Case 10 : Middlesex-London’s Public Health Emergency: HIV in People Who Inject Drugs

Middlesex-London is experiencing an alarming rise of new HIV cases in people who inject drugs (PWID). Despite a demonstrably successful harm reduction program and primary care effort, the rapid increase in HIV remains. To help reduce the incidence of HIV in PWID, in association with Regional HIV/AIDS Connection (RHAC), My Sister’s Place, and the Middlesex-London Health Unit (MLHU), the Counterpoint Needle and Syringe Program in Middlesex-London distributed over three million needles in 2016. Nevertheless, healthcare workers continue to diagnose PWID with HIV and other infections. Of those needles distributed, only 1,895,798 were recovered through these organizations and, thus, improperly discarded needles have been spotted across the city on multiple occasions. PWID in Middlesex-London face significant barriers when accessing care and support. Barriers, including, but not limited to, psychosocial (i.e., stigma, social support), structural (i.e., housing, treatment access, poverty), and institutional factors (i.e., patient-physician relationship), can hinder PWID from accessing adequate healthcare and support services. With an aim to address some of the barriers faced by PWID, the Middlesex-London Health Unit has established an HIV Leadership Team that works collaboratively with key system partners in the field of HIV treatment and support, substance use, and support for people who experience homelessness. This case demonstrates the impact of social determinants of health such as poverty, homelessness, and inequalities in PWID’s health, well-being, morbidity and mortality patterns, as well as their access to care. This case also highlights the importance of recognizing the influence of social determinants of health in the planning, implementation, and evaluation processes of public health programs to ensure that interventions are effective, cost-effective, and equitable.