>> Steve: IN THE EARLY DAYS OF THE AIDS EPIDEMIC, THE DISEASE SWEPT THROUGH COMMUNITIES,
LEAVING A TRAIL OF DEATH AND FEAR.
THAT'S NO LONGER THE CASE, IN MOST INDUSTRIALIZED COUNTRIES.
BUT TOO OFTEN THE STIGMA OF HIV LINGERS, AND THAT CAN HAMPER EFFORTS TO PREVENT DISEASE
TRANSMISSION AND PUT AN END TO THE EPIDEMIC.
WITH US NOW FOR A FRONTLINE VIEW OF WHAT'S NEEDED: IN VAUGHAN, ONTARIO:
PRACTICING PSYCHOLOGIST TREVOR HART, WHO IS ALSO DIRECTOR OF THE RYERSON UNIVERSITY'S HIV
PREVENTION LAB.
TREVOR, IT'S GOOD TO HAVE YOU ON OUR PROGRAM TONIGHT.
HOW ARE YOU DOING?
>> Trevor Hart: I'M DOING VERY WELL.
IT'S GOOD TO BE HERE.
>> Steve: BEFORE WE TALK ABOUT AIDS TODAY, I'D LIKE YOU TO TAKE US BACK.
TAKE US BACK TO THE EARLY 1980s, AND OF COURSE WE'RE GOING TO HAVE A LOT OF PEOPLE
WATCHING OR LISTENING RIGHT NOW WHO DON'T REMEMBER THOSE DAYS, THEY WEREN'T AROUND, AND I WANT
YOU TO GIVE THEM A SENSE OF WHAT THE GENERAL POPULATION THOUGHT ABOUT AIDS AT THAT TIME.
>> Trevor Hart: WELL, IT WAS A REALLY DIFFERENT ENVIRONMENT FOR A LOT OF PEOPLE.
THEY WERE AFRAID THAT THIS REALLY WAS A DEATH SENTENCE, THAT THEY WOULD BE -- GET THIS
VIRUS AND GET SICK AND EVENTUALLY DIE FROM THE VIRUS.
IT WAS A VERY SCARY TIME FOR PEOPLE, AND THERE WAS A TIME THAT PEOPLE WERE FEELING REALLY
APATHETIC IN THE GENERAL SOCIETY ABOUT THE PEOPLE THAT WERE GETTING HIV.
THEY DIDN'T REALLY CARE ABOUT THOSE PEOPLE WHO WERE GETTING HIV AND WOULD KIND OF HOPE THEY
WOULD GO AWAY.
I WAS JUST CHATTING WITH SOMEBODY ABOUT THIS -- ABOUT THAT HISTORY IN THE '80s AND
SOME PEOPLE IN THE GENERAL POPULATION WERE SAYING HIV ACTUALLY WAS A CURE OF THESE
PEOPLE THAT WE DON'T LIKE.
>> Steve: IN FACT, I REMEMBER WELL, IT WAS OFTEN REFERRED TO AS THE, QUOTE, UNQUOTE, GAY
PLAGUE, SOMETHING THAT HAPPENED TO OTHER PEOPLE THAT SORT OF POLITE SOCIETY DIDN'T NEED TO
WORRY ABOUT.
WHEN DID THOSE PERCEPTIONS BEGIN TO CHANGE?
>> Trevor Hart: WELL, I THINK THEY HAVEN'T CHANGED 100 PERCENT.
I THINK IT WAS IN 1996 THAT THERE WAS THE ADVENT OF HIGHLY EFFECTIVE ANTIRETROVIRAL
THERAPY.
THAT CHANGED HIV FROM A DEATH SENTENCE INTO SOMETHING THAT IS A CHRONIC DISEASE THAT PEOPLE
CAN LIVE WITH.
SO THAT REALLY CHANGED THE PERCEPTION OF HIV AS A DEATH SENTENCE.
