An alarming rise in the number of HIV-positive cases in Saskatchewan has the province's chief medical officer examining all elements of transmission of the virus, including prostitution.
Dr. Moira McKinnon told CBC News that prostitutes who are infected with HIV and have unprotected sex are contributing to the spread of the virus.
On Monday, CBC News broke the story that McKinnon viewed 174 new cases of HIV in Saskatchewan last year — a 40 per cent jump from 2007 — as a "crisis" in public health.
McKinnon identified drug users, particularly those who share needles, and HIV-positive prostitutes as two groups that need attention.
"It's intertwined," McKinnon said. "The sex industry and the drug industry. We know that there are sex workers out there that are infected."
She said prostitutes pose a particular challenge.
"They've been ordered to change their behaviour," McKinnon said. "We have to monitor compliance with that behaviour and that's difficult to do."
McKinnon said one option is to charge prostitutes who knowingly engage in unprotected sex, without disclosing their HIV status.
McKinnon acknowledged such a charge could be difficult to prove. As well, she pointed out, it would be unlikely that a customer would file a complaint for police to investigate.
Prosecution could drive HIV-positive 'underground': McKinnon
And, McKinnon added, even if there were a successful prosecution, it might not make a difference and could make the situation worse.
"They get out after a few years and continue to have unsafe practices," McKinnon said. "In the meantime, the publicity around that case has driven every other intravenous drug user [or] HIV person underground and taken away their access to condoms [or] needles to allow them to have safe practices."
Barb Lawrence, of Regina's Street Workers Advocacy Project, said criminal prosecution is the wrong approach.
"We're facing a really significant problem in this community and demonizing one small group is not the answer," Lawrence said.
McKinnon said she will be working with officials in the Ministry of Justice and police services to look for ways to push HIV-positive prostitutes off the streets.
They will also examine how other jurisdictions have dealt with the problem, McKinnon said.