Scott Harrison reflects on AIDS care

St. Paul’s was one of the first hospitals in Canada to treat HIV/AIDS patients—and today it’s one of the world’s leading clinical and research centres for this disease, providing care to more than 65% of the HIV positive people in the province.

Scott Harrison is the director of Urban Health & HIV/AIDS at Providence. As the 2014 International AIDS conference is about to begin in Melboune, we asked him to reflect on his experience and thoughts of HIV care.

PHC: How did you get involved in HIV care?

Scott Harrison (SH): I was a nurse working in intensive care in the UK in the 90s, prior to the introduction of antiviral treatment and looked after a lot of HIV/AIDS patients. I saw the suffering and the stigma these patients experienced. Caring for vulnerable and marginalized populations was something I have always been passionate about and so HIV care resonated with me.

PHC: Do you think there is still a lot of stigma around HIV/AIDS?

SH: Stigma still exists but it has changed. In the early days, when people didn't really know what was going on, there were a lot of misconceptions about how the virus was contracted. Back then, there was also a lack of public education, which created a lot of urban myths, some of which still continue.

Unfortunately, in countries that are experiencing huge HIV infection rates such a Sub-Saharan Africa, stigma continues. I would say in Canada, we are ahead of the curve with stigma. But it persists; mainly because of the way the virus is contracted.

Drugs and sex are taboo topics. People don’t like talking about it; there is a lot of discomfort when people discuss sex. So there is shame associated with HIV because it is contracted primarily through sex and injection drug use. This leads to secrecy and people not wanting to talk or think about HIV compared to other illnesses. It is much easier to talk about heart disease, even though there is some stigma with obesity, it’s not the same as drug use or sex. There is still the idea that this is ‘their fault’ for contracting the virus because of sex and drug use.

HIV is also the only virus associated with a criminal element, which doesn’t help with stigma.

PHC: Can you elaborate more on that “criminal element?”

SH:  For example, you can’t be charged with passing on herpes, yet you can with HIV. Putting legal parameters around HIV perpetuates it as a stigmatized condition.

PHC: You’ve been providing care to those living with HIV for a while, what has been the biggest break through you have seen in the field?

I would say the introduction of the antiretroviral cocktail. Prior to the cocktail, we had limited drugs to treat patients and many of the drugs had devastating side-effects. In the pre-cocktail days, when a patient was diagnosed with HIV, they may have 10 years to live, and that is with taking sometimes as much as four pills a time, six times a day. With the cocktail, sometimes patients just need to take one pill a day and the drugs are very effective. And the earlier we diagnose the better the outcome.

BC is the birthplace of cocktail, and with it, we can give people their lives back if we catch the disease early enough. HIV was a life-threatening sentence and now it is more of a chronic disease. If well managed, the patient can lead a normal life.

PHC: What is on the horizon/what is exciting?

The work through STOP HIV, now called Hope to Health in BC, has been ground breaking. We have created a new way of organizing care to ensure people are diagnosed early, supported and managed all through their disease process.

Part of the project was to remove barriers and offer free HIV testing to adults. PHC actually piloted this approach; St. Paul’s Hospital has been doing routine offers of HIV tests for everyone admitted to acute care for many years. It’s exciting to see this role out to the rest of the province.

PHC: What are you most proud of at PHC?

I am most proud of working with an amazing team of clinicians, social workers, nurses and doctors. They are a committed and highly skilled team who are passionate about their work and give exceptional patient care every day. They are working on front lines with vulnerable populations and supporting people with trauma, addiction and HIV.

Thank you Scott for sharing your experience and thoughts with us. What do you think about stigma and HIV/AIDS? Have we made progress in Canada, or do we have a long way to go? We want to hear from you, have your say on Bloom!