BUT I STILL THINK THAT MOST PEOPLE IN CANADA PERCEIVED IT TO BE A GAY DISEASE.
IT IS DISPROPORTIONATELY FOUND IN MEN WHO HAVE SEX WITH MEN.
BUT ABOUT HALF THE PEOPLE GETTING HIV TO THIS DAY IN CANADA ARE NOT PEOPLE WHO HAD
SEX WITH MEN, THEY'RE MOSTLY HETEROSEXUAL FOLK.
>> Steve: HOW DO THEY GET IT?
>> THEY GET IT FROM HAVING SEX MOSTLY.
MOSTLY THEY HAD SEX WITHOUT CONDOMS.
THERE'S THAT WHOLE JUDGMENT THAT PEOPLE HAVE ABOUT PEOPLE THAT HAVE HIV, BUT THAT'S MOSTLY HOW
PEOPLE ARE GETTING IT, IS BY HAVING ANAL OR VAGINAL SEX WITHOUT CONDOMS OR IF THEY'RE
ENGAGING IN INJECTION DRUG USE AND SHARING NEEDLES WITH OTHER PEOPLE.
>> Steve: HOW DO YOU THINK IT IS THAT 40 YEARS LATER AND 40 YEARS OF, YOU KNOW, PEOPLE WHO
DO WHAT YOU DO FOR A LIVING CONSTANTLY PUTTING OUT INFORMATION THAT UNSAFE SEX CAN
LEAD TO THIS, WHY IS THIS STILL HAPPENING?
>> Trevor Hart: WELL, I THINK IT'S STILL HAPPENING BECAUSE PEOPLE ARE NOT A BIG FAN OF
USING CONDOMS.
I THINK THAT'S A PART OF IT.
AND I THINK A LOT OF PEOPLE RIGHT NOW SEE THAT THE HIV EPIDEMIC, ISN'T THAT KIND OF
OVER?
ISN'T THAT REALLY SOMETHING THAT HAS PASSED?
UNFORTUNATELY, IT HASN'T PASSED.
IN FACT, CASES ARE GOING UP IN CANADA AS WE SPEAK AND HAVE BEEN GOING UP FOR THE PAST FEW YEARS.
BUT I THINK THERE'S A PERCEPTION OF, IT'S SOMEBODY ELSE THAT GET HIV, NOT ME.
OR IT'S ONLY SPECIFIC COMMUNITIES.
IT'S NOT ANYONE I KNOW.
AND THEN THERE'S ALSO A CONCERN THAT FOR SOME PEOPLE, CONDOMS, WHICH IS STILL THE MOST COMMON
ROUTE FOR PREVENTING HIV, THAT THEY'RE NOT PARTICULARLY ATTRACTIVE TO SOME PEOPLE.
THEY'RE NOT AS INTERESTED IN USING THEM.
MOST HETEROSEXUAL PEOPLE ARE USING CONTRACEPTION IF THEY NEED TO USE A METHOD, BUT
CONTRACEPTION IS AGAINST PREGNANCY, IT DOESN'T ACTUALLY PROTECT YOU AGAINST HIV.
>> Steve: HELP US UNDERSTAND WHICH DEMOGRAPHIC MAY BE REFUSING TO FOLLOW THE FACTS
CAREFULLY.
YOU'D ASSUME IT'S YOUNGER PEOPLE WHO HAVE NO FIRSTHAND MEMORY OF LIFE IN THE 1980s AND '90s
WHEN AIDS BECAME A MAJOR FACTOR ON THE HEALTH CARE SCENE.
IS THAT IN FACT THE CASE?
>> Trevor Hart: I DON'T THINK SO.
I THINK THAT THE EVIDENCE IS THAT IT'S PEOPLE ACROSS THE BOARD.
YOUNGER PEOPLE, OLDER PEOPLE.
WE'RE SEEING SOME INCREASES IN HIV AND SEXUALLY TRANSMITTED INFECTIONS LIKE SYPHILIS OR
GONORRHEA OR CHLAMYDIA IN ELDER CARE HOMES.
