Saskatchewan is a leader in the country in preventing opportunistic diseases caused by poverty. With new changes in income support programs and increased housing instability, things are getting worse.
Saskatchewan has the highest HIV rate in Canada, with more than three times the national average. New cases are emerging through what is known as vertical transmission (from mother to child), which is largely not the case in richer nations, as such cases are preventable with the use of antiretroviral drugs.
Injecting drug use is the most common mode of transmission in the province, and is highest among indigenous peoples, where the continuing legacies of colonialism, political poverty, intergenerational trauma, and substance use are intertwined.
Indigenous people have faced these challenging conditions with resilience, mobilizing local-led HIV responses and advancing in the way Indigenous people know. But these efforts continue to be undermined by limited funding and the failure of the provincial government to provide sufficient income support for those living in economic insecurity.
The percentage of HIV in Saskatchewan is rising. (Shutterstock)
Syphilis epidemic
The increase in HIV levels in Saskatchewan is happening in parallel with a new epidemic of syphilis.
This is not surprising, as syphilis increases susceptibility to HIV; this is a harbinger of new HIV infections. The incidence of syphilis is growing exponentially, to more than 800 cases in 2021, from five cases in 2016. The disease is extremely infectious in its less severe early stages and can, like HIV, be transmitted during pregnancy.
When transmitted during pregnancy (congenital syphilis), syphilis can have serious consequences, including stillbirth and babies born with a number of health problems, including skeletal and facial abnormalities, deafness, blindness, and significant neurological problems. In 2016, there were four cases of congenital syphilis in Saskatchewan; four years later there were more than 50.
Babies born with syphilis can have a number of health problems. (Pixabay)
Both HIV and syphilis are opportunistic infections that are more likely than the reality of living in poverty. Both are asymptomatic in their early stages, so people may not know they are infected. Poverty stress and substance use can contribute to people engaging in more risky behaviors for HIV and syphilis than they might otherwise.
Once infected, both syphilis and HIV can be treated, but treatment can be intensive – syphilis during pregnancy may require several appointments, and HIV requires daily medication. When people live without a secure home and live on a meager income, they need to devise creative strategies to survive and be screened, tested or treated for new infections is not always a top priority.
The benefits are reduced
Inadequate levels of social assistance in Saskatchewan have long contributed to the problem, which is now exacerbated by changes that have recently reduced overall benefits.
Unlike its predecessor, the new program does not fund the actual utility costs, but instead provides an insufficient fixed amount. Other aids were reduced or eliminated, such as clothing, furniture and school supplies.
Saskatchewan’s Prime Minister Scott Moe speaks to the media after the Saskatchewan budget was introduced in March 2022. CANADIAN PRESS / Liam Richards
The new program also abolished direct payments to landlords, which previously ensured that no matter what, rent was always paid. These changes mean more people are being evicted than ever, with the Saskatchewan Landlords Association reporting that 30 percent of people receiving social assistance are unable or unable to pay their rent in the months following the change.
In November 2021, the Ministry of Social Services said it would pay rent and utilities directly to recipients at risk of homelessness, but housing organizations said that was not yet the case.
More uncertainty, less resources
Rising levels of syphilis and HIV are exacerbated by these changes in income support because people have more insecurity and fewer resources than before.
Although pregnant women and new parents often use different strategies to get what they and their children need, their efforts are undermined by a fragmented care system, a lack of culturally responsible services and limited access to existing interventions. This includes screening and testing for asymptomatic, unidentified and / or untreated infections.
Ensuring adequate levels of social assistance is key to public health. We need no other reason to ensure that people have enough to live on than to reduce the rate of completely preventable infectious diseases. But it also makes economic sense.
Read more: CERB was luxurious compared to provincial social assistance
The cost of treating people who have contracted these diseases, and especially children, costs significantly more over time than providing adequate social assistance. Reducing social assistance rates is a costly mistake, and the most marginalized pay the most.
People living in poverty work hard to make ends meet and find creative strategies to get the most out of every dollar, but there is a limit. Without sufficient social assistance to meet people’s basic needs, more and more people find themselves in precarious circumstances and need access to more intensive and long-term interventions.
In Saskatchewan, there is a vicious circle of cutting public funding for social assistance to support people in difficulty, only to intervene when things are much, much worse.
Add Comment