Alarming Rise in Sexually Transmitted and Blood-Borne Infections
Inquiry--Debate Continued
December 5, 2024
Honourable senators, I speak today to Senator Cormier’s inquiry calling attention to the alarming rise in sexually transmitted and blood-borne infections, or STBBIs, in Canada including HIV/AIDS. I want to thank you, Senator Cormier, for your leadership on this issue and for your clarity and eloquence in rightly framing this crisis as one of overlapping and intersecting concerns about public health, human rights, equality and justice.
Rising rates of STBBIs and HIV/AIDS are not just a public health emergency but also a reflection of the failures of our existing health and social supports to adequately reach and meet the needs of those who have been disproportionately marginalized for reasons including systemic colonialism, racism, misogyny, heterosexism, ableism and class biases. Behind prison walls, these already glaring and unconscionable inequalities are starkly magnified by harsh, punitive settings. Not only do prisons fail to provide incarcerated people with adequate health care, but correctional policies and practices also continue to create barriers to prisoners being able to access the community-based health and other services and supports that they urgently need.
In Canada, according to the National Collaborating Centre for Infectious Diseases, recent incarceration correlates with an increased risk of contracting sexually transmitted and blood-borne infections. A person’s risk of contracting hepatitis C increases by 64%, and for HIV/AIDS, the risk increases by 81%. Given the mass incarceration of Black and Indigenous peoples, especially Indigenous women — a direct result of Canada’s colonial history — these risks are not inevitable, nor are they merely a health crisis. In fact, they are a continuation of the systemic marginalization that disproportionately and unjustly exposes people to preventable harms.
Other key and interrelated risk factors for STBBIs include substance use and inadequate housing, which combine to put women in Canadian federal prisons at particular risk. In federal prisons, 9 in 10 women have experienced physical or sexual abuse. Research from the National Collaborating Centre for Infectious Diseases highlights that there are clear links between the incarceration of women, poverty and lack of social supports and the risks of STBBIs related to abusive partners, forced sex, coerced sex work and other forms of sexual exploitation, as well as the use of substances, including as a means of women anaesthetizing themselves to such realities as they struggle to navigate and survive abuse, assault and poverty.
As the National Inquiry into Missing and Murdered Indigenous Women and Girls explored and as their Calls for Justice underscore, for too many women, the very factors that led to their criminalization are also those that put their health and lives at greater risk in federal prisons.
Within prisons, disproportionately high rates of infection are largely attributed to the severe lack of programming and supports for those with addiction who enter prisons and the subsequent sharing of needles among those in prison.
Since the early 1990s, correctional and health authorities in Canada and internationally have recommended needle exchange initiatives for prisons. In 2006, the Public Health Agency of Canada released a study on the effectiveness and risk-benefit analysis of a prison needle exchange program, which found that needle exchanges could effectively reduce the transmission of HIV and hepatitis C.
In 2018, Correctional Service Canada finally rolled out the Prison Needle Exchange Program which, unfortunately and despite the critical need, currently operates in only a fraction of Canada’s prisons. The aim of this program is to implement measures to help address drug use and addictions in federal corrections. However, its effectiveness has been undermined by overarching correctional policies and practices that prioritize drug suppression.
As expressed by the Correctional Investigator:
Maintaining a zero-tolerance approach to drugs that relies on ever more intrusive detection, disciplinary and repressive measures — strip-searches, body cavity scanning, cell searches, charges, urinalysis testing — is a costly game of diminishing returns. If a person is so desperate, indebted or addicted enough to the point of concealing drugs in body cavities with potentially life-threatening consequences, then surely this level of desperation should point us to consider other less intrusive, evidence-based and compassionate approaches of addressing the harms of illicit drug use behind bars. . . .
Specifically, in his 2021-22 annual report, the Correctional Investigator concluded that only an alarmingly low number of participants had been able to access the Prison Needle Exchange Program. The Union of Canadian Correctional Officers representing guards in federal penitentiaries has estimated the number of program participants to be around 50 out of a prisoner population of nearly 13,000.
The Correctional Investigator has critiqued the strict eligibility criteria for the program as enforced by Correctional Service Canada, including a requirement to undergo a threat risk assessment, as well as the lack of patient confidentiality and the perceived involvement of the parole board in the program. Prisoners are understandably concerned about the privacy of their health information and the potential for this information, as well as their participation in the program, to be used against them in proceedings that determine how and when they can integrate into the community.
