Vancouver HIV/AIDS Care Co-ordinating Committee

Key social environments in which the HIV epidemic occurs are the home, school, workplace and community, as well as the larger social service, health care, legal and correctional systems. These environments are shaped, in turn, by gender and culture. Each social environment poses unique challenges for the design, delivery and acceptance of effective HIV prevention and treatment strategies.

HIV-positive women face a variety of unique medical and psychosocial issues. The same social determinants that tend to make women particularly vulnerable to HIV infection also result in many HIV-positive women not receiving optimal care. Almost one quarter of all newly diagnosed infections in BC occur in women. The proportion of HIV-positive women who use injection drugs has increased, and a disproportionate number of HIV-positive women are aboriginal.

Women who are HIV-positive are often isolated and may lack supportive social networks. The stigma associated with HIV infection is very real for women, especially in ethnocultural communities and rural communities. Many women live in poverty, lack safe and secure housing, have difficulty maintaining adequate nutritional intake, lack transportation, and face major child care difficulties. They may also face violence within their relationships and their communities. Further, women continue to be the major caregivers in our society, and child care, partner care, and parent care issues can preclude women from adequately addressing their own health care needs.

Optimal women-centred HIV care must not only address the psychosocial and other barriers to care, but must take into account the unique medical issues associated with HIV in women. These include gynecologic complications such as cervical cytologic abnormalities, inflammatory and infectious diseases of the female genital tract, as well as menstrual cycle changes and issues associated with menopause. There may also be intrinsic differences in viral load in women and differences in side effects and toxicities to antiretroviral drugs.

Reproductive issues must be addressed in a non-judgemental fashion, and women’s reproductive choices respected and supported. Management of pregnancy requires specialized care, with the woman involved all facets of decision making, including the use of antiretroviral therapy during pregnancy. Optimal pregnancy care, including antiretrovirals, has resulted in dramatically decreased rates of perinatal transmission (now less than 5% in women receiving care). Optimal care requires close collaboration between the woman, an HIV-aware obstetrician, an HIV specialist, a pharmacist, a nutritionist, a social worker and a pediatric HIV specialist.

The provincial initiative recommending that all pregnant women in the province be offered HIV testing as part of routine pregnancy care has resulted in more than 6,000 women being tested in each of the last three years. There continues to be a need for improvement in this area, however. It is clear that many women are still not being offered testing in pregnancy, while some are being tested without their knowledge and consent. HIV diagnosis of women in pregnancy not only decreases the rate of perinatal transmission, but also means that more women will potentially be able to access new antiretroviral therapies.

Diagnosis of HIV infection in women remains problematic. Unless women identify themselves as being injection drug users or partners of injection drug users, they continue to be viewed by many health care professionals as being at low risk, and many women are still not being offered testing. Lesbians, especially, are considered at low risk for HIV by physicians. As a result, women are still being diagnosed late in the course of HIV disease. It is likely that many women in the province remain unaware of their HIV status.

There are resources available to HIV-positive women in BC. The Directory of Services for HIV-Positive Women and Children was published in October 1997. Further help, support and care can be obtained through the Positive Women’s Network and the Oak Tree Clinic.

Transgendered persons living with HIV/AIDS also face an enormous range of issues and challenges. Individuals may find themselves leading isolated lives. The stigma associated with HIV disease may be compounded by the stigma faced by the transgendered community in general. Access to non-judgemental care and support is essential.

The former High Risk Project worked to create a supportive social environment for transgendered persons and to provide a range of practical supports to community members. A successor organization is currently in the developmental stage.

The LGBT Health Care Access Project conducted community consultations with the FTM community in Vancouver. Reports from FTM community members revealed both negative and positive experiences when seeking health care.

On the positive side, it was noted that providers are becoming more informed on FTM health issues and, as a result, respect is being demonstrated and care is improving.

Many of the negative experiences reported seemed to result from a lack of information about FTM issues in general, a lack of experience on the part of providers when working with FTMs, and negative attitudes held by care providers. Participants suggested that research, information and education must be circulated in the health care systems and society at large if these situations are going to be prevented in future.

The LGBT Health Care Access Project also held community consultations with the MTF community in Vancouver. Again, both positive and negative experiences with the health care system were reported.

