still have unconscionably limited access to HIV/AIDS medications).
So why are we still “seeing red?” Why are we angry today?
We are angry because HIV still disproportionately affects marginalized communities in Canada. Social inequity, stigma and the HIV vulnerability that they produce have not magically disappeared. The HIV response continues to be characterized as much by policy failure as by limited, incremental improvements.
Yes, there has been policy progress. The 2015 election halted Prime Minister Harper’s hard-right turn in many HIV-related policy fields, including the longstanding war on supervised injection sites, which have been clearly shown to prevent HIV transmission. We applaud the belated federal shift towards evidence-based, not ideologically-driven drug consumption policies.
Still we are angry. We are angered by the criminalization of HIV non-disclosure. Canada is exceptionally aggressive in prosecuting people for not disclosing their HIV status prior to consensual sex. Persons living with HIV/AIDS have been charged at alarming rates using sexual assault law, normally reserved for crimes of sexual violence, even where no HIV transmission occurred.
Racialized and Indigenous people have been the disproportionate victims of these laws, which fail to recognize the dangers some people (particularly women) may face when disclosing their HIV status, nor the science demonstrating that HIV transmission is vanishingly unlikely when people are on treatment, with an “undetectable” amount of the virus in their bloodstream.
While encouraged by recent mobilization to challenge the criminalization of non-disclosure, we are disappointed by Canada’s slow progress in revising these regressive, outdated laws.
Above all, we are angry that HIV/AIDS rates continue to be far higher among Indigenous, racialized and LGBTQ+ people. It is no coincidence that these are also populations more likely to face intersecting forms of marginalization and discrimination including poverty, colonization, racism, sexism, homophobia and transphobia – forces collectively referred to as the “structural drivers” of HIV.
The causal links between structural drivers and HIV vulnerability are complex, but the evidence, in the form of HIV/AIDS statistics, is overwhelmingly clear: poverty-related risk, plus stigma and exclusion, equal vastly higher HIV rates among structurally marginalized groups.
For example, HIV rates are at least 2.7 times higher in Indigenous populations than in the Canadian population as a whole. This reflects much larger policy and political failures on the part of the Canadian state. Indigenous scholars have long called for strengths-based approaches to Indigenous health, and for the state to cede real control of health and other programming to Indigenous communities. But from the Missing and Murdered Indigenous Women and Girls inquiry to pipelines to health services, Canada is still failing to engage with Indigenous communities on an equal, nation-to-nation basis.
Indigenous sovereignty may seem far removed from HIV/AIDS policy, but this is precisely the point. HIV transmission via shared needles can be reduced in part through the relatively simple policy “fix” of supervised injection sites, particularly where these are part of a more comprehensive harm reduction strategy; the prosecution of HIV non-disclosure can be addressed through specific changes to criminal law. To address the structural drivers that produce higher rates of HIV among Indigenous (and racialized and LGBTQ+) populations, there is no single, simple policy change; more fundamental and far-reaching change is required.
To make real progress in addressing HIV/AIDS, we need bold, creative policy interventions focused not on “vulnerable” individuals but on the discriminatory social and economic environments that produce this vulnerability. These policies might include guaranteed basic income for people living in poverty, mandatory school-based supports for LGBTQ+ youth (currently under attack by Alberta’s Kenney conservatives), and significant new funding for strengths-based, culturally-grounded programs led by and for Indigenous persons living with HIV/AIDS to suggest only a few.
On this day, we cannot celebrate simply because regressive policies have been partially undone. We need more courageous policy action at all levels of government to address the structural drivers of HIV/AIDS. Seeing red remains crucial if we are to confront this epidemic in ways that reflect a deep commitment to progressive social policies and social change.
Suzanne Hindmarch is Assistant Professor of Political Science at the University of New Brunswick. Michael Orsini is Professor in the School of Political Studies at the University of Ottawa. They are expert advisors with EvidenceNetwork.ca.
With Marilou Gagnon, they are co-editors of Seeing Red: HIV /AIDS and Public Policy in Canada, which will be released by the University of Toronto Press in March 2018.