IT'S NOT UNIQUE TO YOUNG PEOPLE.
>> Steve: YOU SAY THE RATES ARE GOING UP IN CANADA.
HOW ABOUT IN OTHER WESTERN NATIONS?
>> Trevor Hart: WELL, NOT UNIFORMLY.
IT'S NOT INEVITABLE THAT CASES SHOULD BE GOING UP IN CANADA.
WHILE CASES HAVE BEEN GOING UP OVER THE PAST FEW YEARS BY ABOUT A QUARTER, NEW CASES IN CANADA,
IN THE UNITED STATES, WHICH HAS A MUCH LESS WELL-FUNDED HEALTH CARE SYSTEM, THEIR NEW CASES OF
HIV ARE GOING DOWN BY 8%, AT LEAST IN THE GENERAL POPULATION, IN THE SAME TIME PERIOD.
AND IN THE U.K., ACROSS I THINK ABOUT AN 8-YEAR PERIOD, THEIR CASES HAVE GONE DOWN BY ALMOST A
THIRD.
>> Steve: AND TO WHAT DO YOU ATTRIBUTE THAT TO?
>> Trevor Hart: WELL, IT'S HARD TO SAY.
BUT ONE THING I CAN SAY IS THAT WE KNOW WHAT -- WE KNOW WHAT METHODS ARE EVIDENCE-BASED THAT
ARE AT THE LARGE PUBLIC HEALTH LEVEL AND IT'S ALL ABOUT GETTING TESTED FOR HIV.
IT'S ABOUT PUBLIC HEALTH AUTHORITIES ACTIVELY PURSUING HIV TESTING FOR FOLKS WHO ARE
MORE AT RISK FOR HIV.
BUT EVEN IN THE GENERAL POPULATION, IT'S ABOUT GETTING PEOPLE TESTED AND WHEN THEY GET
TESTED, IF WE FIND OUT THAT SOMEBODY IS LIVING WITH HIV, THAT WE GET THEM EFFECTIVE
TREATMENT.
BECAUSE WE KNOW IF PEOPLE HAVE EFFECTIVE TREATMENT, THEN THEY WILL LIVE LONG WITH HIV AND ALSO
IF WE CAN GET THE VIRAL LOAD THAT THEY HAVE SUPPRESSED, SO IT'S SO LOW THAT IT CANNOT BE
TRANSMITTED TO SOMEBODY ELSE, THAT PERSON ALSO CAN'T TRANSMIT THEIR HIV EVEN IF THEY DO HAVE
SEX.
OR IF THEY DO EXCHANGE NEEDLES.
>> Steve: IN TERMS OF PUBLIC HEALTH MESSAGING, THOUGH, IT WORKED WONDERS DEALING WITH THE
GLOBAL PANDEMIC WE'RE FACING RIGHT NOW, IT WORKED WONDERS TO SAY TO PEOPLE: YOU KNOW, IT
MIGHT BE A GOOD IDEA TO GET VACCINATED OR YOU'LL DIE.
DO YOU THINK THAT'S A GOOD APPROACH TO TAKE WITH AIDS?
>> Trevor Hart: I THINK THAT THE FEAR-BASED APPROACH DOES WORK.
IT WORKS IN THE SHORT TERM.
BUT I THINK IN THE LONG TERM, IT DOESN'T TEND TO WORK QUITE AS WELL.
THAT FEAR-BASED APPROACH WORKED PRETTY WELL IN HIV WHEN PEOPLE WERE INITIALLY DYING AND DIDN'T
KNOW WHAT TO DO OR THEY WERE LIKE, LISTEN, THESE PEOPLE HAVE TO START WEARING CONDOMS AND
CONDOM USE INCREASED LARGELY IN GAY AND BISEXUAL MEN AND INCREASED TO A LESSER EXTENT IN
THE HETEROSEXUAL POPULATION.
