Mike Payne: How the Team at Nine Circles Provide Knowledge, Resources and Expertise to Reduce HIV Transmission

World AIDS Day started in 1988.

It was established to raise awareness of the AIDS pandemic caused by the spread of HIV infections, and to mourn those who have lost their lives to this dreadful disease.

I'm joined today by the Executive Director of Nine Circles Community Health Centre, Mike Payne.

Mike, Welcome to Humans On Rights.

Thank you, Stuart.

It's great to be here.

So, Mike, we're going to get into sort of your involvement and how you have seen things change over your time at Nine Circles.

How Nine Circles became the community centre that it is.

But how did Mike Payne get involved in this area of this community service?

Where did you start your journey, Mike, right?

Yeah, honestly, A bit, A bit accidentally, or luckily, I guess maybe now I would say, I first got involved prior to Nine Circles Community Health Centre with an organization called Aid Shelter Coalition of Manitoba.

That was in 2002.

So I was much younger, much younger guy then and and really, my journey brought me.

I was a team parent.

And so, for a long time, working two or three jobs and and co raising my daughter and kind of struggling my way through but really interested in sexual health for reasons because of how it had impacted my life and  thinking about how I can contribute.

I had started university later in life because of of just my circumstance, and was focusing over at U F W on sociology and justice and law, moving into conflict resolution studies.

So going to school, working lots of service jobs and wanted to do something as a volunteer that would bring me a little bit closer to work that had maybe a bit more meaning.

You know, it's good work to work in a restaurant, but I wanted to do something else and something that I could apply some of my education, too, because I learned better that way.

And I, a friend, directed me to aid Shelter Coalition of Manitoba.

This is a group that was, you know, poorly resourced, working in the Tower of Crossways in common, just across the street from where I am now really working with folks, um, living with HIV on issues of income, security and housing.

Still, at that point dealing with the fact that a lot of people, when they found out they were living with HIV, it was a pretty devastating experience, and people were still at that point in the late nineties, early two thousands of getting ill quickly.

There were still a lot of negative side effects from treatment that impacted people's lives and also what people were experiencing as they were losing their jobs, either for health or because of issues of stigma and discrimination.

Housing providers were refusing the House folks, um, palliative care providers were refusing to liberate services to folks living with HIV, all based on fear and a lack of understanding of the disease and how it works.

So nine circles really was an advocacy body that worked with people one on one to help them get their basic needs met, find them a safe place to live, get them on some kind of income protection so that they could live, Stay Billy, and then also to advocate against the system or with the system to try and make sure that the resources that are there for everybody else would also be there for people living with HIV.

And I really fell in love with the work because it was really an introduction for me, as as someone who grew up in a fairly privileged environment.

I grew up in Fort Richmond and surrounded by a university, um, kind of environment, just to see the level of inequity that really existed.

And to see specifically how this group of people, this diverse group of people, were met with really unfair barriers at every turn of their life simply because people were afraid of them and a bit unwilling to educate themselves.

So it made me mad, which is always a good way to get me involved in something.

And it's now been, you know, over 20 years.

And I'm in this movement still, because there's still a lot of work to be done.

Yeah, so, Mike, thank you for the for kind of laying the foundation.

Let me just kind of go back to, You know, obviously you talk about being a young teen parent, so that's an interesting sort of way to start off your your journey in life with responsibilities.

I mean, it's not.

It's obviously you've come out of that very, very well.

I hope everybody in your family is as Well, absolutely.

Yes.

Everyone's great.

Yeah, good.

Okay.

And I And then the other thing, Mike, I'd be interested in When did you first discover HIV and what it meant?

I mean, it got you interested in trying to deal with all the stigmas that I want to talk about in some depth.

But you know, that got you involved and got you mad.

When did that first enter your your your vocabulary I mentioned.

Yeah, I mentioned being a teen parent.

It was 19 when when my daughter was born.

It is also at the age of 19 that I came out as a gay man at the time, really making the decision.

I I had, you know, struggled certainly with my sexual orientation.

More so, I think, around how it would be treated in the context of my sexual orientation and had been really kind of exploring what resources were out there.

And I had the opportunity through Rainbow Resource Centre, actually to meet a group of gay dads, many of whom are at that point the story really was men who where parents a mayor may not have had a particularly connected relationship with their Children because they had come out later in life and and struggled to reconcile sometimes their relationship with their Children.

