Top health officials say they are trying to limit the spread of the monkeypox virus while also preventing stigma against those most affected — particularly gay, bisexual and other men who have sex with men — but their messaging may be a part of the problem, according to some advocates.
More than 21,000 people, in over 70 countries, have contracted the virus, which causes painful sores and blisters among other symptoms. An estimated 98 per cent of confirmed cases are in men who have sex with men.
This week, the head of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, warned stigma “can be as dangerous as any virus and can fuel the outbreak.” At the same time, he urged men who have sex with men to reduce their number of sexual partners or to reconsider having new sexual partners “for the moment.”
The Public Health Agency of Canada (PHAC), which has reported at least 745 cases since the first two cases were detected in late May, also urged men who have sex with men to limit sexual partners, especially casual acquaintances.
“I think when we try to tell people ‘Stop doing this. Stop doing that,’ it doesn’t really work,” Devan Nambiar of the Gay Men’s Sexual Health Alliance in Toronto told CBC News. “It hasn’t worked in any infection.”
Devan Nambiar, manager of capacity building at the Gay Men’s Sexual Health Alliance in Toronto, said the stigma of HIV/AIDS is still prevalent after more than 40 years. (Submitted by Devan Nambiar)
It is important to make people aware of the risk factors so they can make informed decisions, and to be compassionate and concise in the messaging, he said, but not to stigmatise people for their sexual activity and behaviour – something gay men, in particular, have endured since the early years of the HIV/AIDS pandemic when the illness was widely considered a “gay disease.”
Lessons learned from that era have been applied to public health care today, but there are criticisms that history is repeating itself with the handling of the monkeypox outbreak.
Some advocates attending the International AIDS Conference (AIDS 2022) in Montreal from July 29 – Aug. 2 say health officials need to prevent the perception that a viral threat, like HIV/AIDS or monkeypox, only affects one portion of the population.
“[We] lived that with the HIV epidemic. We certainly saw that with COVID-19. Let’s not do it with monkeypox, right?” said Linda-Gail Bekker, deputy director of the Desmond Tutu HIV Centre at the University of Cape Town’s Institute of Infectious Disease and Molecular Medicine in South Africa and a past president of the International AIDS Society, which organized the AIDS 2022 gathering.
Engagement key to combating health threats
The conference returns to Montreal for the first time since 1989, a time when access was limited to drugs that could prolong the lives of people infected with HIV. The majority of those dying from AIDS at that time were gay, bisexual and other men who have sex with men, transgender women, as well as injection drug users.
WATCH | Is monkeypox messaging missing the mark?
Concerns over public health messaging around monkeypox
2 days ago
Duration 2:05
As monkeypox cases spread worldwide, overwhelmingly among men who have sex with men, there is growing concern that public health messages targeting that community have missed the mark.
The monkeypox virus, however, is not a sexually transmitted infection like HIV, the virus that causes AIDS; it’s transmitted through close personal contact with someone who is infected, but also through direct contact with materials that have touched the bodily fluids or sores of an infected person, such as bed sheets or clothing.
Bekker believes that without proper communication and engagement with affected groups — whether it concerns HIV/AIDS or monkeypox — there is a risk of discrimination that may lead to people not seeking or being able to access the services they need.
Gay men take health into their own hands
Nambiar, who will also be attending the AIDS 2022 conference which begins Friday, said gay and bisexual men have long been their own health-care advocates, having to “figure a lot of things out for ourselves” because of “indifference” to the LGBTQ community.
“We have led the work in many things actually, in terms of getting self checks, taking [on] advocacy, taking autonomy in terms of our well-being, fighting for our rights,” he told CBC News.
With monkeypox, he said, gay and bisexual men have been speaking up loudly since early on, calling for paid leave so they can properly quarantine, and to demand access to testing and vaccines.
He said it’s an individual decision to get vaccinated to protect against monkeypox, something about 27,000 eligible people have done so far in Canada, according to PHAC.
