1. In Relation to HIV/AIDS
Harm Reduction
In Relation to HIV/AIDS
Corena Ryan
Client Care Coordinator
2-Spirited People of the 1st Nations

2. Harm Reduction
What is it?

3. SIMPLY:
Harm Reduction is reducing the harm in your life.

4. How does this relate to HIV/AIDS?

5. Today’s Choices and Decisions
If someone chooses to try or use drugs that alter their state of mind, body, emotions or spirit, one must be aware of their actions and be prepared as best as possible to reduce the harm

6. Behaviours
There will always be situations or issues in our lives that are challenging and sometimes difficult.

7. Behaviour and Action
There will always be situations or issues in our lives that are challenging and sometimes difficult.
Its not what the issue or problem is, it is how we relate or act on it that can make a situation go little or go big.

8. Some youth:
Engage in sex or sexual activity

9. Some youth: Engage in sex or sexual activity
Smoke cigarettes, drink alcohol

10. Some youth: Engage in sex or sexual activity
Smoke cigarettes, drink alcohol
Sniff chemicals, gas, household products

11. Some youth: Engage in sex or sexual activity
Smoke cigarettes, drink alcohol
Sniff chemicals, gas, household products
Take prescription medication without a prescription or not under Doctors supervision

12. Some youth Engage in sex or sexual activity
Smoke cigarettes, drink alcohol
Sniff chemicals, gas, household products
Take prescription medication without a prescription or not under Doctors supervision
Experiment or use other legal or illicit drugs. Including Intravenous drugs/medications/substances – using needles

13. Know anyone who Engage in sex or sexual activity
Smoke cigarettes, drink alcohol
Sniff chemicals, gas, household products
Take prescription medication without a prescription or not under Doctors supervision
Experiment or use other illicit drugs. Including Intravenous drugs – drugs/medications/substances using needles
Cut, slash, pierce, tattoo and or share ink

14. Some people drink alcohol or use drugs as a coping or social mechanism.
Does this mean everyone who drinks and uses drugs has HIV or AIDS?

15. NO

16. HIV Transmission
Anyone who shares needles to inject a substance into their body (illicit or otherwise; insulin, steroids, hormones, silicone, botox, etc..) or tattooing has a high risk of transmitting or receiving HIV

17. HIV Transmission
Anyone who shares needles to inject a substance into their body (illicit or otherwise; insulin, steroids, hormones, silicone, botox, etc..) or tattooing has a high risk of transmitting or receiving HIV
Anyone who shares body fluid – breast milk, blood, semen, vaginal and anal

18. What might put you at risk?
Falling in love
Wanting intimacy
Trusting, even though you don’t know your partners HIV status
Being under the influences of substances that might loosen your inhibitions
Travelling and meeting new people
Being in prison or jail

19. How is HIV transmitted if I don’t do injection drug use or use needles?

20. How about sexual activity?!

21. Some Examples of Sexual Activity Include:
Masturbation
Penetration
Oral sex

22. Masturbation

23. Masturbation
Includes yourself or with someone else, each other, dry humping

24. Masturbation Yourself or with someone else, each other, dry humping
All low risk of transmitting HIV

25. Penetration

26. This includes oral, anal and vaginal

27. Oral sex

28. Oral Sex
For men this is called fellatio – “blow jobs”

29. What is a man’s risk of getting HIV from receiving fellatio?

30. What is a man’s risk of getting HIV from fellatio?
GOOD QUESTION!

31. Receiving Fellatio – Risk
Man’s risk very low – there needs to be an active blood flow in the mouth.

32. Receiving Fellatio Risk
Man’s risk very low – there needs to be an active blood flow in the mouth.
The body usually would clot that quickly. That is why kissing is not a risk. Why would you kiss someone with a bloody mouth anyway?

