Canada votes on Monday, September 20, 2021! In addition to voting, you have an opportunity to raise issues you care about with all candidates vying for a seat in parliament. To help you engage with political hopefuls in your community, Casey House is sharing five questions to ask any candidate about issues related to HIV, harm reduction, and compassionate, socially-just health care.

1. Canada’s blood donation policy continues to exclude the 2SGBTQ/MSM community

In order to donate blood in Canada, men who have sex with men must be abstinent for three months before donating. As Casey House’s chief medical officer Dr. Ed Kucharski explains, “This thinking is not only outdated and discriminatory, it ignores science. The current evidence makes it clear why 2SGBTQ/MSM should be eligible to donate blood in Canada”. While Canadian Blood Services intends to recommend this policy change by the end of the year, the federal government can and must act sooner.

Question for candidates: Will your party mandate Health Canada to immediately end Canada’s discriminatory blood donation policy?

2. HIV continues to be highly stigmatized in Canada

One in five people living with HIV are denied health services because of stigma and discrimination. This affects people’s willingness to be tested and then to seek treatment and support, and fuels misinformation about HIV and the impact it has on those who live with it. Speaking up against HIV stigma makes a difference, and we need more people to know the facts, correct misinformation, and use language that empowers people living with HIV.

Question for Candidates: How will you correct misinformation and insist on language that empowers people living with HIV?

3. Canada’s overdose epidemic is a national crisis

More than 21,000 Canadians have died of overdose since 2016 due to the toxic drug supply. Providing access to harm reduction services (such as safer drug use and consumption services) and a safer supply of regulated drugs, as part of comprehensive mental health and addictions care, is essential to reduce the risks of drug use, save lives, and improve health care for people who use drugs.

Question for Candidates: What will your party do to ensure that harm reduction services and safer supply programs are more available, as part of mental health and addictions care?

4. Racialized communities are disproportionately impacted by HIV infection rates

Systemic barriers to health equity and access to health care mean that disparities exist in HIV diagnoses and outcomes. In 2019, almost half of new HIV infections were among Black people (25.5%) and Indigenous peoples (24.7%), despite these communities accounting for a much smaller percentage of the country’s overall population.

Question for candidates: How will your government formally acknowledge and address racial inequality in health care, and address disproportionate rates of HIV in Black, Indigenous and racialized communities?

5. Canada’s fight against HIV is chronically underfunded

Since 2003, community-based programs that connect people living with, or at risk of, HIV to vital services have been underfunded, to the tune of more than $123 million in commitments that were never delivered. As a result, many organizations have closed or discontinued programs. With 62,050 Canadians living with HIV and 2,122 new HIV diagnoses reported in 2018, Canada’s HIV response needs to be adequately funded. On World AIDS Day 2020 Senator René Cormier introduced a motion that called on the federal government to increase HIV-specific funding to $100 million annually.

Question for candidates: How will your government apply the lessons learned from the COVID-19 pandemic to deepen the federal government’s investment in the HIV epidemic and reduce new HIV infections?

Every Canadian citizen has the right to vote. When you exercise this right, you help choose who represents you in government.

Are you registered to vote?

If you’re not already registered (or if you’re unsure and need to check), use Elections Canada’s Online Voter Registration Service OR visit any Elections Canada office by Tuesday September 14, 6:00 p.m. If you’re a newcomer to Canada, learn more at settlement.org.

Do you know who is running in your riding?

Visit elections.ca and type your postal code into the Voter Information Service box for information about your riding.

Learn about the many ways to vote, including accessible voting options for people with disabilities.

Use Your Voice: Five questions for federal candidates on inclusive health care

Read Casey House’s 2020-21 impact report, our annual compilation of outcomes and accomplishments from an unprecedented year. The report includes our response to COVID-19, initiatives in harm reduction and enhancing client care, as well as the pivot to virtual fundraising events.

Casey House Wendy Cheuk Ed Kucharski

Just before the pandemic kicked in last year Casey House welcomed its first clinical pharmacist – Jon Smith. While the plans for Jon’s first year were adapted due to COVID-19, what remained unchanged was his commitment to “meeting clients where they are on their health journey”.

Jon speaks passionately about his role, “Providing innovative and compassionate HIV care is challenging and rewarding work: in addition to dispensing medications and advice, I work with the clinical teams to assess each inpatient client’s medication history and health concerns. I also monitor their drug therapy each day, looking for medication-related issues and adverse effects.”

