Since the mid 1990s, Tharao’s work has focused on mobilizing black populations to work with one another and their allies to build an effective response to the challen- ges they face. Their work paid off; in 2003 Ontario became the first province to adopt a strategy to deal with HIV in black popula- tions. “We started from ground-zero and have been able to mobilize and build an insti- tutional response that’s informed by research, policy and service providing organizations and individuals,” she says. Tharao has also worked with countless committees includ- ing the Ontario HIV Treatment Network’s Scientific review committee and the Community Network Advisory Committee, the African and Caribbean Council on HIV/AIDS in Ontario, and the Governing Council of the African and Black Diaspora Global Network on HIV and AIDS. And somewhere in between it all, she’s found time to pursue her PhD at the University of Toronto’s School of Public Health.


“To provide effective care, you need to look at HIV within the context of women’s lives.”


But Tharao’s contributions haven’t just been at the committee or policy level. Early on, she recognized that HIV positive black women also needed help on a very basic level. “Women were having a hard time grappling with the technical information that they were getting from the doctors,” she explains. So in 2003, she helped organize a meeting for HIV positive black women to discuss their day-to-day challenges. Just 19 women attended the first meeting, but today more than 350 attendees regularly discuss a range of topics from medication, to training, to sexuality. “At the beginning you could never bring them together. They were so silent—they were called the silent voices of the HIV epidemic,” Tharao says. “Now, I’m telling you—you can’t shut black women with HIV up.”


Tharao may act as the bridge between the worlds of research, service delivery and policy but she says nothing would be possible with- out the cooperative effort of service delivery, nonprofit and governmental organizations. “Separately, we can only make so much dif- ference,” she says. “But collectively, we can move mountains.”


“HIV is a disease with a remarkable ability to dissect our society and find disadvantaged people.”


Treating the Streets


FROM ALBERTA TO AFRICA, DR. STAN HOUSTON HELPS MARGINALIZED PATIENTS UNDERSTAND THEIR DISEASE AND ADHERE TO TREATMENT.


Northern Alberta and Western Uganda may be a world apart, but when it comes to the treatment and care of HIV positive patients, the two may be closer than you think. With limited access to treatment added to hurdles like homelessness, substance abuse or psychiatric problems, adherence to antiretroviral therapies can be a challenge for those living with HIV—whether they’re in Africa or Alberta. “Although there are huge differences, there are also huge similarities that we should


learn from,” says Dr. Stan Houston, an infectious disease specialist at the University of Alberta. “HIV is a disease with a remarkable ability to dissect our society, find dis- advantaged people and put them at an increased risk of getting the disease.” Houston’s interest has focused on the impact of lifestyle factors on the effective- ness of antiretroviral treatments for underprivileged and marginalized patients. In Edmonton, his patients are what he calls “disproportionately” inner-city people, immi- grants and people from rural areas, including Aboriginal communities. But his interest in HIV didn’t start in Saskatchewan, where he attended medical school, or in Alberta, where he now practices. Instead, Houston’s interest in HIV was first piqued in 1987, as he began the first of three years of work in Zimbabwe. He arrived just as the first cases of HIV were beginning to present to clinical care. “Almost on a month-by- month basis you could see the increase in HIV,” he says. “It was very exciting—although mostly in a bad way.” Since then, Houston has focused on the issues affecting HIV posi- tive patients, with a particular interest in TB. In addition to Zimbabwe, his work has taken him to South Sudan, as a consultant for Doctors Without Borders, and Uganda. Houston is now the Director of the Northern Alberta HIV program, where he works


as part of a team that provides care to HIV infected and affected individuals living in Northern Alberta and the Northwest Territories. He is also a former member of the Committee to Advise on Tropical Medicine and Travel (CATMAT), an expert advisory body that assists the Public Health Agency of Canada with health-related advice for health care professionals and travelers, including those living with HIV. But Houston’s work in Canada hasn’t been limited to clinical or research settings. He also sits on the council for Street Works, an organization that has been offering a range of servi- ces (including needle exchange and HIV prevention) to Edmonton’s inner-city population for more than 20 years. Every two months, he also volunteers on “the van,” a mobile needle exchange and outreach vehicle. This, he says, keeps him in touch with what it’s like to be an HIV positive patient in Edmonton’s inner-city, which ultimately improves patient care. “It has kept me grounded in the realities of what the lives of my patients are like,” he says, adding that his work with Street Works has given him further insight into the practical issues involved in fitting treatment into the lives of his patients. “There’s a lot more to health than HIV. We should keep that in perspective.”


Thinking Positive verge: 7


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