Given the lack of planning and administration of the program, most prisoners were not aware of the Prison Needle Exchange Program’s existence. Correctional data also indicates that of those who do manage to be approved for the program, fewer than 20% participate actively — a factor noted in analyses of the challenges of overdoses and deaths in prisons.
The extent to which Correctional Service Canada is undermining its own Prison Needle Exchange Program was made abundantly clear in the holiday cards that MPs and senators received last year from the Union of Canadian Correctional Officers. While opening these cards, many of our staff teams were disconcerted, to say the least, to find a slew of inappropriate and stigmatizing comments, as well as a pen made to look like a bloody syringe, that aimed to sow fear and doubt about proven harm reduction strategies.
The Union of Canadian Correctional Officers argued that instead of needle exchanges, overdose prevention sites should be preferred within federal prisons. As of early 2024, only three such sites were operating, with many of the same barriers to access that prisoners experience with respect to the needle exchanges, especially relating to the possibility of being singled out for stigma and punitive responses. In addition, relying on supervised consumption is untenable for many prisoners given the limitations identified by the Correctional Investigator, including restricted hours of operations and lack of meaningful peer support and assistance.
Correctional Service Canada is responsible for providing a safe environment for federal prisoners, and the Union of Canadian Correctional Officers’ position is beyond disappointing. Surely our experiences — most recently with the health crises associated with the COVID-19 pandemic in federal prisons — underscore the reality that failing to address health risks proactively and effectively in prisons increases public health risks for all in prisons, staff and prisoners alike, and then, by extension, to the public.
The approach of corrections to sexually transmitted and blood-borne infections underscores what we have long known about health care in federal prisons. Viewed through the lens of security and focused on managing behaviour and risk, this is not a safe and certainly not a therapeutic environment in which to meet health and addiction needs.
The Corrections and Conditional Release Act provides opportunities that remain all too rarely used in practice for prisoners to be transferred to the community, including to provincial and territorial hospitals. If we are to meaningfully address the systemic inequalities and discrimination that threaten the health and lives of those most marginalized in federal prisons, it is time to act on measures like those proposed in Bill S-230 that breathe life into these community-based options.
This situation, unfortunately, continues after release from prison. The stigma of a criminal record compounds existing patterns of economic and social disadvantage and marginalization, as well as the resulting risks to health and safety, including as a result of STBBIs.
Black and Indigenous peoples, those with mental health and addictions needs, women with lived experience of violence and members of the 2SLGBTQQIA+ communities — all groups overrepresented in federal prisons and at heightened risk of contracting sexually transmitted and blood-borne illnesses — are among those who could benefit in particular from building networks of support in the community and redressing the gaps and failures of existing social safety nets that have too often created the context for their criminalization and institutionalization.
As Nelson Mandela noted with respect to the AIDS crisis:
The more we lack the courage and the will to act, the more we condemn to death our brothers and sisters, our children and our grand-children. When the history of our times is written, will we be remembered as the generation that turned our backs in a moment of a global crisis or will it be recorded that we did the right thing?
Incarceration should not be a death sentence. It is our responsibility to address the systemic failures that perpetuate health crises and to uphold the dignity and rights of all individuals regardless of their circumstances. I urge that we work together to demand accountability from the Correctional Service to support a comprehensive harm reduction strategy and community-based alternatives to prison in order to protect not just the health of incarcerated people and staff but the health of our society as a whole. Let us not fail in our duty to ensure that justice and humanity go hand in hand. Let us ensure that when the history of our times is written, we have done the right thing.
Thank you again, Senator Cormier, for launching this inquiry and for all you do for so many. Meegwetch, thank you.
Honourable senators, I rise today to speak to the inquiry into the alarming rise in sexually transmitted and blood-borne infections in Canada, including HIV/AIDS.
I want to thank Senator Cormier for calling attention to this important public health issue. He has spoken about the rising rate of HIV/AIDS. Senator Simons has spoken about the return of syphilis. Senator Moodie has spoken about the impact of sexually transmitted and blood-borne infections on children, and you have just heard Senator Pate speak about the impact of these infections on incarcerated people.
Today, the first part of my speech will focus on the most common viral sexually transmitted infection, or STI, and how it can cause cancer. In fact, this viral STI can cause six different cancers. The second part of my speech will focus on one of these cancers in order to increase awareness of it and to help decrease stigma surrounding it. The final part will focus on how these cancers can be prevented.
