A rare case of HIV transmission to a newborn baby was observed only in the CHU Sainte-Justine, and this can be explained by the late treatment of a migrant. A growing number of women in this situation are putting their health and that of their unborn child at risk, doctors lament.
Last month, this baby had to be delivered by caesarean section, a procedure of last resort aimed at preventing transmission when the mother’s viral load is deemed too high at the time of delivery. Despite this intervention, the newborn became infected with the virus, complained DD Isabelle Boucoiran, obstetrician-gynecologist and director of the CHU Sainte-Justine Infectiology Center.
Antiretroviral treatment, administered late in pregnancy, did not prevent transmission in utero to the baby.
The DD Boucoiran is concerned to see more HIV-positive migrant women being referred late, with advanced pregnancies. He fears that administrative reasons, especially the gap between their arrival and the completion of their HIV test by Immigration Canada, or the time taken to receive the result, partially explain this situation. While waiting for paperwork, some don’t know they have the right to essential care to avoid the same diagnosis for their child.
“Some say they didn’t receive the result from Immigration Canada when they got here, denounced D.D Boucoiran. However, a pregnant woman infected with HIV, it is urgent to send her results! It will change everything, for the mother and for the child. There, we not only scrape our drawers to pay for their medicine, but we perform caesarean sections to avoid the worst. It’s not an ideal situation,” he said.
An avoidable fate
The little boy born last month at CHU Sainte-Justine is one of the rare cases of mother-to-child transmission of HIV reported in Canada, which has numbered about five per year since 2013.
“This child will have to take medicine for life, there is no possible cure. He will be followed and will have to live with this stigma for the rest of his life. It is very difficult to talk about it in some communities,” explained Dr.D Boucoiran.
Some fear that the wait due to high numbers of asylum seekers and migrants rushing across the border could lead to delays in treatment for pregnant migrants with HIV. The influx of recent months will lengthen the wait to obtain the popular asylum seeker document, which notably grants access to free health care in Canada.
“Normally, this paper is given during an admissibility interview conducted within 24 hours by the Canada Border Services Agency. But currently, the agency is unable to meet the request and has postponed this interview for several months,” explained Stephan Reichhold, director of the Round Table of Organizations Serving Refugees and Immigrants (TRCI).
In the meantime, asylum seekers are entitled to medical services through the Interim Federal Health Program, but other migrants do not have access to them, including people who entered Canada irregularly without going through an immigration official. immigration
One thing is certain, many pregnant migrants, regardless of status, do not see a doctor for fear of paying, said D.D Boucoiran. According to TRCI, the current flood of applications may also affect the acquisition of the immigration medical examination, where applicants are tested for HIV.
“We regularly have HIV diagnoses during pregnancy, and there, the risk of transmission is higher,” said Dr.D Boucoiran, who believes that all these women should have access to free health care. “These future children will be Quebecers! There, mothers are treated with emergency solutions and their children are born by caesarean section to avoid the worst,” he denounced.
Currently, British Columbia is said to be the only province that covers full medical care for all migrants — not just refugee claimants — without or awaiting status.
At the L’Actuel clinic, which specializes in the treatment of sexually transmitted infections (STIs), there has also been an increase in consultations with migrants, according to Dr Rejean Thomas. “I’ve had several cases of HIV recently. We have to fight to get viral load tests. In the end, it’s the pharmaceutical companies that agree to pay for their treatments. It doesn’t make sense! HIV is a public health problem. Because the people who will be tested and treated will not infect others,” underlined Dr Thomas.
Curiously, he says, for non-status migrants, treatment is free for other STIs, such as gonorrhea or syphilis, but not for HIV. “This is an asymptomatic disease, you really need to do screening to treat these patients. If we let that happen, we will have problems. »
Both the DD Boucoiran than Dr Thomas believes that these migrants, who have a very difficult trajectory, should be taken care of quickly. “Sometimes they are abused,” said the latter. I had a couple the other day, come in, one of them was positive and one wasn’t. »
“One of my patients suffered violence on his journey of several months to get to Canada. One of his children died on the route. These people really need immediate help. However, they live in a acceptable expectation,” said DD Boucoiran.
While cases of mother-to-child transmission of HIV are rare, the wait caused by the current situation at the borders worries gynecologists. ” I am worried. If the viral load is still visible at the end of pregnancy, the risk of transmission to the baby is 15%. If women come early in pregnancy, the risk of transmission is almost nonexistent. The more The sooner we start therapy, the better. »
The small number of migrant women in this situation must convince the State to pay for all their treatments, this specialist believes. “We are not talking about thousands of women. We see about 50 a year. It will not be a huge amount to protect these women and their children. »
Doctors of the World Canada is one of the organizations that offers free medical services to people without status, but many migrants are not aware of this. “In addition to the language barrier, pregnant women also experience intense guilt and shame for having the virus,” explained Caroline Blais, social worker for this organization.
According to the latest Canadian HIV surveillance report, approximately 743 of the 1639 new cases of HIV infection in 2020 were reported among new migrants during their immigration medical examination. At least 254 cases of infant exposure to HIV during pregnancy were reported in the country in 2020, an increase compared to the previous decade.