33. What about giving fellatio?

34. Giving Fellatio - Risks
When there are no cuts in or around the mouth and no loose gums, the risk is low

35. Giving Fellatio - Risks
When there are no cuts in or around the mouth and no loose gums, the risk is low
If there are open cuts and access to the gums, the risk is increased

36. Giving Fellatio - Risks
When there are no cuts in or around the mouth and no loose gums, the risk is low
If there are open cuts and access to the gums, the risk is increased
If the person giving has a cold or sore throat and ingests or swallows, the risk increases –White blood cells are already working

37. What about a woman receiving oral sex?

38. Cunninglingus
When done properly (stimulating the clitoris as opposed to the vaginal opening) or using a dental dam poses little or low risk

39. When done properly (stimulating the clitoris as opposed to the vaginal opening) or using a dam poses little or low risk
The woman receiving has NO risk – the skin is a great barrier. That’s why hugging and touching has NO risk in transmitting or contacting HIV/AIDS

40. Anal Sex

41. Anal Sex
Why Do it?

42. Why do it?
The butt hole/sphincter is full of nerve endings and creates a lot of sensation

43. Why Do it?
The sphincter is full of nerve endings and creates a lot of sensation
Must relax the sphincter slowly

44. Anal Intercourse
And use a condom with lubrication! Lots of it!
WHY?

45. Anal Intercourse
Cellular lining in rectum vulnerable to HIV or AIDS virus

46. Anal Intercourse
Cellular lining in rectum vulnerable to HIV or AIDS virus
Mucosal membrane of the head of the penis is vulnerable to virus and infection
Less chance of tearing when using a lubed condom and more lube

47. What about anal oral sex?

48. Rimming
Rimming can be licking, kissing and/or sucking the butt hole/sphincter

49. Rimming Risk
Rimming can be licking, kissing and/or sucking the butt hole/sphincter
NO risk unless the sphincter is bleeding and the person rimming has cuts in lips or gums – but WHO wants to lick a bleeding anus anyway?

50. Rimming can be licking, kissing and/or sucking the butt hole/sphincter
NO risk unless the sphincter is bleeding and the person rimming has cuts in lips or gums – but WHO wants to lick a bleeding anus anyway?
There is a risk of getting a digestive tract infection

51. What are the risks involved in Vaginal Intercourse?

52. Women’s Risks
Without condom use and success, semen can live in the vagina up to 5 days

53. Women’s Risks
Without condom use and success, semen can live in the vagina up to 5 days
If under 16 – some say 19, mucosal lining of the vaginal walls is not fully developed and is vulnerable to HIV infection

54. Women’s Risks Semen can live in the vagina up to 5 days
If under 16 – some say 19, mucosal lining of the vaginal walls is not fully developed and is vulnerable to HIV infection
Breaking of the hymen puts women at risk because more white blood cells rush to the area to fix the tear

55. Women’s Risks Semen can live in the vagina up to 5 days
If under 16 – some say 19, mucosal lining of the vaginal walls is not fully developed and is vulnerable to HIV infection
Breaking of the hymen puts women at risk because more white blood cells rush to the area to fix the tear
If past menopause, less natural sexual fluids means more possible friction tears

56. Women’s Risks Semen can live in the vagina up to 5 days
If under 16 – some say 19, mucosal lining of the vaginal walls is not fully developed and is vulnerable to HIV infection
Breaking of the hymen puts women at risk because more white blood cells rush to the area to fix the tear
If past menopause, less natural sexual fluids means more possible friction tears
Having a yeast infection while engaging in unprotected intercourse will increase risk of HIV

57. Are there any other women’s risks people should be aware of?

58. YES

59. Increased Women’s Risks
Douching-the body needs to replace natural mucous. The cells do not recognize the material and work overtime trying to get rid of the foreign material

60. Increased Women’s Risks
Douching-the body needs to replace natural mucous. The cells do not recognize the material and work overtime trying to get rid of the foreign material
Having a sexually transmitted infection (STI)

61. Increased Women’s Risks
Douching-the body needs to replace natural mucous. The cells do not recognize the material and work overtime trying to get rid of the foreign material
Having a sexually transmitted infection
Sex hormones – (“the Pill” used to prevent pregnancy) changes the dynamics of the mucosal lining of the vagina and cervix and increases the risk of HIV/AIDS transmission

62. What are men’s risk in unprotected vaginal intercourse?

63. Good question!

64. Men’s risk in unprotected vaginal intercourse
Exposure to vaginal fluids that contain HIV while inside the vagina

65. Men’s risk in unprotected vaginal intercourse
Exposure to vaginal fluids that contain HIV while inside the vagina
Uncircumcised penis will hold the fluids around the head (marinating), increasing risk of HIV transmission

66. What can I do without any risk
What can I do without any risk? aka getting off without any risks involved

67. Other sexual acts without risk
All of these are very safe as long as you do not have any breaks in the skin
Fingering
Deep throat kissing or quick kisses
Holding hands
Body/ dry rubbing
Spanking or biting
Giving/getting hickies
Massage 
Talking “dirty”
Eye candy

