The province of Saskatchewan leads the country in preventable, opportunistic diseases fueled by poverty. With new changes to income support programs and an increase in housing instability, things seem to be getting worse.
Saskatchewan has the highest rate of HIV in Canada, where cases are three times the national average. New cases are emerging through vertical transmission (from mother to child), which is largely overlooked in rich countries because such cases can be prevented with the use of anti-retroviral drugs.
Injection drug use is the most common mode of transmission in the province, and the number is highest among indigenous peoples where an ongoing legacy of colonialism, policy-induced poverty, inter-generational trauma and substance use has been woven together.
Indigenous peoples have faced these challenging situations with resistance, organizing Indigenous-led responses to HIV, and advancing Indigenous ways of knowing. But these efforts are being undermined by limited funds and the provincial government’s failures to provide adequate income support for those living in economic uncertainty.
The rise in HIV rates in Saskatchewan coincides with a new epidemic of syphilis.
This is not surprising, as syphilis increases susceptibility to HIV; It is a harbinger of more HIV infections to come. Syphilis cases are increasing rapidly, from five cases in 2016, to more than 800 cases in 2021. The disease is highly contagious in its less severe early stages and, like HIV, can be transmitted in pregnancy.
When transmitted in pregnancy (congenital syphilis), syphilis can have serious consequences, including stillbirth and babies born with a number of health problems, including skeletal and facial anomalies, deafness, blindness, and significant neurological problems. Are included. In 2016, there were four cases of congenital syphilis in Saskatchewan; Four years later there were over 50.
Both HIV and syphilis are opportunistic infections that are more likely to occur because of the realities of living in poverty. They are both asymptomatic in their early stages, so people may not know they are infected. The stress of poverty and substance abuse may contribute to people engaging in more HIV- and syphilis-risk behaviors than they might otherwise.
Once infected, both syphilis and HIV can be treated, but treatment can be rapid – syphilis may require multiple appointments during pregnancy and HIV requires daily medication. When people are living without reliable housing and exist on insufficient income, they have to come up with creative strategies to survive and being screened, tested or treated for new infections is not always a top priority.
Inadequate rates of social assistance in Saskatchewan have long contributed to this problem, which is now exacerbated by changes that have recently reduced the total amount of benefits.
Unlike its predecessor, the new program does not fund the actual cost of utilities, instead providing an insufficient fixed amount. Other supports were reduced or eliminated, such as for clothing, furniture and school supplies.
The new program also got rid of direct payments to landlords, which previously ensured that rents were always paid, whatever the case. These changes mean more people are being evicted than ever before, with the Saskatchewan Landlord Association reporting that 30 percent of people on Social Assistance did not pay or did not pay their rent in the months after the change took effect.
In November 2021, the Ministry of Social Services said it would pay rent and utilities directly for recipients who are at risk of homelessness, but housing organizations say this is still not happening.
More uncertainty, less resources
Rising rates of syphilis and HIV are made worse by these changes in income support because people have more uncertainty and fewer resources than ever before.
Although pregnant people and new parents often use different strategies to get what they and their babies need, their efforts have been hampered by a fragmented system of care, a lack of culturally responsive services, and limited access to existing interventions. is weakened. This includes screening and testing for asymptomatic, unknown and/or untreated infections.
Providing adequate rates of social support is the key to public health. We should need no other reason to ensure that people have enough lives than to reduce rates of completely preventable, infectious diseases. But it also makes economic sense.
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The cost of treating people who have contracted these diseases, and especially children, tends to be significantly higher over time than adequate social support is provided. Reducing Social Assistance rates is a costly mistake and the most marginalized have to pay the most.
People living in poverty work hard to meet their needs and find creative strategies to make the most of every dollar, but there are limits. Without adequate social support to meet people’s basic needs, more people are ending up in precarious circumstances, requiring access to more intensive and long-term interventions.
Saskatchewan has a vicious cycle of cutting off public funding for social aid to help those facing hardship, only to intervene when things are much, much worse.