Some MTFs reported positive experiences, particularly at Downtown Eastside facilities, which were perceived as more respectful than centres in outlying areas.

On the negative side, MTFs said it was difficult to find knowledgeable, non-judgemental and non-prejudiced providers, informed people at government offices, and supportive people within gay and lesbian organizations.

In the words of one participant: "Mental health services have been the worst. If I need help, I present as a male. Even if the issue is not directly gender-related – for example, depression – one is dismissed and told to go to the Gender Identity Clinic, but the Clinic can’t deal with depression, and the medical system won’t because you’re transgendered."

The HIV/AIDS epidemic has disproportionately affected persons from particular cultural groups:

It is difficult to estimate the number of First Nations people who are infected with HIV in Canada. Several HIV testing studies have been done within specific First Nations and aboriginal populations; however, any attempt to paint a national picture of HIV prevalence and incidence has been patchwork at best. There is no national database on the number of First Nations persons and aboriginals who are HIV-positive, as only AIDS cases are reported. The BC Centre for Disease Control does keep track of HIV test results and has data on ethnic status. Even with these data, we do not know how many people are HIV-positive but have not yet been tested.

The exact nature or strength of barriers to testing for HIV for First Nations persons is unknown. If persons infected with HIV do not get tested, the official prevalence and incidence numbers that policy and program makers use will be low. There are many plausible scenarios that might lead one to believe new and existing HIV infection rates among First Nations persons are higher than those currently reported by centres for disease control.

Relative to the general population, First Nations persons have higher morbidity and mortality rates. If poor health is normalized in a community, it is possible that initial symptoms of HIV – prolonged fever or diarrhoea for instance – might not motivate one to visit the doctor. This scenario is more compelling if health care providers are, for a variety of reasons, difficult to access. Further, even if a First Nations person does go to the doctor, they may not feel comfortable consenting to an HIV test.

Though anonymous testing is generally available in urban centres, it may not, in reality or perception, be available in rural settings. In many First Nations communities there still exists a strong social stigma against HIV and AIDS. If the social consequences of a positive test are high, one may choose not to be tested. This is especially true if the person has any reason to believe that confidentiality of the test results will not be kept. Shame and fear of social isolation might also leave people with little alternative but to conceal they have tested HIV-positive. For instance, a First Nations person who became infected and tested HIV positive while living in an urban centre might return home and choose not to behave in any way, including telling family or friends, that would reveal they had HIV. For these reasons, HIV status might be hidden either directly (by not disclosing status to others) or indirectly (by not being tested). In the latter case there will be no record that the person is HIV positive.

If HIV status is directly or indirectly hidden, there are important implications for receiving proper care and succeeding with effective prevention programs. With the implementation of more effective treatments, the consequences of not accessing appropriate treatment and care could be especially severe. Hidden status, especially when indirect, is also very important for prevention. Someone who does not know they are HIV-positive might still engage in behaviour that unknowingly puts uninfected persons at risk. If the above scenarios are plausible, the actual prevalence and incidence rates of HIV for First Nations persons might be far higher than currently reported.

For these reasons, it is very important that the environment within First Nations communities allow people to seek HIV testing. First Nations persons have to know that their HIV test results will remain confidential and that if the test is positive, their community will support them as best it can in all phases of the disease.

The First Nations Community Health Resources Project (FN-CHRP) represents a research partnership between the University of British Columbia and the Assembly of First Nations. FN-CHRP is a pilot research study on the resource impacts and economic costs of HIV and AIDS among First Nations persons living in Vancouver. This study represents an important first step in identifying the profound economic costs that HIV and AIDS will have for affected First Nations individuals, families and communities across Canada.

Initially, the First Nations Community Health Resources Project expected to recruit between 100 and 150 First Nations participants who were HIV-positive. At the beginning of the project it was thought that a target of even 100 participants might be difficult to achieve. This was for tworeasons. First, the Laboratory Centre for Disease Control had estimated 240 aboriginal AIDS cases in all of Canada, ever, by the end of 1995. This was a reported underestimate since 41% of reported AIDS cases did not contain ethnic identifiers. Still, this low figure suggested a target of even 100 participants might be difficult given the study was located in one urban centre, Vancouver. Secondly, it was felt that First Nations persons might be reluctant to participate given the broad feeling of being "researched to death". Among other reasons, this sentiment exists because academic information has rarely been returned in a meaningful way to First Nations persons. Recruitment for FN-CHRP started in Vancouver in March 1997. More than 200 HIV-positive First Nations persons agreed to participate in FN-CHRP in the following months.