When a Casey House client is discharged from the inpatient unit Jon stays connected and involved. To ensure clients have everything they need to make a seamless transition back to the community Jon contacts their pharmacy to update prescriptions and review their specific needs.

Casey House is always looking for new and innovative ways to care for our community. Last fall, because Jon was on staff, we created an inventory of vaccines for flu, hepatitis B and pneumonia. We developed educational tools and presentations for the clinical team, and established a formalized reporting system to track potential adverse drug reactions. Jon also co-chairs a new drugs and therapeutics committee at the hospital, and started welcoming pharmacy students for six-week residencies.

Jon says it’s been a very rewarding first year. His contributions to our purpose of transforming lives and health care through compassion and social justice supports Casey House in developing relationships with clients that help them build health and stability in their lives.

Donor gifts help Jon and Casey House continue providing care for people living with HIV and AIDS. Contribute to that support- make a donation today.

Pharmacist Jonathan Smith Join Casey House

There is considerable progress to be made on improving health care for people who use drugs. Stigma around substance use continues to be widespread and many health professionals are not well equipped to provide care within the context of people’s lives, choices, and circumstances; however, reducing the risks of drug use through harm reduction in a judgment-free environment is an essential health service. Hospitals have a significant opportunity to increase access to harm reduction and improve health outcomes for people who use drugs.

Harm reduction refers to the evidence-based policies, programs and practices that aim to minimize the negative impacts of drug use, and focuses on working with people without judgment or requiring that they stop using drugs in order to receive support. – Adapted from Harm Reduction International

Harm Reduction Supplies Distribution

A hospital-based response

While Canada is relatively progressive on implementing harm reduction, access to these essential services remains a critical gap in many communities and is not yet common in hospital settings. Harm reduction often includes health services such as access to safer drug use supplies, safer supply prescribing, and supervised consumption services, but it is much broader than service delivery; meaningful and effective harm reduction requires a philosophy of judgment-free, culturally sensitive and trauma-informed care.

Casey House is a sub-acute specialty hospital with a proud history of practicing harm reduction by delivering holistic health care in a welcoming environment, free from stigma. In partnership with Toronto Public Health, our harm reduction services have included providing 24/7 low-barrier access to safer injection and inhalation supplies since 2014, and access to safer crystal meth supplies since 2018. Distributing safer drug use supplies aims to reduce infectious disease transmission and other harms associated with substance use, alongside naloxone kits to reverse overdoses. Since 2020 this service has become more essential with the convergence of the overdose crisis, housing crisis, and the COVID-19 pandemic.

Safer Drug Use Supplies Distribution

Pivoting in a pandemic

In the spring of 2020, when the COVID-19 pandemic forced many harm reduction and outpatient hospital services to close, Casey House continued to provide 24/7 barrier-free access to safer drug use supplies at our front door. This enabled our hospital to not only maintain access to this key service, but also identify and respond to evolving community needs:

Increased Demand: In the six months prior to the pandemic, Casey House distributed an average of more than 4,000 harm reduction kits per month. In the first six months of the pandemic, that average more than doubled to over 9,000 kits each month.

Peer Support: With more people accessing safer drug use supplies at the front door, Casey House expanded services to include support from peers with lived experience of drug use. Through meaningful conversations, peers connect with individuals picking up supplies and provide additional support and guidance based on each person’s need.

With more than 2,000 opioid-related deaths in Ontario in 2020, and a record 34 in Toronto in December alone, the need for harm reduction services continues to grow.

Emerging insights

Around the world, a wealth of harm reduction research and knowledge has been generated over several decades. Building on that foundation, Casey House collects quantitative and qualitative data to gain a stronger understanding of our hospital’s role, the services we provide, and how we can better meet the health needs of our community.

Time and place are key to increasing access to safer drug use supplies

While many community health centres, public health units, and organizations that serve people who use drugs distribute harm reduction kits, Casey House’s location and safe 24-hour access are key reasons people visit our hospital for supplies. Most pick-ups are after 5 p.m. and on weekends, when many local services are not open. Our physical location is especially important: the majority of individuals travel by foot, are not accessing supplies at other locations, and are often picking up kits for more than themselves, extending our reach.

