Vancouver HIV/AIDS
Care Co-ordinating Committee
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Documents: Environment Report 1999-2002
This is a companion document to the Strategic Plan and a work in progress; this version March 31, 2000

INDIVIDUAL CAPACITIES AND SKILLS

Personal Health Practices and Coping Skills

Various prevention programs in Vancouver have focused on personal health practices and coping skills as ways of preventing the spread of HIV disease. Programs such as AIDS Vancouver’s Man to Man, needle exchange programs, and prison education and outreach programs all focus in part on providing the information and materials individuals need to make informed decisions around their own personal health practices.

To date, the idea of health and wellness has generally been overlooked in HIV/AIDS care. The benefits of maintaining and improving general good health are numerous and well worth involving the community on a more active basis. The obvious cost benefit to the health care system alone makes it worth the time and funds required for promotion of this concept. For the purposes of this plan, the term "health and wellness" is defined as any treatment that maintains or improves physical wellness (by, for example, preventing opportunistic infection); emotional or spiritual treatment that improves overall outlook on life; and psychological treatments that encompass information seminars about treatment options. Complementary therapies include bodywork, vitamin supplements and antioxidants that combat harsh drug treatments and their effects on the body.

The benefits of health-promoting practices are many:

  • Regular moderate exercise can help reduce the impact of infectious disease
  • Exercise will slow the loss of muscle tissue
  • Increasing muscle mass can maintain health and promote independence
  • Regular physical activity can help prevent depression
  • Proper nutrition information and practices can prevent opportunistic infection
  • Vulnerable populations benefit from being given more options that promote health
  • More wellness options ensure substance users have a greater degree of reducing harmful behaviour

Health and wellness promotion reduces hospital visits. It means less strain on already overextended organizations that provided health care and support. Improved personal health practices and coping skills involve active participation in an individual’s own treatment plans. Social support networks are strengthened by increased community capacity to care for persons at home.

Several agencies are involved in promoting health and wellness in the context of HIV/AIDS:

  • Friends for Life Society provides holistic support services that focus on the mind, body and spirit connection. Members are provided with the tools they desire to promote their health and wellness through information seminars, counselling and bodywork
  • BCPWA’s Complementary Health Fund reimburses HIV-positive members for complementary or alternative therapies not covered by the health care system, to a maximum of $35 per member per month
  • BCPWA’s Treatment Information Program (TIP) provides a full range of information about conventional, alternative and complementary therapies to HIV-positive persons through personal consultations, community forums, a series of information leaflets, and the bi-monthly publication TIP News; the TIP office, located in the Pacific AIDS Resource Centre at 1107 Seymour Street, is open Monday through Friday from 10:00 a.m. to 5:00 p.m.
  • BCPWA’s Support Services Department offers peer-based counselling, support counselling and healing retreats
  • Residents of the Portland Hotel have in-house access to a small range of complementary therapies and aesthetic services
  • Positive Women’s Network provides monthly one-day retreats and annual weekend retreats that include massage, reiki, shiatsu, reflexology, and iridology
  • Chrysalis Society teaches meditation and provides aromatherapy and art therapy to persons living with HIV disease and AIDS
  • VANDU, through its peer initiatives, has given participants opportunities to learn new coping skills and adapt behaviour
  • SOS provides outreach to the Spanish-speaking community, particularly refugees, and offers assistance in addressing health concerns and risk behaviour
  • AIDS Vancouver’s Man to Man program has been working within the gay community to build a better understanding of the underlying factors which influence gay men’s personal health practices with respect to HIV/AIDS
  • Carnegie Centre has held large public events designed to provide information to individual participants while building the public profile of HIV-related issues

1. CHRP Findings on Personal Health Practices and Coping Skills

The Community Health Resources Project asked the participants in its study a number of questions relating to such personal health practices and coping mechanisms as alternative therapy, exercise, and the use of cigarettes and alcohol.

CHRP asked participants if they had received any alternative therapy and found a statistically significant difference (p<0.001) between IDUs and non-IDUs. The chart below shows that 15% of non-IDU participants used some form of alternative therapy (traditional Chinese medicine, massage, meditation, etc.) at least once in the two weeks prior to the interview, compared to only 3% of IDUs.

CHRP also found a statistically significant difference (p=0.005) between males and females in the amount of time spent exercising. CHRP found that 64% of males and 53% of females in the study exercise for at least thirty minutes at least three times a week. There was no statistically significant difference between the IDU and non-IDU groups.

The majority of CHRP participants smoke cigarettes on a daily basis: 55% of MSM smoke on a daily basis while 84% of IDUs smoke on a daily basis.

The average MSM who smokes daily began at age 16. The average IDU who smokes daily began at age 13. Though it is not reasonable to suggest that all 13-year-old smokers will go on to become IDUs, the above findings do suggest that some will. An area of important investigation is to determine what psychosocial preconditions make smoking more likely for some in early adolescence, and whether these same preconditions make future injection drug use more predictable.

On average in the four weeks prior to the interview, IDUs had 5 or more drinks on at least 3.4 occasions. For MSM the average is 0.9 times.




Healthy Development of Children and Youth

The key to the healthy development of children born to HIV-positive mothers is effective care, planning and support. For pregnant women, it is important that they have access to effective HIV testing and prenatal care.

