The Canadian death toll from HIV — the human immunodeficiency virus that, in its most advanced stages, becomes AIDS — peaked at 1,764 in 1995, a year that ended with the hopeful news that a landmark drug had been approved.
By 1997, the death toll had dropped down to 525, the lowest since 1987, when the epidemic raged and stigma-filled headlines proclaimed the virus, which disproportionately impacts gay men, was “changing ways of addicts, hookers,” “becoming a disease for junkies” and, later, that “public’s fear of catching AIDS unrealistic reaction to publicity.”
May 2020. HIV, still very much a major public health issue, has lessened into a chronic condition and Canadians are, by and large, preoccupied with a new infectious disease threat: the novel coronavirus.
On May 12, the Canadian COVID-19 death toll topped 5,000, two months — practically to the day — after the World Health Organization declared it a pandemic. And while the virus doesn’t carry the same stigma as HIV-AIDS, this particular 21st-century pandemic isn’t without similarities to that 20th-century epidemic.
The narratives are alike in several ways, says Harlan Pruden, who is First Nations Cree from Turtle Island, works at the B.C. Centre for Disease Control and previously served on the U.S. Presidential Advisory Council on HIV/AIDS.
First, there is a fixation on a “vaccine as the panacea,” Pruden says. Second? In the absence of a vaccine, there is the focus on prevention via behaviour modification.
For HIV, the focus is sexual education: using condoms, taking pre-exposure prophylaxis to prevent HIV transmission if you don’t have HIV and taking antiretroviral therapy to reduce the likelihood of transmission if you do.
For COVID-19, the focus is handwashing and physical distancing under threat of expensive fines and possible jail time.
Here’s the thing, Pruden says: if the HIV epidemic taught us a lesson that’s useful right now, it’s that if the government does the messaging right, if it makes sure it’s “trusted, trenchant, timely and evidence-based” then “it doesn’t get to the point that you have 22 people playing soccer in a park… You don’t get to that policing level of intervention.”
That’s worth noting at a time when public health experts, health researchers, criminologists and lawyers have raised concerns about pandemic enforcement, particularly in eastern provinces like Ontario, Quebec and Nova Scotia.
Policing as a public health strategy does not engender trust, says Laura Bisaillon, an assistant professor in health and society at the University of Toronto’s Scarborough campus.
If there is ever a time for trust, it is in the midst of a pandemic, she says, “where things just spiral out of control too rapidly because of how we can transmit information to each other.”
People are habituated to expect policing as a response, Bisaillon says, but that doesn’t mean it should be.
“How we speak to each other, how we question each other either opens people up or closes people down,” she says.
“Policing and criminal law, which are both very serious, should be measures of last resort.”
That’s been top of mind lately for Alex McClelland, a postdoctoral fellow at the University of Ottawa’s criminology department who did his PhD research on the criminalization of HIV-AIDS. He also co-created Policing the Pandemic, a mapping project launched in April to track the ways in which COVID-19 orders are, or aren’t, being enforced nationwide.
“This idea that police should be first responders to a health crisis is flawed,” McClelland says. “It lacks imagination and even evidence.”
If the HIV-AIDS epidemic taught us anything, McClelland says, it’s that “criminal justice responses and policing responses only exacerbate the crisis.”
When McClelland was doing his PhD, he travelled across Canada to meet with people who had HIV to talk about their experiences with the criminal justice system. He met with people who had become registered sex offenders for life because they did not disclose their HIV status to consenting partners — even though there is no risk of transmission if the person is on an HIV medication.
“(The law) is an extremely blunt instrument that doesn’t really understand the nuances and complexities of social issues.”
It’s a concern that’s been raised repeatedly during this pandemic, as people experiencing homelessness report receiving tickets they can’t afford to pay, as Black people recount incidents where white people in parks received no tickets but they did.
As Michael Bryant, executive director of the Canadian Civil Liberties Association, recently told Global News: “All the worst harms that come with abuse of power always disproportionately impact racialized minorities, disabled people and homeless people.”
McClelland recounts one story from 1987: police responded to reports of an alleged neighbourhood disturbance by shooting teargas into the home of a man with dementia and HIV. They strapped him down and arrested him.
And another story from 2007: police used a Taser to arrest a Black man on the street because they thought he had HIV. They were heard telling passersby to “watch out, this man has AIDS, you might get AIDS from him.”
In both cases, 20 years apart, he says, there was a public outcry, and in both cases, the official police response was that they would increase their sensitivity training.
That’s not enough, McClelland says:
“It’s not an institution that’s founded on supporting public health, it’s not an institution that’s founded on supporting marginalized communities, and I don’t think that we can say police have learned anything from the criminalization of HIV.”
So far, the federal government, which at one point said it hoped to tackle the issue of HIV non-disclosure criminalization, is leaving policing this pandemic up to cities and provinces. On May 4, Global News asked Prime Minister Justin Trudeau how he reconciles federal support for cash-strapped Canadians with provinces doling out tickets. He didn’t directly answer.
Policing is the wrong approach in part because of the ramifications from cases like the ones McClelland highlighted, says Richard Elliott, executive director of the Canadian HIV/AIDS Legal Network.
“It’s been driven by stigma and other kinds of discriminatory notions about who is actually deserving of prosecution,” he says. “And when you start overextending coercive and punitive responses… you are immediately making the environment much less safe for people to actually connect with health services.”
In other words, it drives a wedge between a person who needs health help and the providers who can give it.
“Now people don’t think about HIV as a crisis, but they’re still afraid of HIV-positive people,” Frédérique Chabot, health information officer with Action Canada for Sexual Health and Rights told Global News in 2017.
“The stigma is fully alive, and it’s a huge driver for new infections.”
Also in 2017, a Toronto cop sparked protests after he was caught on camera saying: “He’s going to spit in your face and you’re going to get AIDS.”
HIV cannot be transmitted by spit. It can, however, be transmitted by blood, vaginal fluids, rectal fluids, semen and pre-seminal fluid, as well as breast milk. HIV infection rates climbed that year and again in 2018 and in 2019.
“The video, and the actions of the Toronto police officer in it… reflects the same misunderstanding of HIV transmission that has been used to justify the ongoing criminalization of HIV in Canada,” wrote the AIDS Committee of Toronto in a statement condemning the comments.
In response, the Toronto Police Service tweeted an apology and brought in outside experts to educate its members.
While that same stigma isn’t present in COVID-19, which does not appear to discriminate based on sexual orientation, Elliott says its effects still move “along some of the social fault lines of inequities and discrimination.”
That’s visible in the United States, where an Associated Press analysis found that 42 per cent of COVID-19-related deaths are Black people, double their percentage of the population.
The reasons, per the analysis, are because they’re more likely to be working front-line jobs, have less access to health care and are more likely to live in crowded neighbourhoods. Those same inequities exist in Canada, where advocates have been pushing provinces and the federal government to commit to collecting race-based data.
“To the extent that we are failing to actually address those inequalities that determine who is vulnerable or more vulnerable to acquiring SARS-CoV-2 or to developing serious illness if infected, we are replicating the story of HIV,” Elliott says.
— With files from the Canadian Press