3 min

Why is Ottawa’s HIV rate rising?

Complex web of reasons at root; outside the box solutions required

On the wall above my desk at the AIDS Committee of Ottawa, you can find posters from the Exile anarchist shop on Bank St; a massive pirate flag from my Gay Pirate costume at Pride 2006; a thank-you card in the shape of a hot dog; a photo of some of the kids who regularly come to the ACO Children’s Social; and a quote that inspires much of what I do as an outreach worker serving men who have sex with men in Ottawa:

“Change and innovation are of particular importance in relation to an epidemic such as HIV because epidemics are, by definition, extraordinary events. They arise because existing understandings of health and illness, and existing public health systems and institutions, are inappropriate for addressing the particular form the epidemic takes, and for stemming the particular mechanisms by which it spreads.” And finally, “The challenge of containing [HIV] requires innovation and change in relation to both frameworks of understanding and modes of action and intervention.”

Okay, so the quote is a little less thrilling than porn, I admit, but hear me out on this. It’s a quote by Catherine Campbell from a book she wrote about why HIV prevention programs fail. This is relevant in a city like Ottawa, where the HIV infection rate among gay men is growing. Stop and think about that for a minute. It’s 2008. Our community has been grappling with the HIV epidemic since the early 1980s and, a quarter of a century in, rates are once again on the rise.

When guys I chat with at the baths and online hear this, the response is usually some mix of exasperation and despair. “Fuck, if guys still can’t figure out how to hook up and have fun without rates rising, whether you’re HIV-positive or HIV-negative, then we must all be doomed.”

Sometimes there’ll be some shame and blame of some segment of the queer community or another. “Fucking morons who bareback get what they deserve!” or “It’s young kids who think they’re invincible and don’t care if they become infected because they think meds make it easy to live with!” or “Well, what do you expect if you mess with tina?”

Any or all of those issues — barebacking, the lack of mandatory and evidence-based sexual health education in schools, crystal meth — might be contributing to the rise in HIV rates in our city. So, too, might many of the other explanations I frequently hear, like the lack of speedy treatment options for folks struggling with addictions, loss of erection due to condoms that don’t fit right, AIDS fatigue caused by witnessing too many deaths or enduring too many lame public health campaigns, the challenge of getting tested in a queer-friendly and hassle-free environment in Ottawa, poverty and the lack of affordable housing, gay preoccupation with the young and hung that make negotiating safer sex harder as we age or look less and less like air-brushed models.

The title of Campbell’s book is Letting Them Die — a nod to a South African satirist who remarked, “In the old South Africa we killed people. Now we’re just letting them die.” To me, this is a painful reminder of another contributing factor of rising HIV rates in Ottawa: colonialism. Not post-colonialism, but colonialism. Lest we forget that we live, work and play on Algonquin land and that Aboriginal people make up just three percent of the Canadian population while the infection rate for First Nations people is nine percent and rising.

Without discounting any of these as potential factors, none of them on their own is the x factor. I tend to get suspicious when either a guy at the baths or a researcher at a conference explains rising HIV rates too easily. The very fact that, after 25 years, increasing numbers of men are testing positive despite all the education, outreach and dialogue, speaks to just how complex an issue this is. And just how complex the solution must necessarily be.

And what about the increasing prevalence of crack on our streets at the same time that the City of Ottawa chose to stop funding a program proven to abate drug-related HIV transmission? What about the attack on ‘harm reduction’ in general in our city? The Public Health Agency of Canada, which funds some of the HIV prevention work done in Ottawa, is quietly removing the term from its lexicon. Queer trans men are expected to ask for life-saving health information deemed too offensive to put on the shelves. The Ottawa Police Service just created a new nine-person unit aimed at street-level prostitution that will put hustling boys at greater risk.

Understanding why HIV rates are rising and why HIV prevention programs fail is essential to the health of the queer community. That quote on my office wall speaks of innovation. Of a willingness to speak up and challenge convention. Of naming institutions, ideologies, and willful inaction that stand in the way of our entitlement to wellness. Through the next few editions of Capital Xtra, I’ll present some innovative movements already gaining momentum. I’d also like to present your take on all of this. Email me at