You may have already guessed it: I’m talking about the human papilloma virus, otherwise known as HPV. Human papilloma viruses are small double-stranded DNA viruses that affect epithelial cells. Most HPV infections occur without any symptoms and resolve without treatment.
Without vaccination, it’s estimated that 75% of people in Canada will have at least one HPV infection in their lifetime, with the highest prevalence in young adults between the ages 20 and 24. Over 200 HPV genotypes have been identified, and infection with high-risk genotypes can result in cancer. The low-risk genotypes generally do not cause cancer but can cause conditions such as anogenital warts and recurrent respiratory papillomas.
In Canada, HPV is responsible for almost 3,800 new cancer cases each year, and the virus causes almost all cervical cancers, 90% of anal cancers, 40% of vaginal and vulvar cancers, 40% to 50% of penile cancers and 60% to 73% of oropharyngeal cancers.
Colleagues, prior to coming to the Senate, I was an otolaryngologist, otherwise known as an ear, nose and throat surgeon. In my career, I’ve diagnosed far too many oropharyngeal cancers, which leads us to the second part of my speech.
Oropharyngeal cancers occur in the tonsils, base of tongue, soft palate and the posterior wall of the throat or pharynx. The incidence of these cancers peaks between the ages of 60 to 64 years and is more common in men by a 4 to 1 ratio.
The specific mode of HPV transmission to cause oropharyngeal cancer is unclear, but can occur through oral-oral, oral-genital and oral-anal contact. For most people exposed to HPV orally, they are usually asymptomatic, with immune clearance of the virus within one to two years without any medical treatment. But for some people, the virus can invade the immune system and remain latent in the oropharynx for many years.
Historically, the major risk factors for oropharyngeal cancer were tobacco and alcohol consumption, but now the data clearly shows HPV — in particular, the high-risk genotypes — is the main risk factor.
Globally, prevalence of oropharyngeal cancer is rapidly increasing, especially in high-income and developed countries. Data from Canada is consistent with data from the United States, where the proportion of HPV-oropharyngeal cancers increased from 16% in the 1980s to more than 70% in the early 2000s. In 2011, it was predicted that oropharyngeal cancers would surpass cervical cancer to become the most common HPV-associated cancer by 2020. Surprisingly, this occurred the following year, in 2012.
Colleagues, while this inquiry on sexually transmitted infections may cause you to think, “This doesn’t affect me,” allow me to share a true story of someone I know, and to be clear, not a former patient.
At the time, he was a fiftyish-year-old fit and active man with a several-month history of a hard lump in his upper neck that was not going away and, in fact, was slowly getting bigger. He had no other symptoms. He had quit smoking many years prior and was a social drinker. In other words, he did not have the historical risk factors for a head and neck cancer.
Yet, he was diagnosed with an oropharyngeal cancer, and, yes, it was HPV-associated. He was embarrassed because HPV is a sexually transmitted infection. He was concerned that people would think he was an unfaithful husband, and he was worried that he was going to give HPV to his wife. Stigma is powerful.
The good news is that he was diagnosed correctly, treated appropriately, he learned that he would not give HPV to his wife and has been cancer-free for several years. He now knows that HPV-associated cancers are on the rise and that he has nothing to be embarrassed about.
For the third and final part of my speech on how to prevent HPV-associated cancers, I will read excerpts from the July 2024 update from Canada’s National Advisory Committee on Immunization, or NACI, along with their latest recommendations:
HPV vaccination, along with surveillance and screening strategies, are core public health measures for the prevention of HPV infection and HPV-associated cancers.
NACI had three strong recommendations — meaning that they apply to most populations or individuals unless there’s a clear and compelling rationale for an alternative approach — and one discretionary recommendation — meaning that it may be considered for some populations or individuals in some circumstances.
The three strong recommendations were human papillomavirus, or HPV, vaccination for all individuals aged 9 to 26 years; individuals aged 9 to 20 years should receive one dose of HPV vaccine and individuals aged 21 to 26 years should receive two doses of HPV vaccine; and the 9-valent vaccine should be used as it provides protection against the greatest number of HPV types and associated diseases.
The fourth and discretionary recommendation was that individuals 27 years of age and older may receive the HPV vaccine with shared decision making and discussion with a health care provider.