Some public health authorities have set up pop-up vaccination clinics at locations frequented by men who have sex with men, including gay bars, bathhouses and cruising areas. The response to monkeypox has been “pretty decent” in Canada, Nambiar said, though he can’t say the same for other countries.
In the U.S., which now has the highest number of recorded cases of monkeypox, the response to the outbreak has been criticized. One AIDS advocate compared the U.S. government’s initial response to monkeypox to their handling of the COVID-19 pandemic, when the country led the world in deaths and less than 70 per cent of the population is fully vaccinated.
LISTEN | Dr. Anthony Fauci on HIV/AIDS, monkeypox and COVID-19:
The Current20:50Dr. Anthony Fauci on the lessons learned from COVID-19, HIV/AIDS and monkeypox
We talk to Dr. Anthony Fauci about the COVID-19 pandemic, the lessons he learned from the fight against HIV/AIDS, and what the world needs to do to get rising monkeypox cases under control.
HIV/AIDS overshadowed by converging threats
As fears grow over monkeypox, and with COVID-19 case numbers again rising, health professionals gathering in Montreal worry about whether the world will be able to meet the UN’s 2030 target to end HIV/AIDS as a global health concern.
There were an estimated 38.4 million people living with HIV/AIDS globally in 2021, with approximately 1.5 million new HIV infections last year. The United Nations said that is a million cases higher than global targets and a sign of “faltering progress.”
This week, at the launch of a new UNAIDS report titled In Danger, UNAIDS Executive Director Winnie Byanyima warned “the response to the AIDS pandemic has been derailed by global crises,” including the war in Ukraine and international economic instability.
“The actions needed to end AIDS are also key for overcoming other pandemics,” she said.
Over the four days of the AIDS 2022 conference, there will be a push to “counter apathy” in combating HIV/AIDS globally and a call “to re-engage and follow the science.”
Winnie Byanyima, executive director of UNAIDS, holds up the 2022 update on the global AIDS situation at a news conference in Montreal, ahead of the World AIDS Conference this weekend. (Ryan Remiorz/The Canadian Press)
“Some of this is going on the offensive,” said Bekker, noting there is an additional challenge with the polarization around science that has emerged in the COVID-19 pandemic.
Nambiar said some of that apathy towards HIV/AIDS comes from being “inundated with viruses,” with the mutated variants and subvariants of COVID-19, and now monkeypox.
But he said one of the important lessons that has been learned over the years, that certainly applies today, is that a successful response to a public health emergency requires cooperation between governments, public health workers and community organizations. That didn’t happen immediately with HIV/AIDS, but he sees it developing now in response to monkeypox.
Though there have been remarkable achievements in the last four decades to prevent the transmission of HIV and allow people to live with the infections as a chronic illness, Bekker wants to remind people that doesn’t mean the HIV/AIDS pandemic is over.
“I would say we’ve got the hardest mile to come,” she told CBC News. “We really do need to gird our loins, pull ourselves together as a community and say, ‘What can we do to reach that last mile?'”
Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.
The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.
The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.
The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.
“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.
When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.
“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.
“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.
The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.
Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.
The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.
“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.
They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.
“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”
This report by The Canadian Press was first published Oct. 17, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
CALGARY – Alberta’s health minister says a new agency responsible for primary health care should be up and running by next month.
Adriana LaGrange says Primary Care Alberta will work to improve Albertans’ access to primary care providers like family doctors or nurse practitioners, create new models of primary care and increase access to after-hours care through virtual means.
Her announcement comes as the provincial government continues to divide Alberta Health Services into four new agencies.
LaGrange says Alberta Health Services hasn’t been able to focus on primary health care, and has been missing system oversight.
The Alberta government’s dismantling of the health agency is expected to include two more organizations responsible for hospital care and continuing care.
Another new agency, Recovery Alberta, recently took over the mental health and addictions portfolio of Alberta Health Services.
This report by The Canadian Press was first published Oct. 15, 2024.
Rana Van Tuyl was about 12 weeks pregnant when she got devastating news at her ultrasound appointment in December 2020.