IT DIDN'T LAST FOREVER.
EVENTUALLY PEOPLE DO TEND TO TIRE OF PUBLIC HEALTH REGULATIONS, ESPECIALLY IT'S NOT
SOMETHING THAT CAN BE DONE QUICKLY LIKE A VACCINATION.
WE'RE SEEING THIS IN THE CoVID-19 EPIDEMIC.
WE'RE SEEING THAT FOLKS -- EVEN IF THEY WANT TO DO IT AND THEY'RE GOING TO DO IT, THEY'RE
FEELING A BIT TIRED, THEY'RE FEELING A BIT EXHAUSTED BY THE SOCIAL DISTANCING, THEY'RE
FEELING EXHAUSTED BY THE MASK-WEARING AND ABOUT THE ANXIETY THAT THEY'RE
EXPERIENCING BECAUSE OF CoVID-19.
AND FOR HIV, I THINK A LOT OF PEOPLE JUST -- THEY JUST WOULD RATHER NOT TALK ABOUT IT.
THEY'RE FATIGUED ABOUT HEARING ABOUT HIV, ESPECIALLY DURING THE CoVID-19 EPIDEMIC, BUT
EVEN BEFORE THEN, THEY'RE FATIGUED AND THEY KIND OF WISH IT WOULD JUST GO AWAY, SO THEY
DON'T THINK ABOUT IT.
>> Steve: YEAH, THAT DOESN'T REALLY WORK, THOUGH, DOES IT?
>> Trevor Hart: UNFORTUNATELY, IT DOESN'T.
>> Steve: NO.
>> Trevor Hart: AS EVIDENCED BY OUR INCREASING CASES IN CANADA.
>> Steve: RIGHT.
LET'S TRANSITION HERE FROM YOUR WORK AS A RESEARCHER INTO THIS TO YOUR WORK AS SOMEBODY WITH A
PRIVATE PSYCHOLOGY PRACTICE WHO DEALS WITH PATIENTS WHO HAVE HIV.
TELL US WHAT ONE OF THE MOST INTERESTING THINGS IS THAT YOU LEARNED FROM LESSENING TO YOUR
PATIENTS TALK ABOUT THEIR EXPERIENCES WITH THIS CONDITION.
>> Trevor Hart: WELL, I'D SAY ONE OF THE MOST PROFOUND EXPERIENCES IS HIV STIGMA.
SO HIV STIGMA IS THE STIGMA OF LIVING WITH HIV.
IT'S THAT NEGATIVE LABEL THAT'S PLACED UPON PEOPLE BECAUSE THEY HAVE SOMETHING THAT'S SOCIALLY
MARGINALIZED IN SOCIETY.
AND SO WHAT WE FIND IS THAT WHAT THEY'RE CONCERNED ABOUT IS NOT ABOUT, SHOULD I TAKE
MEDICATIONS?
THE FOLKS THAT I'M WORKING WITH WHO ARE LIVING WITH HIV, THEY'RE TAKING THEIR MEDICATION.
THEIR CONCERN IS ABOUT HIV STIGMA.
IT'S ABOUT I'M THE SAME PERSON I ALWAYS WAS, WILL I BE TREATED WORSE, OR WHAT WILL I DO WHEN
I'M TREATED WORSE BY OTHER PEOPLE?
AND IT IS A BIG PROBLEM.
PEOPLE ARE JUDGING PEOPLE WITH HIV, THAT THERE'S SOMETHING WRONG WITH THEM, THEY WERE
DIRTY, THEY WERE BAD, THEY WERE PROMISCUOUS AND THAT'S A TERRIBLE PROBLEM.
WHAT'S OF COURSE IRONIC ABOUT HIV IS YOU GET HIV BECAUSE YOU HAD SEX AND YOU DIDN'T USE A
CONDOM, AND MOST PEOPLE I KNOW, THAT'S ACTUALLY HOW THEY WERE MADE.
