4 New releases 5 Sleep disturbances and hepatitis C virus 7 Results of the First Nations of Quebec Regional Health Survey 7 New CATIE ressources

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1 hope of THE CIRCLE Newsletter The First Nations and Inuits of Quebec HIV and AIDS Strategy Fall 2014 Working with youth : an exciting challenge! Summary 2 Editorial 2 Upcoming events 2 INSPQ training sessions coming near you 3 Resources for working with youths 4 New releases 5 Sleep disturbances and hepatitis C virus 7 Results of the First Nations of Quebec Regional Health Survey 7 New CATIE ressources 8 Viral load and risk of HIV transmission 9 The youth centres and the combat against STBBIs 10 STBBI screening for youths 11 Alcohol and liver damage for people with Hep C and HIV coinfection To work together in the spirit of honor and respect towards a holistic HIV/AIDS strategy for the First Nations and Inuits of Quebec

2 2 Editorial Upcoming events Hello everyone! Once again, the FNQLHSSC will be organizing great activities in the coming year. To mark the 2014 HIV/AIDS Awareness Week, we would like to give First Nations youth a voice. A contest will be launched among high school students so they can develop an awarenessbuilding campaign that reflects them. The winning projects will be announced during the week of December 1, Your turn now to stimulate the creativity of young people in your community! In addition, we are preparing two trainings that will challenge both interveners working on sexual health and those working in the field of addictions. These trainings will be offered in the fall and spring by videoconference. Hope to see you there! Finally, for those of you who have the challenge of dealing with youth, this issue of The Circle of Hope suggests resources to work with this clientele. Enjoy your reading! Toxicomanie et problématiques associées : agir ensemble Le 42 e colloque de l AITQ Association des intervenants en toxicomanie du Québec October 20-22, 2014 Trois-Rivières, QC 18 th Annual Public Health Days November 24-26, 2014 Centre des congrès de Québec Quebec City, QC INSPQ training sessions coming near you Screening intervention for sexually transmitted and blood-borne infections: the nurse s contribution October 23 and 24, 2014 Two-day training provided in collaboration with the DSP Gaspésie - Îles-de-la-Madeleine. THE CIRCLE OF HOPE NEWSLETTER This Newsletter aims to provide an information and communication platform to all the people affected by HIV and AIDS among the Quebec First Nations and Inuits. It also aims to provide an update on the FNQLHSSC HIV/AIDS-related projects. If you wish to subscribe to receive your free copy of the newsletter, or if you wish to publish a text, personal account or open letter, please contact the FNQLHSSC at The opinions expressed in this Newsletter are those of the authors and do not necessarily reflect the official positions of the FNQLHSSC. Prepared by: Marie-Noëlle Caron, CSSSPNQL. Graphic design : Siamois graphisme Treatment of opioid dependence NEW VERSION: Interdisciplinary component November 3 and 4, 2014 DSP Côte-Nord Baie-Comeau on November 3rd Sept-Îles on November 4th Preventive intervention among people with STIs and their partners November 19 and 20, 2014 Two-day training provided in collaboration with the DSP de Montréal To learn more about the available courses, see the directory developed by the INSPQ. To request training, please contact the person responsible at your Direction régionale de santé publique. For more information:

3 3 Resources for working with youths Zoom Santé (Focus on Health: info-bulletin of the ISQ): Violence in youths sexual relations: What are the at-risk behaviours involved? Based on data from the Quebec Survey on the Health of High School Students , this new publication considers violence in the sexual relationships of youths using two indicators: violence from the victim s perspective and violence from the perpetrator s perspective. The indicators selected for measuring violence are first analyzed according to certain at-risk behaviours surrounding the use of alcohol or drugs. These indicators are then cross-referenced with the negative impacts of this consumption, such as psychological difficulties or delinquent actions under the influence of alcohol or drugs. Lastly, violence in sexual relations is placed in relation to certain sexual behaviours (including precocious sexual relations, the number of partners, etc.). The results are presented overall according to sex or level of education. You can access the online version by visiting the website of Institut de la statistique du Québec: Mosaïk project: Promotion and prevention tools in youth sexuality Thanks to the Mosaïk project, the employees in the health & social services and education systems, as well as workers in the communities, can count on 70 tools to assist them in their work in the area of sexuality with young people from the pre-school level to secondary five. These tools facilitate promotion and prevention according to several aspects of youth sexuality (human body, sexual stereotypes, puberty, sexually transmitted infections, etc.) and according to the needs expressed by the schools. Designed on the basis of the École en santé (Healthy School) approach, they are the result of collaboration among the health and social services centres, the public health branches, the schools and school boards, and community organizations. Three kinds of tools are available to workers: Tools for taking action regarding the secondary school environment, allowing the creation of a network of allies against homophobia. Tools for working with pre-school and elementary school children, for purposes of pedagogical activities or learning and evaluation situations in math, languages, or ethics and religion. Tools to encourage parental involvement. These tools can be downloaded free of charge from the École en santé website: New release of the SexEducator Counteracting the trivialization of sexual exploitation Issue 24 Summer 2014 This issue of the SexEducator aims to define the notion of consent to sexual activities and its components, and to expose the absence of consent in situations where minors are sexually exploited. It also provides tips for interventions with adolescents to counteract trivialization of sexual exploitation in the media and help vulnerable youth, some of whom risk involvement in prostitution. For complete magazine: Source:

4 4 CONTINUED: Resources for working with youths SEXOclic Promoting healthy sexuality among young people The SEXOclic website was launched six months ago. The response has been exceptional, which is encouraging news for this new interactive space for teachers and youth workers. It provides informative and educational information for promoting healthy and responsible sexuality among young people. The result of a collaborative effort between the Montréal Public Health Branch, the regional branch of the ministère de l Éducation, du Loisir et du Sport, and five school boards in Montréal, SEXOclic has also benefited from the contributions of numerous sexologists. The site s content is presented under the following five headings: S informer (get informed): provides relevant information about promoting healthy sexuality among youths. Se préparer (prepare): contains suggestions for planning promotion and prevention activities in sexuality. S outiller (get the right tools): this is a research engine to find tools that provide exceptional insight. Soutenir les parents (support for parents): suggests strategies to support and promote parents involvement. Formation (training): describes various training activities on the theme of sexuality. All teachers and workers involved in promoting healthy sexuality for youths will benefit from the many resources available through SEXOclic. Source: New releases! Guide d intervention sur les infections transmissibles sexuellement à déclaration obligatoire (in French only) 2014 edition Based on scientific data, this guide presents the recommended public health interventions to take following notification of: Chlamydia trachomatis infection, gonococcal infection, syphilis, lymphogranuloma venereum, chancroid or granuloma inguinala (ITS-MADO). This guide replaces the following documents: Prévenir et enrayer situations et orientations sur les infections transmissibles sexuellement à déclaration obligatoire (2003); Protocole d intervention sur les infections transmissibles sexuellement à déclaration obligatoire (2004) and Programme québécois d intervention préventive auprès des personnes atteintes d une ITS et auprès de leurs partenaires (2004). Available at Get the June 2014 update! Guide québécois de dépistage des infections transmissibles sexuellement et par le sang (in French only) 2014 edition This guide presents the technical and scientific information necessary for properly carrying out screening of sexually transmitted and blood-borne infections. The recommendations it contains are based on the most recent scientific data. Available at

5 5 CATIE News Sleep disturbances and hepatitis C virus Hepatitis C virus (HCV) infects the liver and injures this organ. If HCV is left untreated, over time this virus continues to injure the liver, causing inflammation and the replacement of healthy, functional liver tissue with scar tissue. In chronic HCV infection, the liver gradually becomes dysfunctional, complications occur and the risk of developing liver cancer increases. Study details Researchers analysed data from the following participants: 20 HCV antibody positive (suggesting past infection) women, 12 of whom had detectable HCV genetic material (RNA) in their blood, indicating ongoing infection 19 healthy and HCV-negative women All participants were in their mid-50s and had been exposed to HCV several decades ago, before routine screening of the blood supply for viral infections was done. According to the study researchers, none of the participants had any of the following conditions or factors that could have affected their sleep: HIV co-infection severe liver injury (cirrhosis) a history of neurological or psychiatric disease a history of injecting street drugs engaged in shift work One of the many complications that can arise from chronic HCV infection is disturbed sleep. Liver and brain researchers in Hannover, Germany, have collaborated to study sleeprelated issues in people with HCV. Their work adds to the growing body of evidence that poor-quality sleep may occur in some people with HCV infection. Furthermore, it appears that sleep-related problems may be, at least in some cases, the source of fatigue that is reported by many people with HCV. What is novel about the German research is that sleep-related problems were detected despite the absence of severe liver injury. used medicines that can affect sleep, including opioids, anti-anxiety drugs, antidepressants and interferon The women underwent extensive evaluations, via medical surveys, of their health, in particular the following issues: sleep quality daytime sleepiness fatigue depression anxiety