So, um, I had made an early commitment to do that a little bit differently.

And so I came out early when my child was born to just make sure that I always had a genuine relationship with with my daughter and my family.

I thought that was important for me and in doing so, the reaction that I got was not what I expected.

It was a lot of concern and panic relating around HIV and AIDS, which I'll be honest.

I knew nothing about at that point, so it's likely good that the flag was raised.

My family and my friends were primarily concerned with my health because of what they were reading and what they were seeing.

Um, and that equation of gay man equals HIV that has been and in many ways still stigmatises the HIV efforts that are made.

So um, I had to quickly learn what I didn't know.

Part of my introduction to a shelter coalition and organisations like it was part of that exercise is partly how I found out about them because I was trying to learn a bit more about HIV and also then learned about the different organisations that we're delivering services in that area so certainly quickly focused on how to protect myself from the transmission of HIV and also really quickly, again learned new to the queer community.

I saw really clearly how fear and stigma was playing out at the community level, you know?

Yeah, in those days, you know, people would whisper in your area, you know, be careful.

Um and that was the language at the time.

You will be careful about that group of people or or that bar, because that's where you'll meet a lot of people who have HIV.

And Mike, let me just interrupt for one second.

Just when you say in those days What?

What what years are we talking about?

Just contact that for a second.

You know, not that long ago, right?

Late nineties, I would say.

Not too far away.

Yeah, and I you know, that's the part about, uh, I think that is incredible.

As you're sharing your personal experience and your professional experience that you're involved in is this whole notion around the stigma and you know, watching that as it's developed, just share with us.

What what you've seen.

If you've seen progress and why you think we've seen progress and how much more has to be done to deal with this issue around HIV?

Yeah, you know the wonderful story.

If there's a wonderful part of of being in the HIV movement as long as I have, um, there have been some really quite exceptional things that have happened.

If you look at HIV treatment and and even in the time that I've been engaged, how you know it went from being people have described it as a death sentence, right in the in the eighties and prior to something that was treatable.

But with medications where the side effects were so damaging to humans, that it was actually was difficult to decide which was better, whether to be treated or not to now, where treatments for some individuals can be down to one pill a day versus the stories in the eighties and nineties, where people were taking handfuls of medication multiple times a day to stay alive.

Now we've got folks taking one pill a day.

In the coming year, we'll be looking at injections as an option for people as a treatment choice.

We look now at interventions like post exposure prophylactics and pre exposure pep and prep that can prevent um, HIV from taking hold in in your body.

We look at treatment outcomes now that lead us to the language of equals.

You are undetectable equals one transmittable that if you're on treatment and treatment works effectively and it doesn't for everyone.

But when it does, you can have an undetectable viral load.

That means in 2000 and 21 even if you're HIV positive and your viral load is undetectable, you can't transmit HIV to anyone else that it's virtually impossible to have that happened.

We wouldn't even fathom that that would be the case in the nineties.

So that's amazing how that's happened and that there are preventative resources like prep now available for people who understand the risks associated with their sexual health and want to do something proactive about it.

So that's exciting.

Um, we've also seen changes significant changes in some parts of the system where you know palliative care is a good example where palliative can respond differently to folks living with HIV than they would have in the past.

Where we haven't seen the kind of progression that I would have hoped for is around the issue of stigma.

There still is so many folks that I know who are living with HIV.

We'll often talk about you know, the disease of HIV or the infection of HIV.

It can be problematic.

You will impact your life just like any other illness will.

But the real challenge of HIV is is the stigma is the way that people look at you.

It's the way that you're treated in your community, in your workplace, in your school, in the health care system often comes up as a challenge.

That's something that we're still really is our target Now we need to figure out how to re educate ourselves in the system, to think about the way in which we're treating people living with HIV and why we're doing that.

And it's more complex in that way than it used to be because we're also really learning more about ourselves as a society and recognising that it's HIV stigma and it's racism and it's homophobia and it's transphobia, so it's harder to unpack it's harder to name the intervention that's going to make a difference.

But it's essential because it is the primary issue that prevents people from living well with HIV in this province and and Mike on the issue.

I think one of the myths always was transmission of HIV, you know, there was this.

I mean, all of those horrific Miss, I didn't want to talk about it because I don't want to.

I don't want to bring them back.