The FN-CHRP survey asked the question, "When you are back home, how comfortable do you feel telling people you are HIV-positive?" Of those who responded, 63% (40 of the 63 respondents) stated that they were either "somewhat uncomfortable" or "very uncomfortable". Thirty of these 40 negative responses were "very uncomfortable."

When asked why they where uncomfortable back home, 8 of 63 (12.7%) responded "personal safety" or "gay bashing," etc., 18 of 63 (28.6%) responded "banishment" or "not wanted around", and 22 of 63 (34.9%) responded "stigma." Comments from more detailed responses included:

Of those respondents who considered Vancouver home, 40% (42 of 106) felt uncomfortable disclosing their HIV status to others. Interestingly, no one stated that their discomfort was based on concerns that access to health care would be threatened.

The results from the FN-CHRP survey are consistent with the scenarios presented above where barriers to testing and seeking proper care might exist in home communities.

FN-CHRP data used below are from 151 persons enrolled in Vancouver before July 1, 1997. From the tables below it is clear that both First Nations women and men are becoming infected with HIV. Though much of the infection is reportedly taking place due to injection drug use, women are becoming infected through unprotected sex with men and similarly men are becoming infected through sexual contact with women.

Gender of Participants
Gender	Number	Percent
Male	102	67.5
Female	45	29.8
Transgender	4	2.7
Total	151	100.0

Reported Infection Route
Risk Category	Number	Percent
Male, Injection Drug Use (IDU)	55	36.42
Male, Sex with Male (SM)	22	14.57
Male, SM and IDU	4	2.65
Female, IDU	29	19.21
Female, not via IDU	16	10.60
Transgender (SM or IDU)	4	2.65
Male, Sex with Female	9	5.96
Male, Other	12	7.95
Total	151	100.00

Median Time from Infection
Reported Transmission Route	Number	*Median Time from Seroconversion (Years)**
Male, Sex with Male	19	7
Male, Injection Drug Use (IDU)	48	4
Female IDU	29	2
Female, no IDU	13	2
Male, Sex with Female	9	2
* The term "median" means that half the sample was equal to or less than the median figure and half the sample was equal to or greater than the median figure

The epidemic of HIV disease is still in its early stages for First Nations persons. Persons living with HIV can be asymptomatic for many years before their immune system breaks down and they succumb to AIDS. Table 3 shows that many First Nations persons have become infected with HIV only in the last few years. This means that the highest need for care and treatment and support is still in the future.

First Nations communities will have to plan adequately to care for persons in their community who are living with HIV and AIDS. If stigma and shame remain for First Nations persons living with HIV, they may choose not to return home for care, treatment and support.

First Nations persons living with HIV in Vancouver are accessing combination drug therapies at a rate significantly lower than non-First Nations men who have sex with men. The reasons for this are not clear but will be investigated in future research.

FN-CHRP will continue analysis and attempt to identify costs unique to First Nations persons living with HIV. Future analysis will include the costs of caregiving and support from friends and family.

It will be difficult for First Nations communities to plan properly for future HIV/AIDS care, treatment and support needs if First Nations persons are hesitant to get tested. Uncertainty about the number of First Nations persons living with HIV also makes the effective prevention programs difficult to design and implement.

The BC Aboriginal HIV/AIDS Task Force released a comprehensive report in 1999 title, The Red Road, The Path to Wholeness: An Aboriginal Strategy for HIV and AIDS in BC. The recommendations are referenced in detail in the Vancouver HIV/AIDS Care Co-ordinating Committee (VH/ACCC) 1999 - 2002 Care Strategies document.