6 6 Continued: Sleep disturbances and hepatitis C virus Participants also had a small device strapped to their wrist that recorded their activity over five days. Results Women with a history of HCV compared to women without past exposure to HCV were significantly more likely to have the following: fatigue poor sleep quality daytime sleepiness reduced health-related quality of life Researchers found that women with a history of HCV were more likely to have anxiety and/or depression compared to women without this history. Other research In the past decade, a growing body of research suggests that chronic HCV infection, particularly in cases when there is extensive liver injury, has an impact on the brain. Reports have emerged linking chronic HCV infection with the following: chronic fatigue difficulty thinking clearly problems with memory reduced quality of life depression In the present German study, the researchers noted that their participants had only mild liver disease yet they still had sleep-related issues. Thus the findings from the German study suggest that sleep-related problems may occur earlier in the course of liver disease. The body s internal clock, sleep and its disruption Liver specialist Professor Daniel Shouval (Hadassah-Hebrew University Hospital in Jerusalem, Israel) reviewed the German study and made the following comments in the Journal of Hepatology: Sleep patterns are dictated by a 24-hour clock [in our body]. This clock is affected by light and darkness cycles which control numerous metabolic activities such as body temperature, blood pressure, [levels of the hormones] melatonin, cortisol and growth hormone, urine output as well as mood and cognitive abilities. These [24-hour cycles, circadian rhythms] exist not only in humans but also in animals, plants bacteria and fungi. Professor Shouval notes that recent research suggests that the disruption of the built-in 24-hour clock and cycles may have serious consequences. For example, inadequate sleep may lead to exhaustion, increased irritability, mood fluctuations such as depression, anxiety or anger, reduced concentration, attention deficit disorder, decreased memory, decreased productivity and creativity, drowsiness, unintended sleep [during the daytime], weight gain, metabolic abnormalities such as [elevated levels in the blood of the fatty substance called triglycerides] and more. Back to the German study The results of the German study are useful in that they document some problems related to sleep in women with a history of hepatitis C virus who have a mild degree of liver injury. The study is relatively small but did exclude potential volunteers whose behaviours or conditions might have biased the ability of researchers to interpret the results. Additional research is needed to uncover the precise reasons for disturbed sleep in people with HCV. Dr. Shouval suggests that there may be unfavourable interactions between HCV, the immune system and the brain that may affect sleep and the body s internal 24-hour cycles. HCV treatment evolves In the past decade, the standard treatment for HCV infection was a combination of long-lasting interferon (called peginterferon) and a nucleoside analogue called ribavirin. These drugs work by harnessing the body s immune response against HCV. However, research on HCV treatment has progressed rapidly and many new treatments that directly attack HCV are being developed. These new drugs are called direct acting antivirals (DAAs). There are two new DAAs recently licensed in Canada and other countries simeprevir (Galexos, Olysio) and sofosbuvir (Sovaldi). These drugs are powerful and generally safe when used as part of combination therapy. Furthermore, treatment with either simeprevir- or sofosbuvir-based regimens is usually shorter than in the past when treatment consisted of only peginteferon and ribavirin. In the years ahead, more DAAs will likely be approved, giving people with HCV and their doctors more treatment options. As HCV treatment becomes simpler and more effective, particularly with regimens that use only DAAs, hopefully complications such as sleep disturbance will become uncommon. Sean R. Hosein Complete references of the original article available at Source:

7 RHS Results Sexual Health The results of the First Nations of Quebec Regional Health Survey are now available! Here are a few highlights related to sexual health: Sexual activity Approximately 50% of those ages 15 to 17 years have had sexual relations. Number of partners 80% of the sexually active people only had one partner in the year prior to the survey. The proportion of respondents who had 3 or more partners decreased by half between 2002 and 2008 (16.3% compared to 8.6%). Condom use 86% of individuals with multiple sexual partners used condoms either always or most of the time. Always using condoms is more prevalent among young people (84% among those 12 to 14 years, 50% among those 15 to 17 years and 33% among those 18 to 24 years). Danger sign Nearly one in five individuals (20%) stated that they have had sexual relations without a condom because they were under the influence of alcohol or drugs. Screening Women are more likely than men to report having ever been tested for STIs or HIV (49% compared to 33% for STIs, 35% compared to 24% for HIV). Young people under 18 years of age reported having undergone less screening, particularly for HIV, compared to other age groups. Contraception Condoms (32.3%) and birth control pills (12.6%) are the means of contraception most used by the participants. Source: FNQLHSSC New CATIE ressources! Two new healthy-living booklets from CATIE! Each booklet contains plain language information for people who have Hep C or HIV and inject drugs: Treat Me Right: Getting treated for Hep C or HIV if you inject drugs This pocket-sized booklet contains easy-to-understand messages about Hep C and HIV treatment for people who inject drugs. Complete with lots of practical information, this resource is a great starting point for someone who has questions about Hep C or HIV treatment. What Works: Tips for taking care of yourself if you have Hep C or HIV and inject drugs This pocket-sized booklet contains easy-to-understand messages about how to take care of your health if you have Hep C or HIV and inject drugs. Complete with lots of practical tips, this resource is a great starting point for someone who has questions about how to manage their health. For more in-depth information, visit our online resource Pre-fix. To order or download the documents, visit CATIE Ordering Centre at