But my point is that, you know, I think from a from an advocacy from an education standpoint, the understanding of what?

How how that can be transmitted.

I mean, that's, I think, where the education piece has to come in, not only for those people in that community, but for those that want to support people in that community.

How have you seen that?

Or or have you seen that become something that has made a change in in from your perspective, as the executive director of Nine Circles Community Health Centre?

Yeah, well, again, it's one of those areas where I wish the change was more pronounced than it is.

I think you know when you're thinking about this.

My guess is you're reflecting on things like you can't get HIV from a toilet seat and you can't get HIV from sharing cutlery, and you can't get HIV from sitting in the same chair as somebody else.

And the sad reality is, those types of questions that we would have gotten in the eighties and nineties are questions that we get all the time today, whether it's through the sex friendly Manitoba website or through education sessions.

These are questions that come up constantly because we have not done a good job as a society of properly educating people around HIV and HIV transmission.

We've muddied and confused the issue by aligning HIV with populations.

You know, Understanding where HIV infections lie at a population level is an important thing to know, to do good public health work to do good prevention, planning and communication.

But it sometimes has and continues to really confuse community, right.

So in the beginning, the alignment between HIV AIDS and gay men has been really, really harmful, and it continues to be harmful in terms of people's understanding of their own risk.

So I think the one thing still today that the most important thing that every single Manitoba in could do on World AIDS Day and and beyond that is to take the time to go online, um, come to nine Circles website or go to the Katie website C A t i e dot c a.

Their exceptional.

They've got simple, accessible resources and videos.

Educate yourself about how HIV actually works within the body and how it's transmitted and share that information with your family and the people that you care about and ideally start to think about how you might challenge in a kind way in a good way.

When you hear people say things that are inaccurate because it is the biggest risk to Manitoba's on contracting HIV is how many people still have no idea how it's actually spread.

Right.

So, Mike, let's talk a bit about sort of policy, as it as it has an impact on HIV.

Is there an area that you feel that whether it's governments or institutions or advocates or or educators, I mean anybody that's involved in this that could do a better job around the policy or how do you feel?

Policy and education have advanced the discussion around stigma or just generally around HIV.

Mm, yeah, well, we think specifically about education and health education.

I think.

You know, I normally defer this conversation to my colleagues at Sexuality Education Resource Centre because they're very much the experts.

But I'll wait in to what I know.

And what I do know for sure is, as has been the case for the last 30 years, there is really a struggle to make sure that education that's been received in the school system is accurate and as an of the quality that we wanted, you know, every school, every instructor, they still have a different way of delivering this information.

There's lots of opportunities for people to opt in and out of the information that they receive.

I think we have long advocated for and and really would love to see much more intentional, measured education.

That happens that it is really value neutral, right?

It can be difficult for folks in schools.

Um, it certainly was for me growing up, and I know for my daughter it was, and I hear from my nieces and nephews.

Now it's still not improved that it really is a bit of the luck of the draw about the quality of sexual health education you'll get into the school system, and we would love to see that more regulated.

We would love to see that more managed by individuals with expertise in sexual health.

And we'd love to see supports and play that, if you are instructed, an instructor in a school system who is accountable for delivering sexual health information that there be some really intentional mandatory training and evaluation tools that are available for you, especially when we think about, you know, again, the the alignment of stigma relating to things like HIV or drug use.

Talking about sexual health in the context of the queer community, um, and the whole range of sexual health activities that may be questioned but not allowed in schools right, because it doesn't feel safe to do so.

So I think there that is really the starting place is making sure that young people really learn in a sex positive way that that sex is normal and sex is healthy and sex is a part of our lives.

Most people's lives, not everybody's but most people's, and it's less fearful.

Um, if you actually understand how it works and what the risks are and how you can mitigate those risks and how you will access the resources that you need and way too many barriers in our system right now, based on fear or stigma or personal values that kind of take us away from the science of it.

And if we could focus on the science of it and then absolutely allow families to have conversations about what they've heard and make their own informed decisions for sure.

But that would be something that I certainly would love to see improved.

One of the things I know nine circles has really committed ourselves to hear with our health educators is actually focusing our energies, though, on adult sexual health education, because a lot of people didn't get that information when they went to school for lots of different reasons, and if you didn't get it in school, you're kind of not getting it at all.

