Saskatchewan Province is leading the country in preventable, opportunistic diseases made possible by poverty. With new changes to income support programs and increased housing instability, things are getting worse.
Saskatchewan has the highest rate of HIV in Canada, with cases more than three times the national average. New cases occur via what is known as vertical transmission (from mother to child), which occurs largely unseen in richer countries, as such cases are preventable with the use of antiretroviral drugs.
Injection drug use is the most common mode of transmission in the province, and the numbers are highest among indigenous peoples where continued legacy of colonialism, policy-induced poverty, intergenerational trauma and drug use are intertwined.
Indigenous people have encountered these challenging conditions with resistance, by mobilizing indigenous-led responses to HIV and promoting indigenous ways of knowing. But these efforts are still being undermined by limited funding and provincial government failures to provide adequate income assistance to those living in economic uncertainty.
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Syphilis epidemic
Increasing HIV numbers in Saskatchewan are taking place along with a new epidemic of syphilis.
This is not surprising, since syphilis increases susceptibility to HIV; it is a harbinger of more HIV infections to come. Syphilis cases increase exponentially, to more than 800 cases in 2021, from five cases in 2016. The disease is extremely contagious in its less severe early stages and can, like HIV, be transmitted during pregnancy.
When transmitted during pregnancy (congenital syphilis), syphilis can have dire consequences, including stillbirth and infants born with a range of health issues, including skeletal and facial disorders, deafness, blindness, and significant neurological problems. In 2016, there were four cases of congenital syphilis in Saskatchewan; four years later there were more than 50.
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Both HIV and syphilis are opportunistic infections made more likely by the reality of living in poverty. They are both asymptomatic in their early stages, so people may not know they are infected. The stress of poverty and drug use can contribute to people engaging in more HIV and syphilis risk behaviors than they would otherwise.
Once infected, both syphilis and HIV can be treated, but treatment can be intense – syphilis during pregnancy can require multiple appointments and HIV requires daily medication. When people live without reliable housing and exist with insufficient income, they have to come up with creative strategies to survive and to be screened, tested or treated for new infections is not always a top priority.
Benefits reduced
Insufficient prices of social assistance in Saskatchewan have long contributed to the problem, which has now been exacerbated by changes that have recently reduced the total amount of benefits.
Unlike its predecessor, the new program does not fund the actual cost of utilities, but rather provides an insufficient fixed amount. Other supports have been reduced or eliminated, such as those for clothing, furniture and school supplies.
THE CANADIAN PRESS / Liam Richards
The new program also got rid of direct payment to landlords, who had previously ensured that, no matter what, rent was always paid. These changes have resulted in more people being evicted than ever, with the Saskatchewan Landlord Association reporting that 30 percent of people on social assistance were unable or unable to pay their rent in the months after the change took effect.
In November 2021, the Ministry of Social Services declared that it would pay rent and utilities directly to recipients at risk of homelessness, but housing organizations say this is still not happening.
More uncertainty, less resources
The rising rates of syphilis and HIV are exacerbated by these changes in income assistance because people have more insecurity and fewer resources than before.
Although pregnant people and new parents often use various strategies to get what they and their children need to get by, their efforts are undermined by a fragmented system of care, a lack of culturally responsive services and limited access to existing interventions. This includes screening and testing for asymptomatic, unidentified and / or untreated infections.
Providing adequate social assistance is the key to public health. We need no other reason to ensure that people have enough to live on than to reduce the rates of completely preventable, contagious diseases. But it also makes economic sense.
Read more: CERB was luxurious compared to provincial social assistance
The cost of treating people who have contracted these diseases, and especially children, over time costs significantly more than providing adequate social assistance. Reducing social assistance is a costly mistake and the most marginalized pay the most expensive.
People living in poverty work hard to achieve their lives and find creative strategies to make the most out of every dollar, but there is a limit. Without adequate social assistance to meet people’s basic needs, more people end up in precarious circumstances, requiring access to more intensive and long-term interventions.
There is a vicious circle in Saskatchewan to cut public funding for social assistance to support people who are experiencing problems, only to intervene when things are much, much worse.