Language barriers, different ethnocultural norms and persistent myths about HIV/AIDS have contributed to a limited awareness of risk behaviours and prevention strategies in newcomer populations. Many service providers are often unaware of the risk for HIV in different ethnic communities. It is important to recognize what may have put newcomers at risk before immigrating to BC. For example, unsafe injections during mass immunization campaigns have been cited as the main reason for transmission of HIV cases in developing countries.

Language is the largest barrier to care faced by HIV-infected persons who don’t speak English. Over 50% of children in Vancouver schools come from homes where the mother tongue is not English, and over 100,000 people in the GVRD speak neither English nor French. V/RHB Community Health Services clinics, Bridge Health Clinic (serving refugees and marginalized immigrants), and most hospitals now offer care in most languages either through interpreters or the AT&T language line. Increasingly, physicians in the community who speak languages in addition to English are accepting HIV clients.

The BC Centre for Disease Control, STD Division collaborates with different ethnic communities in getting information out in their first language and, in conjunction with the Vancouver/Richmond Health Board, has published updated educational materials on HIV and other STDs in Vietnamese, Chinese, Spanish, Punjabi, Hindi, and Amharic (Ethiopian). The BCMHSS Women’s Project has also translated these materials into Burmese and Khmer (Cambodian).

The street nurse program has outreach workers for STDs/HIV/AIDS who speak Spanish and Burmese. Storefront Orientation Services (SOS) located in the Downtown Eastside also provides outreach to the Spanish speaking refugees and new immigrants for HIV/AIDS services. The Asian Society for the Intervention of AIDS (ASIA) focuses on the East and Southeast Asian communities by providing education, support and advocacy to help address factors that marginalize members of these cultural groups, including HIV phobia, homophobia, racism and sexism.

Some newcomer groups believe that AIDS is a "gay disease." As a result, many women do not realize that they are at risk when they are in a monogamous heterosexual relationship. They either do not recognize that their male partners may also have sex with men, or they do not realize injection drug use is prevalent in certain sub-cultures within their communities.

Other groups are concerned about intergenerational and intercultural conflict when behavioural norms for Canadian youth are perceived as wrongful by newcomer parents. This can result in overly restrictive and/or abusive parenting that may increase the likelihood of youth leaving home and ending up on the street. There is also concern for gender and power relationships in newcomer communities and the increased risk for transmission of HIV to vulnerable partners in abusive relationships.

Since 1997, peer education/support groups have been held in the first language of women from nine different language groups through the BC Multicultural Health Services Society, Refugee and Immigrant Women’s Health Project for the Prevention of STDs/HIV/AIDS. The curriculum is developed and regularly updated by representatives from each of the nine language groups. By building trust with a small group of women who meet together for eight to ten sessions, there is an opportunity for women to learn about their risks, to find personal solutions within their community, and to learn how to look outside of their cultural group for help when necessary. This program is now in the process of securing funds to develop an STD/HIV/AIDS peer education for the men in these language groups.

An additional barrier to some newcomer populations, specifically refugee claimants and those who have not yet qualified for residence status, is the lack of coverage under the Medical Services Plan. Through collaboration among the BC Centre for Excellence in HIV/AIDS, Oak Tree Clinic, BC Centre for Disease Control, V/RHB clinics, community clinics, AIDS service organizations and other non governmental organizations, there is an attempt to stretch the safety net to its maximum in order to catch those who would otherwise fall between the cracks.

In 1995, the Ministry of Health published a discussion paper on a proposed multicultural health policy framework. The paper identified key obstacles to equitable health status and access to health services in a multicultural society, including:

The BC Centre for Disease Control’s Report shows that young gay and bisexual men continue to seroconvert at alarming rates [see Appendix C].

Homophobia, racism, and other forms of stereotyping and discrimination are factors contributing to gay men’s vulnerability to a range of health concerns, including HIV. The impact of growing up gay in a homophobic world may hurt the development of self-acceptance and self-esteem. It may also stand in the way of development of interpersonal skills needed to respond effectively to health concerns.