So how we kind of make sure that there is that opportunity for people to go back to school for lack of a better word and really understand the fundamentals is one of the things that we've prioritised just to give people an opportunity to catch up.

So, Mike, you've been at nine circles now for some 20 odd years as the executive director.

What would you say has been one of the biggest, most significant changes that you've seen that nine circles has had in a positive way on the community?

Oh, gosh, I think that, you know, nine circles has worked very hard over these 20 years to a couple of things.

But I will highlight, I guess, one to create a safe place for all of those human beings who are impacted by HIV, whether they've been infected with the virus or whether their families or partners of people who care about folks, whether their community allies who see what's happening and want to make a difference.

We try to create a safe place where every doorway is the right doorway and you can come in a judgement free space where we don't care how you got here, and we care about what you need.

That's really that the underpinnings of harm reduction.

You see that model evolving through the community health movement and many other movements.

Stein circles, as always, position themselves there, and that is something that is, I think, been really important to the community of just being safe.

The other thing we've tried really hard to do is make sure we have been able to well align what we see in the HIV HIV movement to the issues of health, equity and human rights.

The reality is the commonality that you see in the HIV movement is a human rights issue.

It's a health equity issue when you when you saw the early impact of HIV on on gay men, When you see the impact on HIV on indigenous people on people of colour, on people with people who use drugs, the reality is the common link.

Every time is not what population you belong to.

It's the reality of those populations that are overrepresented in the stats when it comes to HIV.

Infections are also the communities who are less likely to access services in the community because of issues of homophobia and racism, and those types of systemic barriers to get in people's way.

The communities that are most likely facing issues of poverty in an overrepresented way, negative encounters with services that are intended to be there for all folks, whether that's negative encounters with the justice system or the health care system, There's a common bond here.

HIV affects everybody, and we see that in the stats every year.

But it predominantly impacts those communities who are already struggling to find equity and find footing in the system.

And that's always been the case.

Then we've tried to really highlight that consistently over the last number of years.

So when people ask about, you know, well, why are so many gay men represented in these stats in the nineties are now?

Why are so many indigenous people over represented in these stats?

Now my answer is always homophobia and racism, and we can change that.

We can control that.

And that's the driving force.

And I think that HIV has been that opportunity.

If there is an opportunity out of it that it forces us to really look deeper than the virus and really look at what's happened in that community that's left these folks so vulnerable, does that make sense?

You know, it's fascinating, Mike, because you're reading my mind a bit in the sense that you know, I did a bit of research and I see that the theme for World AIDS Day for 2021 is end inequality and AIDS.

And I was going to ask you about that.

You kind of just answered that.

I mean this notion, this inequality that exists, which is, I think so unfortunate yet having said that, part of the learning process, as always as I found, is to open your mind to make an effort to understand it, educate yourself and then look at how do you take action and get involved through that process?

And And I would ask from your perspective, Mike, what?

Is there something that you would say?

We need to do the following steps to, and I'm going to ask you if if do you think that in in our lifetime that that you know, you can eliminate HIV and I, That's so That's an open ended question to come to, But what steps?

If it's not about elimination, to eradicate as best as possible, what steps should we as as the community as citizens, people that live here, what steps should we be taking?

Yeah, so, you know, I'll start with something quickly that I've already said, I think one of the things I often say to people When when you learn that someone you know or somebody you care about or you hear you know you know Bob is HIV positive and that gets shared with you from anyone other than Bob, Quite frankly, one of the first things I guess I would really ask people to reflect on is why is that information being shared by anyone but Bob?

And if one of the first things that comes to mind you and this is not shaming, I think this is normal for a lot of people is a query about I wonder how that happened.

How did they contract HIV?

That's where you start.

That's where you start to really think as an individual.

Wait, Why does that matter, right?

What am I trying to?

Why am I trying to place a judgement on this?

At the end of the day, people find themselves living with HIV.

They find themselves being diagnosed with cancer.

They find themselves being diagnosed with hepatitis C.

These things happen to folks, and our effort needs to be.

How can we support them?

I wonder what I can do to be supportive and as I mentioned earlier.

The first thing that every single Manitoba in could do is so easy.

I'm doing it right now.

You just look again at Katie or the CDC website, everything you need to know about what it is, what it isn't and how it it is shared.

It's all right there, right?

So you can answer all of your questions.