Across Canada, HPV vaccinations are currently offered to school-aged children and adolescents as part of publicly funded, school-based programs. These programs were initially launched in 2007-08 for female students and were expanded to both it biological sexes by 2017 in all provinces and territories. However, many children and adolescents remain unvaccinated with recent estimates of vaccine coverage remaining below the targets of 90% by 17 years of age. Recent data on vaccine uptake shows that certain areas, for example, rural and remote populations, have lower vaccination and higher cervical cancer rates. Specifically, First Nations, Métis or Inuit populations in Canada experience higher rates of HPV infection and associated disease, as well as lower cervical screening cancer rates, which can be complicated by stigmatization and discrimination when accessing health care.
Of note, recent Canadian data reports that Indigenous women are 2 to 20 times more likely to be diagnosed with cervical cancer compared to non-Indigenous women, and have a mortality rate of cervical cancer 4 times higher than non-Indigenous women.
Immigrant and refugee populations in Canada also have lower cervical cancer screening and higher HPV infection rates, putting them at increased risk of HPV-associated morbidity and mortality.
Intersectionality among residents, race and socio-economic status may further compound health inequities.
Mitigation strategies that could promote equity include tailored catch-up programs; expanded, publicly funded vaccine access, such as in primary care and pharmacy settings, additional school-based clinics, simplified consent approaches; and reallocation of resources for doses to populations made vulnerable.
The vaccine is available for private purchases for those who are not included in their jurisdiction’s publicly funded HPV immunization programs.
Data from around the world confirms the effectiveness of the HPV vaccine in preventing cervical cancer. In England, the incidence of cervical cancer was reduced by 87% in women in their twenties who were offered the vaccine when they were aged 12 to 13 years as part of the U.K. HPV vaccination program.
Among Swedish girls and women aged 10 to 30-years-old, HPV vaccination was associated with a substantially reduced risk of invasive cervical cancer at the population level.
In Canada, if one uses the coverage observed in Quebec where they have 85% vaccination coverage, the projection is for near elimination of high-risk HPV infections in females and males within the next 15 years. In Ontario, where vaccination coverage is between 62 and 67%, the projection is lower but still comes in at a 90% reduction in HPV infections.
Finally, data showing a reduction in other HPV-associated cancers, such as oropharyngeal cancer, is more limited and delayed given its slower projection compared to cervical cancer.
In closing, an upstream approach to health promotion focuses on awareness and the root causes of disease rather than just the symptoms. Dear colleagues, I thank you for your interest in health and for your attention. Thank you. Meegwetch.
Honourable colleagues, I rise today to speak to the Senate inquiry regarding a critically important public health issue, the alarming rise in sexually transmitted and blood-borne infections, including human immunodeficiency virus, or HIV. I would first like to thank Senator Cormier for launching this inquiry and for the other speakers that we’ve been hearing from since he has.
The infections of chlamydia, gonorrhea, syphilis, hepatitis B and C and HIV are grouped together, and public health practitioners encourage testing for them concurrently for one simple reason: if you’re at risk for one of them, you’re at risk for all of them.
There is a very clever ad for the shingles vaccine that, by the way, I would encourage you all to take advantage of, including the HPV vaccine as we’ve just heard. And it says, “Shingles doesn’t care.” Well, sexually transmitted and blood-borne infections don’t care either. They are transmitted through the exchange of genital fluids, through intimate skin-to-skin contact and through contact with blood, and because they are often present without symptoms in the early stages, they are easily transmitted unknowingly.
HIV does not discriminate. Globally, 44% of all new HIV infections were among women and girls of all ages in 2023. In sub-Saharan Africa, women and girls of all ages accounted for 62% of all new HIV infections. In all other geographic regions, including North America, over 73% of new HIV infections in 2023 occurred among men and boys.
Every week, 4,000 adolescent girls and women aged 15 to 24 became infected with HIV globally in 2023; 3,100 of these infections occurred in sub-Saharan Africa. December 1 marked World AIDS Day and the beginning of Indigenous AIDS Awareness Week. During this time, we remember those we lost to HIV as we continue to support those living with it by raising awareness, increasing our knowledge and working to end the stigma and discrimination surrounding HIV.