Her fetus’s heartbeat had stopped.
“We were both shattered,” says Van Tuyl, who lives in Nanaimo, B.C., with her partner. Her doctor said she could surgically or medically pass the pregnancy and she chose the medical option, a combination of two drugs taken at home.
“That was the last I heard from our maternity physician, with no further followup,” she says.
But complications followed. She bled for a month and required a surgical procedure to remove pregnancy tissue her body had retained.
Looking back, Van Tuyl says she wishes she had followup care and mental health support as the couple grieved.
Her story is not an anomaly. Miscarriages affect one in five pregnancies in Canada, yet there is often a disconnect between the medical view of early pregnancy loss as something that is easily managed and the reality of the patients’ own traumatizing experiences, according to a paper published Tuesday in the Canadian Medical Association Journal.
An accompanying editorial says it’s time to invest in early pregnancy assessment clinics that can provide proper care during and after a miscarriage, which can have devastating effects.
The editorial and a review of medical literature on early pregnancy loss say patients seeking help in emergency departments often receive “suboptimal” care. Non-critical miscarriage cases drop to the bottom of the triage list, resulting in longer wait times that make patients feel like they are “wasting” health-care providers’ time. Many of those patients are discharged without a followup plan, the editorial says.
But not all miscarriages need to be treated in the emergency room, says Dr. Modupe Tunde-Byass, one of the authors of the literature review and an obstetrician/gynecologist at Toronto’s North York General Hospital.
She says patients should be referred to early pregnancy assessment clinics, which provide compassionate care that accounts for the psychological impact of pregnancy loss – including grief, guilt, anxiety and post-traumatic stress.
But while North York General Hospital and a patchwork of other health-care providers in the country have clinics dedicated to miscarriage care, Tunde-Byass says that’s not widely adopted – and it should be.
She’s been thinking about this gap in the Canadian health-care system for a long time, ever since her medical training almost four decades ago in the United Kingdom, where she says early pregnancy assessment centres are common.
“One of the things that we did at North York was to have a clinic to provide care for our patients, and also to try to bridge that gap,” says Tunde-Byass.
Provincial agency Health Quality Ontario acknowledged in 2019 the need for these services in a list of ways to better manage early pregnancy complications and loss.
“Five years on, little if any progress has been made toward achieving this goal,” Dr. Catherine Varner, an emergency physician, wrote in the CMAJ editorial. “Early pregnancy assessment services remain a pipe dream for many, especially in rural Canada.”
The quality standard released in Ontario did, however, prompt a registered nurse to apply for funding to open an early pregnancy assessment clinic at St. Joseph’s Healthcare Hamilton in 2021.
Jessica Desjardins says that after taking patient referrals from the hospital’s emergency room, the team quickly realized that they would need a bigger space and more people to provide care. The clinic now operates five days a week.
“We’ve been often hearing from our patients that early pregnancy loss and experiencing early pregnancy complications is a really confusing, overwhelming, isolating time for them, and (it) often felt really difficult to know where to go for care and where to get comprehensive, well-rounded care,” she says.
At the Hamilton clinic, Desjardins says patients are brought into a quiet area to talk and make decisions with providers – “not only (from) a physical perspective, but also keeping in mind the psychosocial piece that comes along with loss and the grief that’s a piece of that.”
Ashley Hilliard says attending an early pregnancy assessment clinic at The Ottawa Hospital was the “best case scenario” after the worst case scenario.
In 2020, she was about eight weeks pregnant when her fetus died and she hemorrhaged after taking medication to pass the pregnancy at home.
Shortly after Hilliard was rushed to the emergency room, she was assigned an OB-GYN at an early pregnancy assessment clinic who directed and monitored her care, calling her with blood test results and sending her for ultrasounds when bleeding and cramping persisted.
“That was super helpful to have somebody to go through just that, somebody who does this all the time,” says Hilliard.
“It was really validating.”
This report by The Canadian Press was first published Oct. 15, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