And then, honestly, you can put those questions aside knowing you're not at risk, most likely or if you are at risk, you'll understand how and then you can move on from that, and you can focus on what you would do for anyone else.

If I found out my neighbour was diagnosed with cancer, probably the first thing that people do in Manitoba is they bring them a casserole because they know that they're probably struggling with that diagnosis.

They want to be helpful.

And I don't know very many people who have found out their HIV positive, and the first thing that their family or friends did was bring them a casserole.

And so I think I'd love for us to start thinking along those lines.

How do I help my this person in the community that I care about.

The other thing that people really can do for themselves and for the people that they care about is really embrace again.

The realities of you know, whatever your perspective, is whether you should have sex before you get married or after you get married or whether you can believe in marriage.

I don't really care about any of that stuff.

What you should know is if you're going to be sexually active, routine testing, it's part of what you do right.

It's one of the things that should be included into your health care regime.

Unfortunately, not every primary care provider, not every doctor and nurse practitioner is there yet.

And that's one of the things that nine circles does with the health care system is.

Really, We should initiate that people shouldn't have to come to their doctor to say, Oh my gosh, I think I should get a regular STD tests because of blank blank blank.

Ideally, we get to the place where your doctor says, Hey, it's it's that time of year.

It's time to check your cholesterol and because you're sexually active, we should do a set of S T.

I test like that's where we want to get to.

But until we're there, individuals may need to be brave and an initiate that question themselves.

But routine testing is important, right?

Knowing having that opportunity to talk about how you're engaged in your sexual health with your primary care provider gives you an opportunity to learn ways of preventing risk that you may not have known about.

There's a lot of people who don't know about Prep.

Prep is a pill that you can take every day.

If you're at risk for HIV and you're not going to contract HIV.

In most cases, that's true.

Most people don't know that, and and so we need to raise awareness by starting the conversation being okay to talk about sexual health to include routine testing because that will also offer you an opportunity for early diagnosis.

And if you get a regular test on an annual basis or every two years or whatever you and your doctor decide is the right thing to do, it allows you to know early on whether you have syphilis or whether you have committee or whether you have HIV and then you can respond to it either by curing it because it's a cure for some of those or by treating it, which again will allow you to feel confident that you're not transmitting it to anyone else and that you're going to stay healthy even with that diagnosis.

Does that make sense?

Yeah, totally.

Let me just come back to one thing you said, though prep is a pill you mentioned, and that's a pill that you can take daily.

Is that something that you would just go to your doctor or walk in clinic?

Or how would somebody get that prescribed?

And is it, uh, something that is quite commonly filled here in the province of Manitoba?

From a from a pharmacist?

Yeah, so let's talk about Let's talk about pep and Prep.

Let's do them both because they're great things to chat about.

And those are some of the things that are new ish, I guess, in the movement.

So both really are stem from HIV treatment.

So there's a set of medications improving and evolving all the time that allow folks living with HIV to be treated to manage HIV in their system.

To the point, as I mentioned becoming undetectable, Um, The other thing those medications can do is two things.

Pep is post exposure prophylaxis, and essentially, Pep is I'll give you an example.

So I went out on a Friday night and I ended up having a sexual contact with someone that I realised.

You know, I don't really know that person very well, and I have actually quite a bit of anxiety about that, and I have reason to believe maybe that choice was in the moment.

And I'm I'm concerned about that.

I may have put myself at risk.

Pep is exactly for that.

It really has been, well utilised in a clinical field.

So if I get a needle stick up, I'm a nurse, and I'm doing work with someone who is living with HIV and actually get a needle poke.

I'll implement pep, but it can also be implemented in this scenario I've given you.

So essentially you're gonna go to the hospital.

Unfortunately, right now in Manitoba, it has to start in the hospital and hopefully it comes a little more accessible in the future.

You're going to let them know what happened.

You have a short window period.

You have only a couple of days to do this, you're going to want to move quickly.

You're going to go to the hospital.

So I've had this uncomfortable experience.

Pep is something I need, and they can initiate pep in the hospital and then you can plead it in the community.

And essentially, it's a dose of medication that we normally used to treat HIV.

That, if you take early, can actively prevent HIV from taking hold in your body if it presents if it is there.

So a really important resource for folks in cases where they've had an unintentional or unplanned exposure.

And they want to try to do everything they can to make sure that they prevent that from becoming actually evolving into HIV.

So that's been in place for a really long time.

