New HIV diagnoses in Manitoba have increased 130 per cent in two years, according to data from the Manitoba HIV Program.

169 people were diagnosed and referred to the program in 2021. That number jumped to 256 in 2022, and 388 in 2023. In 2024 so far, the program is reporting over 300 diagnoses.

The number of diagnoses per capita in Manitoba is also about five times higher than the provincial average; Manitoba’s rate in 2023 was 26.4 diagnoses per 100,000 people, while new diagnoses sat at 4.7 per 100,000 people nationwide in 2022.

“We are unfortunately in the middle of a crisis in Manitoba,” said Manitoba HIV program director Kimberly Templeton.

The program, which received provincial funding last year on World AIDS Day, is connected with about 2,300 people in Manitoba living with HIV.

Templeton says Manitoba’s diagnoses also differ from the Canadian average in which populations they’re affecting.

“Whereas in most other parts of Canada we’re seeing HIV impact gay, bisexual, and men who have sex with men, in Manitoba we’re really seeing that this is something that’s impacting folks who are heterosexual, and folks who are injecting drugs, specifically methamphetamine.”

“It is important to note, that this is a symptom of much larger systemic influences, including social and economic disparities that we that we see in Manitoba,” Templeton added.

Almost half of women and almost 30 per cent of men who were diagnosed between 2018 and 2021 were also experiencing houselessness, the program’s data says. 80 per cent had at least one other health condition, and Indigenous people were disproportionately affected, with a staggering 85.1 per cent of women referred to the program in that timeframe identifying as Indigenous.

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The numbers don’t come as a surprise to Dr. Yoav Keynan. The Section of Infectious Diseases head at the University of Manitoba is the co-author of a study on barriers to accessing HIV care in Manitoba.

“What are the social and structural factors that impact… the likelihood of acquiring HIV,” he said. “We undertook this study to try to understand barriers and facilitators; what makes people more or less likely to progress in the cascade and have good outcomes versus not progress?”

32 interviews with people living with HIV who were connected to the Manitoba HIV Program revealed some trends Keynan calls “impressive and depressing.”

Half of males and 70 per cent of females reported sexual abuse “among other traumatic childhood experiences.” Many also reported emotional abuse and experiencing violence. Keynan calls it a “perfect storm.”

“It’s not HIV occurring alone, it’s HIV and other infections and other co-morbidities that result in tremendous effects on the lives of people, on hospital admissions, on mortality and on and on our health care system,” he said.

The study also found people living with HIV can face significant stigma and discrimination in healthcare settings, particularly if they are also using substances or are houseless. This can discourage them from continuing HIV care, which can involve doctors’ appointments and taking medication regularly.

Nine Circles Community Health Centre’s harm reduction space – named the Pit Stop – is designed to have the opposite effect.

“For folks who can’t navigate appointments and aren’t going to live in that way, we offer that care right here,” said Executive Director Mike Payne, pointing to an exam room just near the building’s entrance.

About 130 people drop in daily, he said, whether it is to get tested for sexually transmitted and blood-borne infections (STBBIs), take some menstrual products, get naloxone training, or have a snack. Payne says building relationships with the community at risk of contracting HIV is key.

“It’s hard for folks to stay on treatment if they’re houseless. It’s hard for folks to stay on treatment if they’re denied access to supports because they’re using substances.”

Nine Circles is one of five sites to deliver Manitoba HIV’s Program to Access Treatment for HIV and Support (PATHS). The program connects patients to various supports to help them stay consistent in their HIV care; early numbers show 77 percent of participants are on HIV treatment, compared to 28 per cent of those who are on the program’s waitlist.

Consistent use of anti-retroviral medication can render a person’s HIV viral load undetectable. A person with an undetectable viral load can’t transmit the virus sexually. This year, the province began covering the cost of this medication, and a preventative medication known as PRep.

It’s a step in the right direction, says Payne.

“For folks who were struggling and trying to make decisions – Am I going to pay my rent or am I going to kind of take all of my medication? – that issue has been resolved and people are able to take their medication more consistently,” he said.

But the biggest barrier to care “remains the issue of just stigma and a lack of understanding,” Payne added.

“Nothing presents as a barrier with HIV at this point to living well unless these structural issues prevent you from doing that. And that’s where really the work now has to be… stop isolating HIV as its own issue and recognizing that HIV is an indicator of structural problems, because it always has been.

“When we first met HIV, it was telling us that the way that we were treating gay men and the way we were excluding gay men from our systems was making them sick. And this is no different now. And when we look at the populations who are impacted, we can see the relationship.”