The Vancouver Lymphadenopathy AIDS Study (VLAS), begun in 1982, represents the largest and longest-running study of 1,000 gay men in Canada. The Vanguard Project began in 1995 as an extension of the VLAS. These studies have examined the relationship between the social determinants of health and HIV risk and disease progress among gay men. Findings of these studies include:

The Vanguard Project, a study of HIV incidence and associated risk factors, looks at the rates at which young gay and bisexual men are becoming infected with HIV. The project examines the factors that might put young gay and bisexual men at risk for HIV, and looks at which sub-populations of the gay community are in need of particular attention. The project has found a strong correlation between early experiences of non-consensual sex and ongoing risk behaviour in adults. The study suggests that traumatic experiences early in life may discourage or prevent gay men from establishing coping skills around sex, work, where they live, and the kinds of social networks they establish. This can be particularly important when it results in difficulty negotiating relationships with partners and friends. A lack of self-acceptance, low self-esteem, and limited social support in the community can increase vulnerability to health concerns such as HIV, STDs, drug and alcohol use, anal health problems and violence in relationships.

Male sex trade workers are especially vulnerable. The Vanguard Project has found that male sex trade workers are vulnerable to HIV infection because of unfavourable living conditions, substance use and sexual risk behaviour. Unstable housing appears to place male sex trade workers at particular risk for HIV infection.

The LGBT Health Association, through the LGBT Health Care Access Project, conducted a community consultation through focus groups with community members. Most participants found local health services to be good. In particular the effectiveness of LGBT clinics at The Centre and at the Downtown Community Health Centre was noted.

However, many gay men reported that they used the health care system with caution. It was perceived that homophobia exists across the system (emergency rooms, specialists and male doctors were mentioned specifically), and this creates difficulties in accessing health care and disclosing sexual orientation, sexual practices and health concerns.

Gay or gay-friendly doctors were found to be important but difficult to find. Youth in particular reported difficulty in finding gay-friendly clinics. Access was also noted as a difficulty by gay First Nations and Latino men and gay men of colour. Gay men who are immigrants or refugees also reported a fear of disclosing sexual orientation.

Gay First Nations men and gay men of colour reported that they separated out their health concerns, bringing general concerns to their family doctor and gay-related health concerns to LGBT-specific clinics.

The groups recommended improving the health system by educating care providers about homophobia, biphobia, HIV/AIDS and racism. They also suggested expanding culturally sensitive, multilingual, LGBT-friendly service in hospitals and health care organizations.

Gay men and men who have sex with men are faced with many important issues with respect to HIV/AIDS. These issues include:

There are many important legal issues that affect people who live with HIV/AIDS. These include:

People with HIV/AIDS are encouraged to have certain legal documents in place, including a will, a living will, a power of attorney, a health care directive and, in some cases, a deed of committee.

The availability of accessible and affordable legal services is limited. While legal aid is available to people with low incomes, the eligibility requirements are restrictive. Only those individuals with very low incomes are able to obtain legal aid; for example, for one person the monthly income cut-off is less than $1000. Furthermore, access to legal aid is becoming even more difficult since the BC government cut $6 million from the budget of the Legal Services Society in February 1997. For people living with HIV in need of legal advice who do not qualify for legal aid, the options are limited: a private lawyer or a community advocacy organization with limited capacity to deal with legal issues. Private lawyers are expensive, although there are some law firms who tailor their fees to meet the income level of the client.

The 1998 Supreme Court of Canada decision in R. v. Cuerrier held that individuals aware of their HIV-positive status may be found guilty of a criminal offence if they do not disclose their HIV status to a partner before having unprotected sex. This decision has created an urgent need for education, both for people living with HIV and also for a myriad of service providers such as health care workers, counsellors and therapists for whom the decision will have repercussions in areas such as confidentiality and duty to warn.

New legislation pertaining to guardianship has been promised for some time and will have an impact on individuals living with HIV/AIDS.

Although not able to offer members legal advice, BCPWA’s Individual Advocacy Services Department can offer assistance, including representation, with a wide range of quasi-legal issues, including residential tenancy, BC Benefits, Canada Pension and Canada Disability Pension, Employment Insurance, wills and estates, guardianship and representation, and many others.

Eight percent of CHRP participants received legal assistance from an agency, group, organization or individual at least once in the two weeks prior to being interviewed.

Education regarding legal issues is important and is the responsibility of all agencies serving people with HIV/AIDS. In conjunction with legal issues, many agencies are also in need of expertise and resources to develop policy and ethical guidelines related to many aspects of HIV/AIDS.