Most people don't know about it.

It's not as accessible as we'd like it to be.

But that's your strategy.

You start at the hospital and then you completed in the community Prep similarly, is an evolution from there, so prep is a medication that we would normally used to treat HIV, but so I'm someone who knows okay, I look at the risk factors I have multiple sexual partners.

Possibly.

I use injectable drugs, sometimes whatever my risk factor is because we're not judging those things.

People live their lives the way they live them.

I know that I'm putting myself at some modicum of risk for HIV, and I'd like to reduce that risk.

That sounds like the safe and responsible thing for me to do.

So what I get to do now and now it's covered in Manitoba.

As of just the last couple of months before, it was a bit expensive, so that's partly why folks don't know about it.

But now it's covered.

It's on the formulary, and if you have a treaty right, it's fully covered and has been for a while.

But I'm going to go to my primary care provider, and I'm going to say, Look, I think I should be on prep and your primary care provider should be able to, and it's reasonable to expect them to have a professional conversation with you about what puts you at risk and and based on those risk factors, if perhaps the right thing for you, they just prescribe it, just like they would prescribe your blood pressure medication or anything like that.

There's a little bit of work, you know you need to get tested to make sure you don't already have HIV, of course.

And then there is an expectation that you have some routine testing afterwards.

They want to make sure that, you know, ideally, if if you're on prep, you're also still using condoms and those types of things, they may ask you to get routine STD testing done just to make sure you're not at risk for other STDs.

But you should be doing that anyway.

We've talked about routine testing.

That's just what we do in healthcare now.

And they're also going to be just watching forward to say, as we would with any other medication, making sure you know, your liver's tolerating it well and things like that.

But just like again, any other medication that you would take.

This is what prep does and prep is 99% effective in preventing HIV infections for folks who take it properly or as recommended by their doctor.

And there's lots of research emerging now that tell us it's it's at least 70% effective and possibly more in preventing HIV transmission for people who use drugs.

So 99% when it's about sexual activity and somewhere between 70 and higher, we're still learning for people who use drugs.

So prep is a game changer in terms of the opportunity to prevent the spread of HIV, and it's one of the ways that we could eliminate it in the long term.

The challenge, of course, is making sure that people who are at high risk for medium risk for HIV infection know about prep, have a health care provider that they feel safe to talk to about prep and are supported than to be able to take prep on a regular basis and again, getting it on the formulary this year was a huge step forward, so cost shouldn't be what gets in the way.

Now we need to make sure that we all can have that conversation about why it's important to us in a non judgmental space, and that takes a little bit of courage from those of us who need to kind of go and talk to our doctor about that and also an expectation of our primary care providers and Manitoba to educate themselves and be prepared to have a judgement free conversation so that they can offer this resource to people when they need it.

Perfect.

Thank you so much for that, Mike.

Let me just pivot a little bit around the issue of where we are today with this pandemic known as covid 19.

How if you have HIV, what should you know about Covid 19?

How can you ensure that you are protected from the potential of getting covid 19, Right, So So you know the reality of HIV.

I mean, the most significant thing that HIV will do in your body is that it's going to impact your immune system, right?

Left untreated and unsupported, it can kind of badly damage your immune system.

And even with treatment, there's a vulnerability.

There you're your immune system isn't quite as effective, just like if you were diabetic, for example that that maybe you're not reality for you too.

So for folks living with HIV, that vaccine is very important and really paying attention to the public health recommendations around masking and social distancing are really important.

Really.

For covid, what you need to know is, however old you are, pay attention to what they're saying about the vulnerability of seniors and the vulnerability of other individuals with compromised immune systems.

You're more at risk of covid, and you're also more at risk that the implications of covid could be more severe, right?

So you may get sicker than someone who's not living with HIV.

And so that's really the most important thing to be aware of is those public health recommendations are all the more important for you to to really listen to and follow if you want to keep yourself safe.

The other thing.

We pay attention to more broadly around covid and maybe you'll ask me this later.

I maybe kind of trumping that is we really want to pay attention to how our health system and our communities have responded to covid, how quickly they've acted and how how much they've worked to make sure that we're focusing on the science and not identifying the people.

Very early on, we heard a lot of our health leaders talk very clearly about how important it is to not stigmatise people who have covid.

Let's not create a situation where you don't want to get tested or you don't want to know you have covid because you don't want to be shamed or shunned.