It is this stigma and discrimination that will be my focus today, but first a public service announcement. The two ways that HIV can be passed are through sex and by sharing needles or other equipment to inject drugs, including steroids or hormones. HIV can also be passed to a baby during pregnancy, birth or breastfeeding, by sharing needles or ink to get a tattoo, by sharing needles or jewelry to get a body piercing or by sharing acupuncture needles. There is even a risk to sharing common things like nail clippers — anything that has the potential to break the skin. Sadly, these ways can happen without knowledge of the infected person.
It’s also important to know that HIV cannot be passed by shaking hands, working or eating with someone who has HIV, hugs or kisses, coughs, sneezes or spitting, swimming pools, toilet seats, water fountains, insects or animals or through acts of kindness and acceptance.
Since November 1985, all blood products in Canada are checked for HIV to ensure that it’s safe to get a blood transfusion. And there’s no chance of getting HIV from donating blood.
So how can you protect yourself and others? The number one way is to know your status and the status of your intimate partner by getting tested.
In certain circumstances, like good prenatal care, routine testing of pregnant mothers is done to protect the unborn baby by offering treatment before birth and ensuring appropriate care in the newborn period. Although there is no vaccine to prevent HIV or hepatitis — or the other sexually transmitted diseases that I talked about — there are things you can do to avoid passing or getting these infections, but they cannot be passed through healthy, unbroken skin. Promoting the use of condoms during sex and making them readily available as a harm-reduction strategy is good public policy.
When, as a health care provider, I began to encounter people at risk of HIV and hepatitis C in the early 2000s, there were limited ways to protect against these infections and treatment was difficult or non-existent. It was a pretty scary time. People did not want to be tested because they were afraid to know.
Today, thanks to advances in pharmacology, there is a cure for hepatitis C and treatment to make the viral load for HIV undetectable and therefore untransmittable to intimate partners. In short, there is hope.
There is also medication to prevent infection for those at highest risk for HIV. If you are HIV-negative and at higher risk for HIV, you might be a candidate for pre-exposure prophylaxis, or PrEP. PrEP involves an HIV-negative person taking certain HIV drugs to reduce the risk of contracting HIV. A person starts PrEP before being exposed to HIV.
If you are HIV-negative and may have been exposed to HIV, you can take post-exposure prophylaxis, or PEP. PEP drugs must be started as soon as possible, within 72 hours of being exposed to HIV, and must be taken for 28 days.
Public health and community service providers can help people to better understand and assess their risk, but they must do so with the understanding that a person’s behaviours are only part of the picture. Understanding a person’s HIV risk requires the consideration of many individual, behavioural and contextual factors. While personal decisions and actions can affect someone’s risk of getting HIV, other social and structural factors, such as relationship power dynamics, unstable housing or lack of income, can also play a role in shaping their vulnerability to HIV. Explaining risk in a meaningful way can be complex and challenging.
However, understanding the many factors that make up the risk regarding HIV can not only help people assess their own risk but also find ways to better support the people that service providers work with.
Risk is all about uncertainty, and it does not happen in a vacuum. It is influenced by many different factors that can change over time. Broadly, the following factors can affect a person’s HIV risk: whether they have personal factors, including mental health issues or substance use, that can affect their risk in a variety of ways, such as by affecting their judgment or choice making and their ability to navigate consent; whether they have low-barrier access to different HIV prevention strategies; and social and structural factors, including forms of oppression that create health inequities such as racism and homophobia.
Understanding that HIV risk is produced and reinforced through unfair differences in health status or health inequity caused by social and structural factors can help service providers better meet the holistic needs of their clients, for example, by supporting them to access other services, including counselling or housing supports, and advocating for broader systemic changes like policy changes.
In Canada, certain populations have disproportionately high rates of HIV that are concentrated in marginalized groups and communities. The populations that are disproportionately impacted by HIV in Canada include gay, bisexual and other men who have sex with men; two-spirit people; transgender people; Indigenous peoples, including First Nations, Inuit and Métis; African, Caribbean and Black communities; and people who use drugs. However, this does not mean that being a member of one of these populations is a “risk factor” for HIV. Rather, it means that other factors are contributing to increased risk at a population level.
In Canada, populations that have high rates of HIV disproportionately experience a range of social and structural forms of discrimination and exclusion — for example, racism, homophobia and transphobia — that influence their social determinants of health, like homelessness, poverty, social isolation and their ability to access health services, leading to health inequities. In the context of HIV, health inequities in these populations include increased vulnerability to HIV and poorer health outcomes for people living with HIV.