Harm reduction services can improve engagement with health care

Many people accessing safer drug use supplies at Casey House are not connected to health care or other harm reduction services. As well, many ask for information on additional supports, such as shelters, crisis support, clothing, first aid, naloxone, and food. In our experience, training staff and providing safer drug use supplies in a judgment-free environment yields several benefits: it communicates openness, encourages people to speak with health care providers about their drug use, and increases the willingness of both clinicians and the people they care for to discuss drug-related harms. Providing a compassionate space for conversation helps build stronger, more honest relationships which have the potential to deepen engagement and trust with health care overall.

Looking ahead

Our experience thus far points to the promise and potential for hospitals to improve health care for people who use drugs by embracing a harm reduction approach – particularly given the increasingly toxic supply of unregulated drugs and the growing risk of overdose. At Casey House, additional research is underway to dig deeper into the impacts of introducing harm reduction initiatives in clinical care settings. As we continue to enhance our role to meet community needs, we are working towards expanding our hospital services so we can continue to improve health care for people who use drugs.

For more information, contact info@caseyhouse.ca.

Key resources

Miroslav Miskovic, Soo Chan Carusone, Adrian Guta, Bill O’Leary, Karen de Prinse, and Carol Strike. Distribution of harm reduction kits in a specialty HIV hospital. American Journal of Public Health. 2018 October. 108:1363-1365. Abstract available at https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304600

In celebration of the 12 days of Casey House Christmas December 18-29, 2020

Pharmacist Jonathan Smith Join Casey House

1st day: One pharmacist. This spring, Casey House welcomed pharmacist Jonathan Smith to join the integrated team of health care workers caring for clients. Pharmacists play a key role in holistic approaches to health care.

2nd day: Two #smashstigma TV shows to expose HIV stigma. We wrote HIV into the lives of lead characters from two iconic TV shows after a survey showed people would rather see their favourite character die than be diagnosed with HIV. Visit smashstigma.ca

3 Nights of June's HIV+ Eatery

3rd day: Three nights of June’s HIV+ Eatery. Smashing stigma family-style with delicious food made with the help of 14 HIV+ chefs. Get a taste of it here.

4th day: In Canada, someone is diagnosed with HIV every 4 hours and Health Canada’s recent approval of an HIV self-test means there is finally a safe, simple and effective HIV testing option for Canadians.

5th day: Casey House research appeared in five peer reviewed research publications, contributing to a growing body of knowledge of HIV and judgment-free health care.

6th day: Six Untold Stories of Stigma, see the faces and hear stories of how stigma impacted six people living with HIV and how they learned to flourish at smashstigma.ca

7th day: Seven days left to qualify for a 2020 tax receipt. Donate now

12 Days of Christmas 2020

10th day: Ten bed surge unit built in our dining room this spring. Our small but mighty contribution to Ontario’s hospital capacity during the pandemic.

11th day: The inpatient team accessed over $11,000 from our care and comfort fund to provide clients with much-needed necessities, such as a mattress to sleep on, a cell phone to remain connected with their community workers; and home cleaning for hoarding and bedbugs so they can move back into a safe and healthy space.

12th day: A 12 week group based physiotherapy exercise program– clients benefit from a a 60 min class 3x/week for 12 weeks led by physiotherapist and RN that includes warm-up, eleven circuits, cool down and stretches

Casey-House-Annual-Report-2020-21-cover

In anticipation of increased demand due to COVID-19, Ontario hospitals were asked to consider how they could help expand capacity. In response, Casey House is admitting patients in need of sub-acute and palliative care from other hospitals and temporarily expanding.

In addition to offering space in our 14-room inpatient unit, we are reconfiguring the dining room and first floor of the heritage house to make room for 17 additional beds, ensuring each area enables us to replicate the compassionate and expert care for which we are known.

While keeping true to our mandate of specialty care for those with HIV, during this time Casey House is admitting patients who are HIV negative to support our community and allow other hospitals to cope with the anticipated surge caused by COVID-19.

In keeping with our history, we are responding to the pandemic just as we did in the ‘80s when Casey House began, filling a gap when we see one. And, while Casey House is pleased to be part of the solution, ideally these additional beds are never filled because Ontario manages to control the surge and additional hospital capacity is not needed.

Although on-site day health programming is suspended because of the pandemic, we continue to actively support clients in the community with food deliveries and telephone calls. The day health program remains a priority, because supporting people residing outside of hospital keeps people out of hospital.

To reduce the risk of COVID-19 infection for clients and staff our facility remains closed to all but essential staff and inpatient clients.