And and I think there's something to look at in terms of how well we did that, to compare it to what we haven't done and still aren't doing in the context of HIV, because that's where the issue is very similar.

Makes sense.

Yeah, yeah, yeah, And I guess, you know, like I just one of the things I just wanted to hear from you because you deal with this every day.

I mean, there's so many things that we deal with now in society, just around covid.

You know, people that have a feeling that they're, you know, they don't want to get the vax and there's a whole discriminatory Well, the whole conversation that's happening around that, that whole issue but the bottom line is, is really what you're saying is that if you're living with HIV, your auto immune so you're more suspect to the possibility of getting covid.

So there's nothing that would be said Mike, that you're aware of.

The people sort of say you should not get the covid 19 facts.

You should actually go and make sure that you do get it.

Yeah, I mean, listen, it's always talk to your doctor.

Of course, there may be complex.

There are those complex health realities that not everything is for everyone.

And there are those very rare circumstances where people may be advised around which vaccine they get or or things like that.

So So I'm not a doctor.

I wouldn't I wouldn't preclude anyone from the possibility that there may be some exception to the rule that's really between you and your doctor.

But what I would encourage is to take it seriously and and be open to doing everything that you can do to protect yourself.

But also I also recognise that, you know, for many folks living with HIV in 2000 and 21 their relationship with their family, their relationship with their employer things are different now for a lot of people, and it's OK, and people can just live a healthy, normal, fulfilling life.

And also they happen to have HIV.

And that's true for many, many people.

Where it's often not true is again for people who are struggling with broader issues of racism or homophobia within their community that already isolates them.

And so I recognise that when you're telling people living with HIV who have those experiences who are already isolated, who are already disconnected from the bit of community that they have telling them to isolate is complicated because they're already isolated and the lifelines that they have are truly lifelines.

And so what?

We asked them to follow the public health regulations.

It also is on organisations like nine Circles and others to make sure that we're finding other ways to help people connect.

Because it is that connection that normally is pushing people to put themselves at risk, more so than even vaccine hesitancy.

Right it It's about not wanting to be completely isolated and disconnected, particularly folks who Merete feel a bit of that isolation even before Covid came to be.

Yeah, you know, and I've I've had other episodes that I've talked around the issue of covid and mental Health Mike and how you know, sort of that isolation and the impact that that's had on so many people.

And and I think, you know, when we talk about mental health, you know, that's one of those conversations.

It seems to be finding its way from the back burner a little bit more to the front burner because through isolation, people are now understanding the you know what isolation does to your mental health.

I mean, you could be in a very good situation with young kids and, you know, a working parent, and you're you know, there's added struggles to working with with isolation as we've seen the impact on mental health.

So, Mike, I wanted to ask you when you look at mental health when you look at HIV and you mentioned this at the beginning and I appreciate you drawing the issue of making this human right, you know, the issue of people, the stigma that comes with this from a human rights perspective.

And, you know, one of the things I always like to do in these podcasts is to draw out the human right that is on this, and it's about it's not so much the human right, but it's about the human right for human beings.

And I'd love you to just talk a little bit about that impact that it has with respect on people but the human right on the human being.

Yeah, so that's a big question.

You know, I think at the end of the day, HIV it is, it really is now just a human rights issue.

I truly believe that I've talked about treatment technology.

I've talked about prevention technology.

The barriers that are facing people living with HIV are are sometimes but rarely about that because we can help people connect to those.

It is the experiences of racism and homophobia and, increasingly, transphobia.

That is the barrier.

It prevents people from learning what they need to learn to, say state.

It prevents people from accessing the services that are in existence.

But people don't feel safe to use and were not treated well when they show up at them.

And all of those are underpinning our experience with HIV.

You'll see that the province will announce on December 1st the stats for for the previous years.

Um, you'll see some of the high.

It will have the highest new infection rates in over a decade, and that's coming at a time where access to testing because of covid restrictions was less than it's ever been, which means the problem is much worse likely than we even know it to be.

And when we talk to our partners in the indigenous community.

When we talk to our partners in the communities who are working with newcomers and people of colour, it's not exclusively the lack of understanding about how to protect yourself from HIV, and that's resolvable.

We work on that every day, and and we can do better on that in communities and in larger systems.

But it is about the lack of trust that people have in the information that we're sharing because of the way that people are treated and what they experience every day.

