'Disheartening' having to issue HIV outbreak warning in Thunder Bay, medical officer of health says

The medical officer of health for the Thunder Bay District Health Unit says it's "disheartening" that public health officials had to declare an outbreak of HIV in the population of the northwestern Ontario city who are homeless or lack stable housing.

Eight new cases of HIV have been confirmed since January 1 and another two are under investigation, the health unit said, with a spike in May and June, which prompted the outbreak warning. Dr. Janet DeMille said that spike includes seven cases which were either confirmed or are being investigated.

"It is quite concerning, very much so, and quite disheartening," DeMille said. "We have been aware that we had ... enough risk in the population that this could happen but we were, we actually had very low rates which was very good."

The health unit said HIV is most commonly spread through sharing needles for injection drug use and unprotected sexual activity.

"We knew that this could happen and we've been doing more work related to HIV, including increasing testing so we would pick up something like this early," DeMille said. "But it is actually quite disheartening that it's come to the point that it's an actual outbreak."

People on the street also deal with "many other issues and many other burdens," DeMille said, including a declared outbreak in the population of tuberculosis in 2018.

The risk has always been there, DeMille said, adding that there have been HIV outbreaks declared in other cities in Ontario — DeMille cited London as an example — as well as a number of communities in Canada and the U.S.

"We've just had more spreading of the virus among people and we reached a certain ... threshold of numbers, number of cases where we've seen, what we call more transmission or spread from person to person," she said.

"We knew that this could happen."

The health unit's street nurses have actively been working with those who are homeless or lack stable housing, DeMille said, speaking with people daily and offering testing, education and counselling; additionally the health unit provides clean needles.

With the outbreak now declared, DeMille said those efforts will continue. Additionally, she said she'll be speaking more with health care providers in the city about "enhancing individuals' access to health care and how we might work better together to support individuals accessing care."

"I think we will be engaging more [with] that population about what their needs might be and looking to try to meet their needs as much as possible."