There are many factors that play a role in determining our
health, including our social status, level of education, income, and daily living situation. These factors have become commonly known as
the determinants of health.
At the heart of the determinants of health are our personal experiences and circumstances, such as the kind of childhood we had, whether
we have a social support network, and our close personal relationships.
How we handle these experiences and circumstances, especially the negative ones, depends not only on our personal coping skills, but
also on what is available to us in the way of support and social services.
For some people, their experiences and circumstances can make them vulnerable to HIV infection.
HIV infection: what increases the risk?
According to the Public Health Agency of Canada's HIV
and AIDS in Canada Surveillance Report, there are two main ways for people to become infected with HIV in Canada:
- having unprotected sex
- sharing needles to inject drugs.
Some populations in Canada are at greater risk for HIV infection because they are more likely to engage in these behaviours.
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Who are Canada's HIV vulnerable populations?
The backgrounder to the Federal Initiative
to Address HIV/AIDS in Canada states that HIV is infecting vulnerable populations, people who have been excluded in one way or another
from Canadian society. This includes those who inject drugs, who now make up approximately half of the 11 new cases of HIV infection in
Canada each day. It also includes:
- women living in poverty
- prison inmates
- young gay men
- Aboriginal people.
Their vulnerability underlines the need to reach these groups through appropriate health and social services. Other populations in Canada
that have recently seen a rising rate of HIV infection are young women between the ages of 15-29 and persons from countries where there are
many and escalating cases of HIV infection.
For statistics on HIV/AIDS in the Canadian population, see: HIV/AIDS Epi Updates.
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The determinants of health play a role in increasing vulnerability to HIV infection. As an example, let's look at how income can affect
our health.
Lack of a secure income can place us at risk
Our lives largely depend upon having a secure source of income, most importantly having enough food to eat and a safe place to live. Not
having enough to live on and a predictable income can lead to undernourishment, a poor living environment, even homelessness. These in turn
can make us more vulnerable to HIV infection by
increasing the likelihood of exposure through risk behaviours.
Martin left his small Northern community as a teenager to find a better life in the city. Unable to get a job with his limited
education and skills, he found himself living on the street. There, he experienced discrimination because he was homeless, and increasingly
felt completely alone...
Martin met another homeless youth who befriended him and introduced him to heroin as a way of escape. What Martin didn't know was that his
new friend was HIV positive and that if he shared a needle with his friend, he could become HIV positive too.
Being homeless and feeling like he did not belong exposed Martin directly to the possibility of injection drug use, putting him at risk
for HIV infection.
A lack of power can make us vulnerable
Let's look at another example of how personal circumstances can make us vulnerable to HIV infection. In a cultural community where wives
do not question their husbands' sexual activities outside of marriage, a woman may find herself at risk of being infected with HIV:
Vera knew that her husband was going to sex workers. This made her unhappy and she worried that he could pass on a sexually
transmitted infection, maybe even HIV, to her.
But Vera did not tell him to stop going to sex workers because she was afraid that he would get angry.
Besides, her mother had learned to live with her father doing the same thing.
Learned social behaviour can lead women like Vera to feel powerless in their own relationships, even when they know that their partners
are putting them at risk for HIV infection. This powerlessness
may be reinforced by the threat of abuse or abandonment or disapproval from their community.
Community-based programs that work with multicultural groups can reach out to women like Vera, helping them to take control of their own
health by offering them counseling, by letting them know what their rights are, and by assisting them in finding emergency shelter if
necessary.
Decreasing the risk
The stories of Martin and Vera show how certain negative determinants of health, such as income insecurity and gender inequality, can
increase a person's risk of HIV infection. This risk can often be reduced, however, through outreach services in the community, including
counseling, social services, subsidized housing and income assistance. The challenge for health communities and policy makers is to ensure
that everyone has access to these services.
Martin's story could be different
Let's revisit Martin's story to see how access to support and services could have made a difference for him. What if an outreach worker,
instead of someone who encouraged him to use injection drugs, had befriended Martin? This outreach worker could have shown Martin where to
find emergency shelter, how to get income assistance, and how to apply for subsidized housing. He could also have helped Martin look at
ways to upgrade his skills and to find a job.
With the right support and services, Martin's story could turn out for the better. Support from the outreach worker and access to social
services could make the difference for Martin, very possibly preventing him from injecting drugs, which could put him at risk for HIV infection.
And what about Vera?
Vera could have benefited from having access to a place in her community where she could talk with other women like herself in a friendly
and informal setting. An example of such a setting would be a community
kitchen, run out of a local community centre, where people can gather together to cook meals for their families while sharing the costs
and labour.
For the community worker at the kitchen, this would be an ideal opportunity to educate Vera and others in a non-threatening environment
about HIV and how to protect themselves. Once gaining Vera's trust, the worker could also work one-on-one with her to develop strategies
for raising her concerns with her husband and for asserting herself.
Addressing vulnerability
Like other Canadians, Martin's and Vera's particular experiences and circumstances made them more vulnerable to HIV infection. Their
stories underline the need to address the factors that increase people's vulnerability - the earlier, the better. By understanding all the
things that put people at risk for HIV infection, we can find ways to intervene and help decrease HIV infection in Canada.
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What we can do
We all have a role to play in reducing HIV infection in Canada.
In our homes, we can:
- inform ourselves by learning more about HIV
- protect our children by educating them about HIV transmission and prevention.
In our communities, we can:
- volunteer our time or support fundraising activities for community
organizations helping people at risk
- encourage HIV prevention activities at our children's schools and in the community.
As Canadians, we can:
- support our local, provincial and federal governments' efforts
to address the negative determinants of health, like poverty and gender inequality, that can make people vulnerable to HIV
- fight the HIV-related stigma and discrimination that can prevent people from getting the information and support they need.
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This article was prepared by the 