Although the mandates of the federal and provincial corrections and forensic psychiatric services extend throughout the province, service provision is concentrated in the lower mainland. Corrections and forensic psychiatric services are not physically located in Vancouver (with the exception of the Vancouver Pretrial Services Centre and the Forensic Psychiatric Outpatient Clinic). However, offenders use the HIV/AIDS programs and services provided by Vancouver hospitals (primarily St. Paul’s) and community-based agencies such as AIDS Vancouver and BCPWA. Many offenders, especially those who serve short sentences in BC correctional institutions, live in Vancouver prior to and after incarceration and use other services provided by the community, such as income assistance, housing and mental health care. Most of the halfway houses to which inmates from federal institutions in the Fraser Valley are released are in the greater Vancouver area. It is for these reasons that corrections services are included in this strategic plan.

Planning must include provision for the medical and the psychosocial support needs of people in correctional institutions and on supervised community release. Serious efforts to implement effective harm reduction and prevention programs must be increased in an attempt to stem the HIV epidemic. Without an effective and aggressive general plan to standardize and improve all current facets of HIV/AIDS care in all institutions, there will be staggering increases in the number of seropositive inmates living in and being released from prisons.

The federal system is responsible for offenders serving sentences of two years plus a day. All male offenders reside in federal institutions located in the Fraser Valley, with the exception of one institution near Victoria. Federal female offenders are provided with care and custody through a ministerial agreement with BC Corrections and reside at the British Columbia Correctional Facility for Women in Burnaby.

Voluntary nominal (i.e., not anonymous) testing for HIV is offered to every offender upon intake, at the commencement of the sentence, and again upon transfer to other institutions during incarceration. As well, an inmate can present him or herself at any time during their sentence for testing.

Currently, all offenders are offered care and treatment on a voluntary basis which is in accordance with the BC Centre for Excellence in HIV/AIDS "Therapeutic Guidelines for Care and Treatment". All offenders who are HIVpositive are provided with periodic consultant appointments as follow-up for care and treatment, in collaboration with the team of specialists at St. Paul’s Hospital. Psychological support is available in all federal correctional settings on request or by referral from health services staff.

In the Correctional Services of Canada (CSC), the requirements for vitamin and nutritional supplements are reviewed on a case by case basis with the health care team and consultants from St. Paul’s Hospital.

Offenders can access treatment and medications through two distribution programs: directly observed therapy or self directed administration. This is negotiated and provided at the choice of the offender.

Each offender is assessed and presented individually to the National Parole Board for possible compassionate release once they have reached the end-stage of HIV/AIDS disease.

CSC reports that harm reduction activities such as bleach and condom distribution, as well as peer counseling and methadone maintenance programs, are fully supported in BC federal correctional facilities. Quarterly routine audits are completed to ensure that adequate supplies of quality products are discreetly available to all offenders at all sites.

All offenders in this system are serving sentences that are two years less a day. Long-term care of seriously ill female prisoners will have to be addressed; otherwise, chronic care needs will be minimal in BC corrections facilities. Those offenders who are incarcerated during the terminal stage of AIDS may be eligible to receive a compassionate discharge and make use of medical facilities in the community. Those offenders who are not discharged and require acute medical care are transported to a local hospital. The HIV/AIDS program at St. Paul’s Hospital has treated several provincial inmates in the acute or terminal stages of AIDS.

None of the provincial facilities in BC has an accredited medical facility and it is not part of any plan to create "hospitals" within the BC corrections system. Inmates requiring hospital-type medical care will continue to be referred out to local hospitals. Given the expectation of a dramatic increase in HIV among the inmate population in the coming years, regional health boards in areas where BC corrections facilities exist must be aware that the presence of these facilities in their areas will have an effect on regional hospital resources.

Community assessments are completed on every conditionally released federal and provincial offender. Probation and parole officers assess the available personal and community support and police and community resources. Issues addressed range from housing and substance use to medical needs. If the offender discloses that he/she is HIV-positive, resources such as AIDS Vancouver, BCPWA, and St. Paul’s Hospital may be mobilized. However, there is currently no funding for the services provided by community agencies to released offenders in transition between institution and community, and this has been identified as one of the most serious gaps in service. As well, probation and parole officers and halfway house staff need training and education regarding the resources available to persons with HIV/AIDS.