68. What about casual contact and nothing sexual about it?

69. Casual Contact It is safe to: Be in a sweat or sauna Swimming
Brushing or braiding hair
Wiping someone’s tears
Sharing clothes – Not underwear for hygiene reasons
Hugging/shaking hands
Sharing a drink
Being in a talking circle
Dancing
Drumming and or singing together

70. What about Mother to Child?

71. Mother to Child
Only 1 in 4 babies will get HIV from an HIV+ mother

72. MTCT Only 1 in 4 babies will get HIV from an HIV+ mother
Living in Ontario, mothers can choose to test for HIV with their pregnancy test or any other prenatal blood test
If + moms to be can take HAART medication during the first trimester and again during labour this will reduce transmission to baby (down to 1%)
Current debate as to whether a caesarian will reduce transmission because it is a controlled birth. Women would rather NOT be cut open if they don’t have to be.
Breast feeding is NOT recommended as HIV lives in milk

73. MTCT
With HAART medication a woman can still plan to have a baby without any major worries of transmission. Risk depends on her blood work. She needs to talk to her Doctor or health care provider to plan the pregnancy first. It is very important to be honest with your Doctor or care giver especially when thinking of having a baby

74. WARRIOR CELLS
White Blood cells are helpers and they are trying to cure the infection. They are the “Warrior Cells” that protect the body. HIV is a virus that is stronger and takes them as POW

75. You’ve been sitting too long Time to get up!

76. Let’s talk numbers!

77. Aboriginal statistics 2007
Canada has approximately 60,000 people living with HIV. The recent statistics presented at the Canadian AIDS HIV Research and Healing Our Spirit conference in Vancouver showed that approximately 4500 people test HIV+ every year. Aboriginal people are disproportionally impacted by HIV and AIDS. In 2007, 40% (1800 or 163 Aboriginal people in each province) were Aboriginal people who tested % (2835 or 258 in each province) of these engaged or were engaging in Intravenous Drug Use and 28% (794/72) positive tests were due to heterosexual contact.
Aboriginal women make up approximately 48-52% (2340 or 213 in each province) of new infections every year. Aboriginal youth make up approximately 10% (450 or 41 in each province) of these new infections.

78. Who Tested Positive in 2007?

79. This speaks to the longevity of our communities and generations.
Aboriginal Non Aboriginal
15-19 year old 75% 60%
20-29 year old 60% vs. 35%
30-49 year old 41% 20%
% 15%
The impact of HIV/AIDS on our youth is enormous.
This speaks to the longevity of our communities and generations.

80. Did you know?

81. Did you know?
For Ontario and Quebec, the provinces do not include HIV rates for Aboriginal people. Aboriginal people include; First Nations, Innuit and Metis. When an Aboriginal person is tested for HIV in these provinces, the majority of the results test positive for AIDS. This is the later stage of HIV. This is when they are presenting with 1 or 2 opportunistic infections (OI). These OI’s can be certain kinds of cancer,pneumonia, yeast infections, bronchitis, wasting (serious unexplained weight loss) and many, many more.
Check for more info.

82. Why you should get tested?

83. Why you should get tested
relieve feelings of uncertainty
opportunity to receive accurate information and obtain support
if you are HIV positive you can begin action now to remain healthy
reduce the possibility of more people being infected
planning for a baby

84. How do I get tested?

85. You have many choices

86. Nominal
Your blood is taken at a Dr.’s office, medical clinic or hospital. They have your Health Card Number.

87. Anonymous
Taken at a clinic or location where they do not use your health card or any other personal information. You will be given a number which is needed to get your results. This way you are the only person who can identify your test result

88. IMPORTANT!
Many physicians offer a "confidential" testing system using a number or your initials. This is not anonymous testing. If you test positive, your doctor can still report your name to the health department
S/he has the option of nominal testing (giving them your name so the Health Unit can do follow-up) or "non-nominal" testing (the Health Unit is told that someone in his/her practice tested positive but the doctor is responsible for post-test counselling and follow-up).

89. Standard Testing
The nurse takes a blood sample from your vein. Results for an HIV test take an average of one - two weeks to return. Test results are given in person whether the test comes back negative or positive.

