World AIDS Day Dec. 1 calls for end to inequality and stigma

Ever since they became widespread some 40 years ago, there have been many advancements in the medical treatment of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). What was once considered a death sentence in the 1980s and ’90s has now transcended into a chronic condition that many people can live with if they have access to medical treatment.

Despite this, there is still a lot of work to be done. If not treated, HIV can lead to AIDS or other serious health complications. Around 37 million people are living with HIV globally, including approximately 64,000 Canadians, says Dr. Añiela dela Cruz, BN’98, PhD, an associate professor in the Faculty of Nursing.

World AIDS Day is Dec. 1, a chance to raise awareness of HIV and AIDS and their associated stigma. Research shows there remains significant structural inequalities and stigma around these infections.
Exploring new approaches in HIV prevention and mitigating stigma, as well as finding ways to provide better care and support services for people living with HIV in Canada has been part of dela Cruz’s work for the last 20 years.

She holds a PhD in nursing and an MSc in health promotion studies from the University of Alberta and began her work with HIV in 2001. She focuses on the social inequities pertaining to HIV and AIDS in the context of migration and settlement, as well as immigration processes and policies.

My hope is that we don't forget people who are living on the margins of society. We are fortunate in Canada to have a publicly funded health system. But the challenges of settling into society as a vulnerable person can really influence people’s quality of life.

- Añiela dela Cruz

She has worked extensively with such vulnerable individuals who are living with HIV, including immigrants and people with protected status, and dela Cruz’s doctoral work examined the experiences of sub-Saharan African immigrants living with HIV in Alberta. Her research has now been expanded more broadly across Canada.

Changes in perception of risk and transmission

One of her early experiences in this area of work was hearing stories from one sub-Saharan African immigrant community in northern Alberta. People shared that they left HIV “back home” because HIV seemed to be invisible in Canada.

HIV was very visible in people’s home countries, being widely discussed on radio and other media, billboards, and in people’s lives. Because people didn’t see HIV in these ways in Canada, many assumed it did not exist in Canada; therefore, dela Cruz says, their perception of risk and transmission changed. People thought they could have multiple sexual relations without the use of condoms.

During her years of work, she says, there has been a common theme that, while people come to Canada to seek a better life, health and social inequities exist for immigrants living with HIV in Canada.

“I've heard that story told repeatedly with many people I've worked with over 20 years,” dela Cruz says. “People come to Canada for a better life. While we may think that as a society that people come here for a better life, it's not without challenges, particularly for this population.”

Study concludes stigma exists

The Alberta Stigma Index Study was recently completed by the Alberta Stigma Index Team, which includes community members, non-profit organizations, AIDS service organizations, academic researchers from Mount Royal University and UCalgary, and peer researchers.

In 2019, the team led a mixed-method study, conducting surveys with 145 people to measure HIV stigma. As well, 25 individual interviews were undertaken with people living with HIV in Alberta. The conclusion from the study was that Albertans significantly experience social stigma in their lives as well as discrimination due to their HIV-positive status.

This negatively impacts their lives socially. For example, people with HIV often hear stigmatizing and discriminating conversations within their social circles. People reported that having this stigma with them in their lives negatively impacts their close social relationships with others and impacts decisions around having sexual or romantic relationships.

“Mitigating stigma lies in these social structures around us: systemic barriers, social attitudes, social policies, public policies and so on,” dela Cruz says. In addition, stigma influences people’s ability to engage in the HIV “care cascade” entailing anything from testing to engaging in health and social care.

World AIDS Day theme: End Inequalities

On World AIDS Day, people around the world unite to show support. This year, its theme is End Inequalities. “There are people still living with HIV and people who are still underserved and under-supported in Canadian society,” says dela Cruz. “Let's prioritize health and get people engaged in that ‘care cascade.’

“It's not just about access to medical care, but it's about looking at their lives holistically. How will their life be lived if they don't have stable housing? If they cannot find employment … while they're adjusting to medications? If they cannot have access to health and social care?”

Her goal is push for policy changes, particularly mandatory HIV screening, which was introduced in 2002 and implemented as part of Canada’s immigration application process.