Listening to health care providers tell you the things you should do when you've had horrible experiences of racism in those health care systems.

Of course, you're not going to trust right, so we can't do one without the other.

We can't have people relying on the information and just accepting the information that we share them because it's based in science and they should trust us because we're the experts.

If we can't show them that we trust them and respect them and and see them for who they are, right.

So I think that has been the challenge and continues to be the challenge of HIV and that is emerging to be the number one challenge around covid as well is we have not built the trust amongst those folks who have not, You know, we haven't earned it.

We haven't earned their trust.

And so when we're trying to get important information and resources out to people and they're not taking up on it, that's a big barrier that we are in control of.

We could change that, getting funding to make sure prevention, technologies and and vaccines and things like that are in play.

That's a different.

That's an advocacy effort that's a money effort.

We need to keep fighting for that and look at whether that's being equitably applied or not.

But the thing that we can work on as I mentioned before every day is our language and our understanding.

And I'm getting a little bit braver as we see people doing all around the world to not just walk away.

When somebody spreads misinformation or somebody says something or does something that excludes another individual, but to actually reach out and say, actually, I know what the I know, what the actual information is.

I'm going to share that, and I'm going to start challenging some of these things so that we can create a safer place for all of those folks who need some support to connect with the things that I already have access to as a white person of privilege, with a job and and all of the opportunities that have been handed to me.

It's time to kind of give that back in a more meaningful and intentional way, and that will help our HIV efforts.

And that will help our covid efforts as well.

Does that make sense?

Yeah, for sure.

Mike, I appreciate that.

And listen, I think we're just about running out of time here, but I just two things one is Please remind me because I want to make sure that I I I put this onto the notes of the podcast, the one website that you referenced.

Your reference it twice, and I want you to tell me one more time.

So those people are listening.

If they just want to find out to educate themselves, name that website again, please.

Right.

So this for good, solid education about HIV and other sexually transmitted infections, I go to Katy dot c A.

That c a t i e dot c A.

It's a national hub of brilliant information.

That's where I go all the time.

If you're looking for information locally about how to connect to services around HIV or STD B, I s, you can check out www 0.9 circles dot c A.

That's n i n e circles dot c A.

Yeah, that's fantastic.

Mike, thank you for sharing.

Hey, listen, Is there anything that you want to just as we close down acknowledging that World AIDS Day is December 1st We've had a great conversation about HIV.

I've learned a lot from you, Mike.

Thank you very much.

Is there one thing that you want to suggest or want to just sort of leave for those people that are listening to this podcast around the issue around HIV s or one thing you'd like to say before we say goodbye?

You know, beyond what I've said already about hoping that people take that opportunity to educate themselves.

The only other thing I think I'd like folks to really think about is is having been in this movement for as long as I have.

I've met some of the most wonderful, amazing, resilient people that that I would ever have the fortune to meet.

And what I'd ask is not only educate yourself around HIV, but just take a couple minutes if possible, to listen to some stories of people living with HIV.

You'll see those on the national news.

You can also go to a website called The Positive Effect, where there's a gathering in Canada of stories of people living with HIV to really just reflect on if and when someone I care about or somebody know someone I know shares with me that they are living with HIV, how will I be able to respond to them in a kind and supportive way?

Just give that reflection and BP thinking about Am I ready to do that?

And how would I do that?

Because it is that moment of kindness that really can make the biggest difference for folks when they find out they're HIV positive, at least until such time as they can receive the information to let them know that it's okay.

And at the end of the day, as long as we certainly want to do everything we can to prevent HIV infections, it's also important to know that it's okay to be living with HIV and that people can live well with HIV and that we need to create space for that in our society because that's the learning.

That's probably most important now.

Yeah, you know, I I think it's such a great way to to kind of end our conversation.

Mike.

It's, you know, using as you did a number of times through this podcast episode, the word kindness be kind to people, be understanding, be you know, just so that generosity and I I just think it's that that is a life lesson that I think we could all do a better job of.

So I just want to say, um, the executive director I've been speaking to today Mike Pain from Nine Circles Community Health Centre Mike, Thank you for your time today and perhaps way way.

More importantly, thank you for all the advocacy and the education that you and your team at Nine Circles Community Health Centre is doing here locally and throughout the province.

Thank you very much.

Thank you.

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