These disparities can also create conditions that enable HIV to spread more rapidly in the population, which further increases health inequity.
The greater the number of people living with HIV in a given population, the more likely it is that a member of that population will be exposed to HIV.
The concept of risk is often used directly or indirectly to place blame on individuals for activities they participate in. It is important to be aware of this when discussing HIV risk with people. Labelling specific activities as “risky” or telling people that they shouldn’t do specific things can reinforce the experience of oppression and exclusion for them.
Additionally, this approach does not acknowledge that the activities that can lead to HIV transmission are sometimes a result of factors beyond a person’s control that limit their choices. For example, there may be a power imbalance in a sexual relationship that determines their use of HIV prevention strategies.
However, one thing that is certain is that undetectable equals untransmittable. This means that a person living with HIV who is on HIV treatment and maintains an undetectable viral load will not pass on HIV through sex; an undetectable viral load means the risk of sexual transmission is zero.
To end inequalities and inequities, we must acknowledge the impact HIV continues to have on communities struggling with social and economic challenges, as well as Indigenous people, gay, bisexual and other men who have sex with men and people who use drugs. We must also recognize that many people diagnosed with HIV may experience mental health challenges, both as a result of the stigma surrounding HIV and the complex emotions that accompany a diagnosis.
Tragically, COVID-19 impacted access to many services for sexually transmitted and blood-borne infections, including testing. As a result, in Canada, there were 1,722 newly diagnosed cases of HIV in 2021, an increase of 5% since 2020.
In 2020, Indigenous people represented nearly 10% of all people living with HIV in Canada, although Indigenous people made up only 5% of the total population in 2021. With data portraying this stark reality, Indigenous voices and experiences must be at the forefront of HIV prevention and care for First Nations, Inuit and Métis communities. We must keep working together toward further incorporating traditional knowledge and culturally safe practices into our HIV health care approaches.
Community-based organizations remain vital in implementing local projects that improve access to HIV prevention, treatment and care and enhance evidence-based harm-reduction strategies.
The federal government’s HIV and Hepatitis C Community Action Fund and the Harm Reduction Fund support community-based organizations and projects that are on the front line in preventing infections and improving access to treatment and care. HIV self-testing is more widely available, including in Northern, remote and isolated communities across Canada, to help reach the undiagnosed as a first step toward connecting people to culturally safe services.
Through continuing to expand these measures, Canada can support the global goal of ending HIV and AIDS as a public health concern by 2030.
The Public Health Agency of Canada collaborates with governments at all levels and regional and local communities. Each partner plays a critical role in engaging with people living with HIV and those at risk of infection to help meet their prevention, testing, treatment and support needs.
During AIDS 2022, Canada endorsed the Undetectable = Untransmittable, or U=U, global declaration. That means that if an individual is receiving treatment and maintains a suppressed viral load, there is effectively no risk of sexually transmitting the virus to others. Promoting this message is one way we can reduce stigma and discrimination.
Global testing and treatment targets for 2025 have been established. Named 95-95-95, it calls for 95% of all people living with HIV to know their status, for 95% of those who know their status to access treatment and for 95% of those receiving treatment to become virally suppressed.
Globally, in 2023, 86% of all people living with HIV knew their HIV status. Among people who knew their status, 89% were accessing treatment. Among people accessing treatment, 93% were virally suppressed.
Although we have variable success toward these targets among some populations in Canada and we have work to do, most provinces are approaching those targets.
While the COVID-19 pandemic affected sexual health services, it has also contributed to promising advances in science and innovative ways of connecting people to testing, treatment, prevention and care that help to collectively drive progress forward. Addressing the ongoing challenge of HIV requires a comprehensive approach.
Scaling up new diagnostic technologies, such as point-of-care testing and self-test kits, will increase accessibility and encourage early detection, particularly in remote and underserved areas.
Advancements in medical research and technology have significantly improved prevention and treatment. Antiretroviral therapies for HIV and curative treatments for hepatitis C —
Senator Kingston, your time has expired. Are you asking for leave to have additional time to complete your speech?
Yes.
Is leave granted, honourable senators?
New medical technologies will help prevent the long-term effects of these infections.
People living with HIV who are on treatment can live long, happy and healthy lives. The first step to treatment and care is knowing your status. I encourage everyone to raise awareness and change HIV-related stigma. By working together, we can put an end to the spread of HIV.
Thank you, woliwon.
