Harm Reduction
In Relation to HIV/AIDS
Corena Ryan
Client Care Coordinator
2-Spirited People of the 1st Nations
Harm Reduction
• What is it?
SIMPLY:
• Harm Reduction is reducing the harm in
your life.
How does this relate to HIV/AIDS?
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
Behaviours
• There will always be situations or issues in
our lives that are challenging and
sometimes difficult.
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.
Some youth:
• Engage in sex or sexual activity
Some youth:
• Engage in sex or sexual activity
• Smoke cigarettes, drink alcohol
Some youth:
• Engage in sex or sexual activity
• Smoke cigarettes, drink alcohol
• Sniff chemicals, gas, household products
Some youth:
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•
•
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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
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
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
• 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?
NO
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
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
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
How is HIV transmitted if I don’t do
injection drug use or use needles?
How about sexual activity?!
Some Examples of Sexual Activity
Include:
• Masturbation
• Penetration
• Oral sex
Masturbation
Masturbation
• Includes yourself or with someone else,
each other, dry humping
Masturbation
• Yourself or with someone else, each other,
dry humping
• All low risk of transmitting HIV
Penetration
• This includes oral, anal and vaginal
Oral sex
Oral Sex
• For men this is called fellatio – “blow jobs”
What is a man’s risk of getting HIV
from receiving fellatio?
What is a man’s risk of
getting HIV from fellatio?
GOOD QUESTION!
Receiving Fellatio – Risk
• Man’s risk very low – there needs to be an
active blood flow in the mouth.
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?
What about giving fellatio?
Giving Fellatio - Risks
• When there are no cuts in or around the
mouth and no loose gums, the risk is low
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
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
What about a woman receiving oral
sex?
Cunninglingus
• When done properly (stimulating the
clitoris as opposed to the vaginal opening)
or using a dental dam poses little or low
risk
• 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
Anal Sex
Anal Sex
• Why Do it?
Why do it?
• The butt hole/sphincter is full of nerve
endings and creates a lot of sensation
Why Do it?
• The sphincter is full of nerve endings and
creates a lot of sensation
• Must relax the sphincter slowly
Anal Intercourse
• And use a condom with lubrication! Lots of
it!
• WHY?
Anal Intercourse
• Cellular lining in rectum vulnerable to HIV
or AIDS virus
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
What about anal oral sex?
Rimming
• Rimming can be licking, kissing and/or
sucking the butt hole/sphincter
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?
• 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
What are the risks involved in
Vaginal Intercourse?
Women’s Risks
• Without condom use and success, semen
can live in the vagina up to 5 days
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
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
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
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
Are there any other women’s
risks people should be
aware of?
YES
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
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)
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
What are men’s risk in unprotected
vaginal intercourse?
• Good question!
Men’s risk in unprotected vaginal
intercourse
• Exposure to vaginal fluids that contain HIV
while inside the vagina
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
What can I do without any risk? aka
getting off without any risks
involved
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
What about casual contact and
nothing sexual about it?
Casual Contact
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•
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•
•
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•
•
•
•
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
What about Mother to Child?
Mother to Child
• Only 1 in 4 babies will get HIV from an
HIV+ mother
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
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
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
You’ve been
sitting too long
Time to get up!
Let’s talk
numbers!
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 +. 63% (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.
Who Tested
Positive in
2007?
»
•
•
•
•
15-19 year old
20-29 year old
30-49 year old
50+
Aboriginal
Non Aboriginal
75%
60% vs.
41%
30%
60%
35%
20%
15%
The impact of HIV/AIDS on our
youth is enormous.
This speaks to the longevity of
our communities and generations.
Did you know?
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 www.catie.ca for more info.
Why you should get tested?
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
How do I get tested?
You have many choices
Nominal
Your blood is taken at a Dr.’s office,
medical clinic or hospital. They have your
Health Card Number.
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
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).
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.
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.
Some Pro’s and Con’s
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.
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
Where else can I get tested?
• Call Sexual Health Infoline at 1-800-668-2437
• 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) 497-3560
• AIDS Committee of Ottawa (ACO) / Comité sida
d'Ottawa (CSO)
251 Bank Street, Suite 700
Ottawa, ON K2P 1X3
Tel. / Tél. : (613) 238-5014
Condom Practices
• Always check the date of expiry
• Make sure the package bubbles when you squeeze itmeans 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
And don’t forget!
THE FEMALE CONDOM!

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
How Long Term Care works with
Harm Reduction and HIV
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.
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,
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,
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
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.
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
Whatever your choice is ..
YOU DECIDE
CHI-MIIGWETCH
CHI-MIIGWETCH
Jody Cotter
CHI-MIIGWETCH
• Jody Cotter
• Elly Antone
Info from:
• 2-Spirited People of the First Nations
• www.2spirits.com
• Canadian Aboriginal AIDS Network
• www.caan.ca
• Ontario Aboriginal HIV/AIDS Strategy
• www.oahas.org
• Healing Our Spirit
• www.healingourspirit.org