THEY WERE MADE BY TWO PEOPLE THAT DID THAT EXACT THING, AND IT WASN'T A BAD THING AT ALL,
WAS IT?
>> Steve: WELL, I GUESS WHEN YOU PUT IT THAT WAY, THAT'S A GOOD POINT.
WHAT DO YOU THINK IT'S GOING TO TAKE IN ORDER TO GET THAT STIGMA, WHICH I THINK IT'S FAIR
TO SAY IS LESS TODAY THAN 40 YEARS AGO, BUT WHAT DO YOU THINK IT WILL TAKE TO GET IT TO BE
EVEN LESS STILL?
>> Trevor Hart: YEAH, I THINK IT MIGHT BE LESS THAN IT HAD BEEN PREVIOUSLY.
BUT I THINK A LOT OF IT IS ABOUT EDUCATION.
I THINK THAT WE IN CANADA COULD BE DOING A MUCH, MUCH BETTER JOB AT ROLLING OUT HIV EDUCATION AND
GETTING THE ORGANIZATIONS THAT DO THIS KIND OF WORK, LIKE THEY'RE CALLED AIDS SERVICE
ORGANIZATIONS, THAT DO A LOT OF THE HEAVY LIFTING WHEN IT COMES TO HIV EDUCATION AND PREVENTION,
GETTING FUNDING TO THEM SO THAT THEY CAN DO THIS WORK IN THEIR COMMUNITIES WHILE SIMULTANEOUSLY
WE'RE SEEING INCREASES IN HIV CASES IN RECENT YEARS, A LOT OF THE AIDS SERVICE ORGANIZATIONS
ARE COMPLAINING THEIR FUNDING IS BEING CUT OVER THE PAST FEW YEARS.
IT IS REALLY QUITE A PROBLEM.
IF WE WANT TO SEE DECREASES IN BOTH HIV STIGMA AND IN HIV, WE'RE GOING TO NEED TO FUND THE
ORGANIZATIONS THAT DO THAT HEAVY LIFTING.
>> Steve: LET ME GIVE YOU THE LAST WORD ON THIS, TREVOR, AND THAT IS, IT IS WORLD AIDS DAY,
AND I WANT TO KNOW WHAT THE CORRECT WORD IS TO USE AS WE COMMEMORATE, OBSERVE,
CELEBRATE -- I DON'T KNOW.
YOU TELL ME.
>> Trevor Hart: WELL, I DEFINITELY WOULDN'T SAY CELEBRATE.
IT'S A DISEASE AND IT'S A DISEASE THAT PEOPLE ARE LIVING WITH, AND BECAUSE OF HIV STIGMA,
I THINK THAT MAYBE COMMEMORATE IS MORE APPROPRIATE.
I THINK I'D BE MORE LIKELY TO CELEBRATE WORLD AIDS DAY WHEN THERE'S A PERIOD WHERE THERE'S
NO HIV STIGMA, WHERE PEOPLE WITH HIV ARE TREATED LIKE PEOPLE WITH ANY OTHER KIND OF DISEASE THAT
IS NOT STIGMATIZED, WHEN THERE ARE NOT NEW CASES OF HIV BECAUSE PEOPLE ARE FINDING WAYS TO
PROTECT THEMSELVES THROUGH PREEXPOSURE PROPHYLAXIS MEDICATION WHICH PEOPLE CAN TAKE
OR THROUGH CONDOMS. AND PEOPLE LIVING WITH HIV CAN LIVE LONG AND HAPPY LIVES WITH GOOD
QUALITY OF LIFE.
>> Steve: SOUNDS GOOD.
TREVOR HART, WHO IS DIRECTOR OF THE RYERSON UNIVERSITY'S HIV PREVENTION LAB.
IT'S REALLY GOOD OF YOU TO JOIN US TONIGHT ON "THE AGENDA."
THANKS SO MUCH.
>> Trevor Hart: THANK YOU SO MUCH FOR HAVING ME.