CBC's iTeam has learned it's not just reserves that are facing an HIV epidemic in Saskatchewan.
The most recent publicly-released data shows Prince Albert (PA) had a new infection rate of 20.9 per 100,000 people in 2013. That's 3.5 times higher than the national rate of 5.9.
Infectious Disease Specialist Mona Loutfy, who runs a regular HIV clinic in Prince Albert, told CBC's iTeam that since January there have been an alarming number of new infections identified in the region.
For the first five months of the year, there were 20 new HIV infections discovered in the Prince Albert Parkland Health Region (PAPHR). There was a total of 12 new cases identified in all of 2014.
Loutfy said those numbers are just one more indication that "there's a significant problem and it's a crisis and somebody needs to do a massive province-wide HIV program."
'It's great more people are coming forward,' says medical health officer
The medical health officer for PAPHR, Dr. Khami Chokani, said "we do know we are seeing more numbers, more absolute numbers now."
He said the higher numbers are an indication that HIV testing is becoming more effective in the area.
"To me it is something that shows the program is actually working," Chokani said. "It's great that more people are coming forward. I think that's what we want."
Chokani also pointed out that just because the raw HIV numbers are increasing in the health region doesn't mean the infection rate is actually increasing.
He said most of the new infections are happening among impoverished aboriginal people addicted to drugs who share dirty needles.
PAPHR has one of the most active needle exchange programs in the country.
Between April 2013 and April 2014, the region handed out 1.2 million needles. By comparison the entire province of Alberta hands out 2.7 million needles annually.
Chokani said those IV drug users are incredibly mobile.
"They are transient populations so just because we are reporting them on our stats doesn't mean they have not been reported by another jurisdiction."
He said they could be travelling to PA from northern reserves or from other cities in Saskatchewan.
He said he won't have the official publicly available statistics until later this year.
"We're busy making sure that they're accurate, that they're clean, that there's no double counting."
Increasing HIV cases 'terrifying,' says infectious disease specialist
Loutfy said no matter how you look at these HIV numbers, they're troubling. And she said if those new cases are coming in from northern reserves that's even worse.
"To me that's even more terrifying because that means there are cases on reserve up north that we don't know about and this problem might be even worse than we know it is," Loutfy said.
She said very often HIV patients are falling through the cracks, and that's partly because of the social conditions they face and the lifestyles they lead.
"They're living in poverty, they don't have housing, they live chaotic lives so they don't get onto retroviral treatment," Loutfy said.
But she said it's also due to a lack of aggressive coordination and testing by the federal and provincial governments.
Loutfy said the lack of a good public health plan in Saskatchewan is having fatal consequences.
"The hospitals in Prince Albert, Saskatoon and Regina have many cases of people with HIV who are dying of what we call AIDS-defining illnesses. People are dying of HIV and AIDS and they're in the hospitals in Saskatchewan," Loutfy said.
"This is something we haven't had for the last 15 years in other provinces."
Doctor says action urgently needed
Dr. Ryan Meili said it's possible for Saskatchewan to stem the tide of HIV, but that will require urgent action.
"There's so much work that has to be done and instead it's sort of smouldering under the radar."
Meili is a University of Saskatchewan professor who also works regularly with HIV patients. He's also a former leadership candidate for the provincial NDP.
Meili said in his practice he often comes across patients who are falling through the cracks between the on-reserve and provincial health care systems.
"Communication gaps can often mean medication gaps or can mean loss to follow up. And that's a big issue," Meili said.
Back in 2009, the provincial government developed an action plan to address the province's growing HIV epidemic. That plan was largely focussed on tackling the problem in the cities.
That strategy expired last year and Meili said health officials still haven't done enough to reach the whole province.
So he's calling on the provincial government to develop a new strategy aimed at tackling the problem province-wide.
"If you have the services only really available in the city in any serious and quality way it forces that migration to some degree," Meili said.
He said rural people would be more likely to access care if it was nearby.
Provincial government gets focused on testing
Saskatchewan's Deputy Chief Medical Health Officer Denise Werker agreed that more needs to be done.
"We have made enormous improvements in Saskatoon and Regina in terms of large urban areas. Now we have to focus more on rural and remote and the coordination of those services."
She said the province is unable to offer services on reserve because it is a federal responsibility. However, she pointed out that recently the province and Ottawa have agreed on a new shared approach to HIV testing.
"We have implemented a policy of 'know your status' universal HIV screening," said Denise Werker.
"In terms of how that gets rolled out, we all have a collective responsibility to roll that out and to make those services accessible."
Loutfy is frustrated that it's taking so long for health officials, both federal and provincial, to act.
"They roll out testing for tuberculosis on reserve, off reserve and they work together," Loutfy said.
"So they do it for tuberculosis flawlessly. So there is precedence. So why aren't they doing that for HIV?"
She said it's in everyone's interest for governments to act in an urgent way and test people at risk of HIV infection in an urgent manner.
"These people need to be tested because if we don't test them and we don't get them treated more people are going to be infected," Loutfy said.
"And it's going to cost Saskatchewan residents more money in taxpayer dollars for people being in hospital."
The chief of the Big River First Nation said his reserve has welcomed the help of Ottawa and the provincial government.
Chief Bruce Morin said he learned Big River was facing an HIV epidemic back in 2011. There are 30 HIV patients in a community of 3,500 people.
He said Ottawa is providing additional funding to help his band deal with the crisis. And he said many of his people seek help in the PA Parkland Health Region.
He said he would like to see more support from the region, but he said in his mind the biggest responsibility falls on the First Nations themselves.
"I think the first step is the communities like ourselves, like Big River First Nation, is to take ownership of what's happening here and work with your membership and start from there," Morin said.
"Like there's no other way. You have to take ownership of what's happening and try and deal with it as best you can.