90. Rapid Testing
The nurse takes a drop of blood by pricking your finger. They test it at the clinic while you wait. You get your result in five to twenty minutes. If the test is negative, no further testing is necessary. But, if the rapid test is positive, the result will be confirmed by taking a tube of blood from your vein and completing a standard test.

91. Some Pro’s and Con’s

92. Nominal
You may not be ready for your result. Public health will find and contact you. They will ask who you have had sexual relations and/or shared needles with.
Not comfortable with present medical relationship
Your doctor will receive your results if taken in their office
Public Health will know how many Aboriginal people are +. This department directly advises the Minister of Health (MoH). The MoH delegates the $ for prevention, testing, treatment and support.

93. Anonymous you choose who to tell if you tested positive
chance of lower anxiety
no one will know if you have been tested
The less testing done in Aboriginal communities means less $ for programs and services

94. Where else can I get tested?
Call Sexual Health Infoline at
North Bay Health Unit
North Bay Parry Sound District Health Unit You can get tested at the North Bay Parry Sound District Health Unit, "The Clinic”
AIDS Committee of North Bay and Area 269 Main Street West, Suite 201 North Bay, ON P1B 2T8 Tel. / Tél. : (705)
AIDS Committee of Ottawa (ACO) / Comité sida d'Ottawa (CSO) 251 Bank Street, Suite 700 Ottawa, ON K2P 1X3 Tel. / Tél. : (613)

95. Condom Practices Always check the date of expiry
Make sure the package bubbles when you squeeze it-means it hasn’t been opened
Move the condom to the side to open. Never use your teeth
Squeeze the tip (looks like a hat) so the ejaculate won’t burst open
Roll all the way down the shaft of the erect penis
When done, take off while semi-erect/hard, tie it in a knot and put it in kleenex for disposal
Never share sex toys without properly washing and changing a condom each time

96. And don’t forget!

97. THE FEMALE CONDOM! 

98. The Female Condom Gives the woman power to put on protection
Can put it on before you even start
Inner ring is supposed to be anchored to the cervix like a diaphragm
Outer ring might stimulate the clitoris during intercourse
Can use for an entire evening of pleasure

99. How Long Term Care works with Harm Reduction and HIV

100. How Long Term Care works with Harm Reduction and HIV
Assist Aboriginal People who live with HIV/AIDS (APHA’s) by
Providing harm reduction materials and information such as; needle exchange, safer crack smoking kits, dental dams, condoms – both male and female and lube.

101. How Long Term Care works with Harm Reduction and HIV
Assist Aboriginal People who live with HIV/AIDS (APHA’s) by
Providing harm reduction materials and information such as; needle exchange, safer crack kits, dental dams, condoms – both male and female and lube.
helping manage healthy lifestyles,

102. How Long Term Care works with Harm Reduction and HIV
Assist Aboriginal People who live with HIV/AIDS (APHA’s) by
Providing harm reduction materials and information such as; needle exchange, safer crack smoking kits, dental dams, condoms – both male and female and lube.
helping manage healthy lifestyles,
minimizing stress on the body, mind and spirit,

103. How Long Term Care works with Harm Reduction and HIV
Assist Aboriginal People who live with HIV/AIDS (APHA’s) by
Providing harm reduction materials and information such as; needle exchange, safer crack smoking kits, dental dams, condoms – both male and female and lube.
helping manage healthy lifestyles,
minimizing stress on the body, mind and spirit,
Provide referrals for traditional medicines, Elders, traditional support

104. How Long Term Care works with Harm Reduction and HIV
End of life care and support. Naadmaagehwiinag Program -Volunteer care teams, buddy program, referral to Community Care Access Centre, hospices and other AIDS service organizations. Funeral arrangements/planning, body transportation.

105. How Long Term Care works with Harm Reduction and HIV
Services include assistance with forms such as the Power of Attorney Forms for Personal Property and Finances, living wills.
Advocacy with health professionals includes; going to and/or arranging (transportation and escort) medical appointments

106. Whatever your choice is ..

107. YOU DECIDE

108. CHI-MIIGWETCH

109. CHI-MIIGWETCH
Jody Cotter

110. CHI-MIIGWETCH Jody Cotter Elly Antone Info from:
2-Spirited People of the First Nations
Canadian Aboriginal AIDS Network
Ontario Aboriginal HIV/AIDS Strategy
Healing Our Spirit