Inmates requiring psychiatric assessment or mental health services may be placed with Forensic Psychiatric Services. Patients at FPS who become ill with HIV/AIDS-related conditions must be transferred in order to receive acute care.

All correctional facilities routinely offer HIV counselling and testing on a voluntary basis to all offenders upon entry to the system. In federal centres, a confidential nominal testing procedure is offered by health services staff with extensive pre- and post-test counselling. Anonymous testing by outside agencies allows maximum access to testing and is currently being offered on a trial basis in some provincial corrections facilities. In the BC forensic and correctional system, some pre- and post-test counselling is provided by nurses and physicians; however, anecdotal evidence suggests that most patients do not receive adequate pre- and post-test counselling.

The responsibility for running alcohol and drug counselling programs within provincial correctional facilities lies with BC corrections. Mental health care is supplied to inmates of BC correctional facilities by Forensic Psychiatric Services and locally contracted psychiatrists and psychologists. FPS provides counselling through treatment nurses, physicians and psychologists on staff.

Provincial corrections and the Forensic Psychiatric Institute provide inmates with HIV/AIDS nutritional services and counselling, as well as vitamin and nutritional supplements and extra meal portions when needed. In federal corrections, the requirements for vitamin and nutritional supplements are reviewed on a case by case basis with the health care team.

Psychological support is available in all federal corrections settings on request or by referral from health care services.

Federal and provincial corrections plan to continue to provide access to community groups in the HIV/AIDS field to visit and provide services to offenders. In provincial institutions, these include BCPWA, clergy, native elders and public health nurses who provide resource information and psychological and emotional support. Educational events sometimes allow offenders to obtain information anonymously. In some institutions, support groups have been established. In federal institutions, public health nurses do not provide services as yet, but if anonymous testing were to be implemented, this would change. AIDS Vancouver and BCPWA’s Prison Outreach Project do establish and support peer counselling programs, education fairs, educational programs and individual support as requested in federal institutions. However, neither federal nor provincial corrections provide funding to these external agencies to cover transportation and other related costs of providing these programs.

There are already many processes in place in the forensic and correctional system for consumer input; for example, the Patient Concerns Committee at FPS, the Office of the Ombudsman, the BC Council on Human Rights, the BC Civil Liberties Association, the Division of Investigation, Inspection and Standards, citizens’ advisory groups in both federal and provincial institutions, the federal investigator, and various inmate committees. There is also communication with families and personal physicians by staff in forensic services and corrections.

A health promotion teaching program was developed as a cooperative effort between federal and provincial corrections and Forensic Psychiatric Services. It was intended that all agencies would be using this program. The basics of health and hygiene, including STDs and HIV, were to have been covered in an 18-module format which was designed to reach the particular population in an effective manner. The program was run a couple of times in a few institutions and then never used again. A similarly developed program originated out of the accepted recommendations of the ECAP Report. Through the combined efforts of federal inmates and community AIDS workers and advocates, this program passed the pilot project and was printed and distributed. However, in British Columbia it was deemed by the Directors of Health Care to be insufficient for inmate training. The manual was then cut down and rearranged, and has only been taught in two institutions to two inmate groups.

After diagnosis of HIV infection, education and counselling are offered to each individual patient/offender as part of the treatment program, though there are reports that such service is inconsistent across the system.

Vancouver HIV/AIDS
Care Co-ordinating Committee

Public Sections

Documents: Environment Report 1999-2002
This is a companion document to the Strategic Plan and a work in progress; this version March 31, 2000

SOCIAL ENVIRONMENTS

Vancouver HIV/AIDSCare Co-ordinating Committee

Public Sections

Documents: Environment Report 1999-2002This is a companion document to the Strategic Plan and a work in progress; this version March 31, 2000

SOCIAL ENVIRONMENTS

Vancouver HIV/AIDS
Care Co-ordinating Committee

Documents: Environment Report 1999-2002
This is a companion document to the Strategic Plan and a work in progress; this version March 31, 2000