A dramatic surge in reported HIV infections has B.C.'s north outpacing the rest of the province in the rate of new infections -- and First Nations people are being hit hardest. According to unpublished data for the first half of 2004, the Northern Health Authority now has 7.6 new HIV-positives per 100,000 people tested -- exceeding B.C. as a whole, which shows 6.3 new cases per 100,000 for the same period. That's up from 2003, when the North reported 6.9 per 100,000 tested while B.C.'s overall rate was comparatively higher at 10.2 new HIV-positives per 100,000. The numbers also show that the northern infection rates are continuing the steep climb already identified by 2002 and 2003 data. Twenty-three new HIV infections were reported in the North during the first half of 2004 -- exceeding the total of 21 new cases for all of 2003, which had already almost doubled the 12 new cases reported in 2002. Continued rise projected Staff at agencies such as Positive Living North, which provides community education and support for HIV-positive clients, are calling it an epidemic. But others are reluctant to invoke this term. As the Northern Health Authority's chief medical health officer David Bowering points out, the term "epidemic" has many accepted definitions which allude variously to the geographic spread, severity, speed and unexpectedness of a disease outbreak. In this latter sense, the North is not experiencing an epidemic. "From my point of view, this is not unexpected," explains Bowering, citing a well-documented high incidence in the North of STDs and HIV-promoting practices as injection drug use, unprotected sex (as suggested by teen pregnancies), and the sex trade. However, Bowering concedes the new data do reveal the "classic front edge of an epidemic," and predicts infection rates will mimic patterns in larger centres by rising sharply for some years before levelling out. Three possible causes Dr. Michael Rekart, Executive Director of the HIV/AIDS program at the B.C. Centre for Disease Control, suggests three possible reasons for the increase. As of May 2003, health professionals are compelled by law to locate and inform current and former sexual partners of people who have tested positive for HIV. "Health professionals [in the NHA] are quite dogged in fulfilling this new duty," observes Rekart, adding this tends to reveal more HIV-positive people who may not otherwise have presented themselves for testing. A rise in injection drug use -- now considered to be the most common means of transmission of the virus in the North as in Vancouver's Downtown East Side -- may also be a factor, especially in Prince George where the vast majority of new cases have been diagnosed. Finally, a Prince George-based research project associated with the BC Centre for Excellence in HIV/AIDS may be encouraging more people to get tested. Modelled after a Vancouver study, the project offers a cash stipend to street-involved, injection drug-using youth in return for their ongoing participation in research. "What might be happening is that we're uncovering an already existing epidemic," says Bowering. Not just an urban issue Although almost new cases are diagnosed in Prince George, people shouldn't assume this is simply an urban problem, say experts. Many new HIV-positives hail from small northern communities, but show up in Prince George statistics because they pass through this nexus of travel routes and choose to get tested here out of well-founded concerns about privacy. And many HIV-positive people decide to settle in Prince George to access a wider range of health and social supports -- mitigating the crushing stigma of AIDS -- while still being reasonably close to home. Whatever their cause, skyrocketing infection rates aren't the only cause for concern. "The face of AIDS is changing, and here in the North, that face is aboriginal," says Cathy Baylis of Positive Living North. First Nations being hit harder than any other identifiable group, and aboriginal women in particular. Even accounting for First Nations' greater presence here (for example, as high as 30 per cent of people in B.C.'s northwest), they are over-represented among new cases. In 2003, First Nations people accounted for at least 57 per cent of newly diagnosed cases, and already represent more than 1/3 of the 23 new cases in the first half of 2004. Baylis predicts it will be much higher. Enough prepared? Health professionals agree that it's behaviour, not race, which puts people at risk. And high-risk behaviour, including participation in the sex trade and intravenous drug use, is frequently associated with the social and economic conditions of B.C.'s most marginalized people. "HIV spreads into aboriginal communities along the routes of poverty and oppression," Baylis explains. "And poverty and oppression aren't letting up." It's not yet clear if the Northern Health Authority is adequately prepared to deal with an onslaught of new HIV cases. \n"As we come to terms with this, it's not just about making diagnoses. It's also about long term care," says Bowering. Myths persist At least five days of public health nursing time are required for each new case, not including additional time needed to notify former partners and collaborate with other service providers to complete treatment plans. Agencies who deal with HIV-positive clients are questioning whether health service providers in the North are sufficiently educated and sensitized to deal with this disease. "One of our HIV-positive clients described an incident where she went to a hospital emergency room for treatment of [complications relating to] her condition," relates Deb Schmitz of Positive Living North West in Smithers. "She was sent away quickly with a prescription, and told she couldn't be treated because there was no 'isolation room.' There is absolutely NO need for HIV patients to be treated in isolation rooms." To Schmitz, such incidents belie shocking levels of misunderstanding among many health service providers about HIV and AIDS. Innovative project goes to roots While the Northern Health Authority drafts an HIV strategy for the North with the help of people like Schmitz, an innovative Prince George initiative is trying to tackle the root causes of people making choices that put them at risk for HIV. The Fire Pit is a new drop-in centre at Fourth Avenue and George Street. Although it welcomes anyone to enjoy food, painting, drumming, singing, and talking circles -- or to simply hang out and chat -- it has a distinct emphasis on First Nations culture. Its location, in the basement of the Central Interior Native Health Society, is no accident. Organizers hope the CINHS will become a primary health care delivery centre, where even the most at-risk and marginalized can easily access -- on terms that speak to their day-to-day realities -- doctors, HIV support workers, drug and alcohol counsellors and social workers. Fire Pit activities reinforce positive aspects of First Nations experience, and indirectly, on how it has been impacted by colonization. Such awareness is critical to the emotional healing that will break intergenerational cycles of substance abuse and social disenfranchisement, says Fire Pit co-ordinator Cathy Baylis. 'About something bigger' For Baylis, a member of the Annishnabe First Nation, that awareness sprang from learning about one of the most punishing expressions of colonialism: forced attendance by First Nations children of government-sanctioned residential schools. "These schools rearranged and eroded our traditional ways of life, and our entire family structure, for generations," explains Baylis, whose father survived the residential experience. "They left a legacy of unresolved grief, trauma, and loss on many levels. People try to cope with that pain by turning to drugs, alcohol and abuse." Such insights can be empowering. "Issues I'd thought were just about me were actually about something much bigger," says Baylis. "This is a critical shift in thinking that needs to occur for healing to begin." Larissa Ardis is a freelance writer based in Smithers, B.C. a version of this story ran in Northward magazine.