The following are important aspects of the care required for infants born to seropositive mothers from birth until the infant’s HIV status is determined:

  • Appropriate delivery and a neonatal resuscitation facility with universal infection control precautions
  • The option of administering hepatitis B vaccine with or without immunoglobulin
  • The option of oral antiretroviral therapy in the first day of life
  • Adequate nutrition to replace breastfeeding
  • Appropriate monitoring and therapy of neonatal drug withdrawal
  • Appropriate support of the parent or guardian to ensure a safe and secure environment for the infant
  • Routine immunization
  • Referral to the infant development program as required
  • Access to appropriate testing for the presence of HIV and HCV
  • Monitoring of prophylactic antiretroviral therapy for the first six weeks of life
  • Appropriate psychosocial support for the parent or caregivers

The following are important aspects of effective planning, care and support for children infected with HIV and their families:

  • Access to lifelong appropriate medical care, involving a family physician and/or pediatrician and an HIV specialist for therapy, monitoring and follow-up
  • Access to appropriate antiretroviral and prophylactic therapies and adherence to medication schedules
  • Immunization
  • A safe and secure home environment that is able to provide consistent care, adequate nutrition and a sociable, active life in a loving environment
  • Access to community facilities, schools and training programs without discrimination
  • Access to recreational activities
  • Access to development or counselling programs as required
  • Access to child-appropriate palliative care, home care programs, and bereavement counselling
  • Access to special learning programs as required
  • Access to disability facilities as required
  • Access to support services
  • Support and training for the extended family members, foster parents or adoptive parents who assume care or guardianship of children infected or affected by HIV/AIDS, including support with grief and bereavement
  • Ongoing care if the primary caregiver is unable to provide care
  • Access to appropriate clinical trials

The following are important aspects of the care required for children of HIV-positive parents:

  • Access to appropriate medical care
  • Appropriate immunizations
  • Access to development or counselling programs
  • Access to community day care centres, schools and training programs
  • An appropriate home environment with adequate care, nutrition and social activities in a loving environment
  • Access to special learning programs as required
  • Access to subsidized child care for all programs in which HIV- positive parents participate
  • Support for seropositive parents in making long term plans for the care and guardianship of their children
  • Ongoing care when the primary caregiver is unable to provide care
  • Bereavement counselling

Other important aspects of the care and support required for healthy child development in the context of HIV/AIDS include:

  • Support for children living in poverty
  • Financial support for nutrition, transportation and child care
  • Support for families struggling with complex medical therapies
  • Support for families struggling with drug and alcohol issues
  • Access to appropriately developed sex education programs for children and youth
  • Respite care for caregivers
  • Support for mothers and pregnant women whose fear of child apprehension prevents them from accessing medical and support services

Some of the services currently available include the following:

  • Clinical HIV management, nutritional management and psychosocial support for infants born to seropositive mothers and infants and children infected with HIV (Oak Tree Clinic, Women and Family HIV Centre at Children and Women’s Health Centre of BC)
  • Respite and palliative care and bereavement counselling (Canuck Place; undergoing restructuring; increased service for all socioeconomic groups is required)
  • Family support services (Hummingbird Kids Society; Western Canadian Pediatric AIDS Society’s Camp Moomba)
  • Access to and enrolment in appropriate clinical trials for children infected with and affected by HIV (Canadian Pediatric Research Group through Oak Tree Clinic)
  • Support, information and education to aboriginal and multicultural communities (Bridge Clinic, Oak Tree Clinic, Healing Our Spirit; more services are required in the lower mainland and the rest of BC)
  • Delivery and HIV management of the newborn (Children’s and Women’s Health Centre of BC, St. Paul’s Hospital, Victoria General Hospital; better coordination is required at other delivery units in Vancouver, the lower mainland and the rest of BC)
  • In-services for day care centres, child care agencies and foster parent groups about universal precautions adapted to childcare settings (nurse clinician from Oak Tree Clinic)


Biology and Genetic Factors

This strategic plan does not directly address HIV vulnerability, care and support in relation to biology and genetic endowment. Future work is needed to develop better understanding in this area.

Hemophiliacs, for example, comprised a very significant proportion of persons infected with HIV disease early in the epidemic due to their use of tainted blood products. The Canadian Hemophilia Association has taken a lead role nationally in advocating for the interests of its members.

Also, persons with organic brain disorders, including the chronically mentally ill, comprise a large group of persons vulnerable to or living with HIV. Some HIV-related supports and services have been dedicated to this group; for example, the Strathcona Mental Health team at Greater Vancouver Mental Health Services dedicated two full-time outreach nurses with an intentional focus on mentally ill persons at risk for or living with HIV disease.

The Mental Patients Association dedicates outreach time to individuals living with mental illness and often HIV disease, who are referred by the criminal justice system.

Recently, the critical situation faced by persons living with both mental illness and addictions, particularly in the wake of the HIV outbreak among injection drug users in Vancouver, has received extensive and much needed media and public focus. However, it must be remembered that those living with serious mental illness who are not injection drug users continue to face serious risk of HIV infection. Ongoing prevention work through centres such as The Living Room and The Kettle is vital.