8 8 ESPACE ITSS Viral load and risk of HIV transmission A clear consensus! Expert consensus concerning undetectable viral load and the risk of HIV transition was awaited with great anticipation. And that consensus has arrived. According to a consensus of INSPQ experts, antiviral treatment that reduces the viral load to an undetectable level considerably reduces the risk of HIV transmission. Thus, the risk of transmission through vaginal sex without the protection of a condom drops from a high level to a negligible or very low level if six essential conditions are met. The risk of transmission during oral or anal sex without the protection of a condom also drops to a negligible or very low level if these same conditions are met, as follows: The viral load of the person living with HIV (PLWHIV) is undetectable by lab kits currently being used in Quebec and remains undetectable for at least six months, as determined by two consecutive measurements, with antiretroviral therapy. The PLWHIV takes the treatments at a rate of 95% or higher. The PLWHIV is in a stable and exclusive relationship with his or her partner. Neither partner has any other sexually transmitted or blood borne infection (STBBI). The two partners are receiving intensive medical follow-up (every 3 or 4 months), which includes measuring the viral load of the PLWHIV, STBBI screening for both partners, and HIV screening for the HIV-negative partner. The two partners are receiving regular and appropriate counselling. The main objective of this evaluation concerning the effect of an undetectable viral load on the risk of HIV transmission was to update a counselling support tool for first-line workers. This MSSS tool, entitled Estimation du risque associé aux activités sexuelles (evaluation of risk associated with sexual activity), has been modified to reflect this expert consensus. FOR MORE INFORMATION (in French) VISIT TO OBTAIN THE FOLLOWING DOCUMENTS: Consensus d experts sur la charge virale indétectable et le risque de transmission du VIH Sommaire du Consensus d experts sur la charge virale indétectable et le risque de transmission du VIH Avis du MSSS sur le risque de transmission du VIH lorsque la charge virale est indétectable Counselling and support tool: Estimation du risque associé aux activités sexuelles Webinar by Dr. Marc Steben, chair of the STBBI Committee Video capsule Interview with Dr. Marc Steben, chair of the STBBI Committee Source:

9 9 ESPACE ITSS The youth centres and the combat against STBBIs Lise Durocher is a senior programs advisor with the Montreal Youth Centre. She was a panelist at the ID-STBBI conference Sommes-nous assez responsables dans la lutte contre les ITSS (are we doing everything we can to combat STBBIs?) held this past April. Ms. Durocher gave an interview at that time to Espace ITSS. How do you see the situation concerning the combat against STDs in the youth centres? The discussions we had at the ID-STBBI conference showed us the need to integrate our actions in the area of STD control and prevention. When you work in a youth centre, you are not always conscious of the fact that preventing the transmission of STBBIs is also part of the job. We tend to feel this is the responsibility of other organizations, such as the CLSCs. But many of the youths making up our clientele present at-risk behaviours for transmitting STDs. We thus have a role to play concerning prevention and sexual health, just as our role involves working with youths at the emotional and psychological levels. At the Youth Centre, we take in youths aged 18 and younger. And because sexuality forms part of the development of our children, pre-teenagers and teenagers, we must give it our attention. Several of them have been victims of sexual abuse which, as the evidence shows, predisposes them to adopt at-risk behaviours: delinquency, self-mutilation, suicide attempts, alcohol and drug abuse, at-risk sexual behaviours. These youths in difficulty are affected by several risk factors, which are exacerbated by other aspects specifically related to sexuality, thereby justifying an educational approach that integrates STD prevention. How is the integration of this prevention work with your partners going? Lise Durocher, senior programs advisor at the Montreal Youth Centre We developed interventions with our partners at the Direction de la santé publique (DSP- public health branch) when we saw how important our youths needs were in terms of their psychosexual development. At the time, we already had a sex education program in place, but we realized we lacked a certain level of expertise in terms of prevention in the area of sexual health. So from that time on, we have enjoyed a great dynamic with our DSP partners, who had already prioritized youths in difficulty. When they found out that we were working on a sex education program, they became interested in it. And thanks to the collaboration of the Health and Social Services Agency, we were able to enhance this sex education program. At the same time, we had the opportunity to make our sponsors aware of the importance of including this component in our work with youths in difficulty. The research initiated by DSP, in which we collaborated, allowed us to better understand the extent of our clientele s needs, particularly concerning very high at-risk practices and unwanted pregnancies. Today, we are making sure that all the programs offered by our services take account of the needs of our youth clients in terms of their psychosexual development. Is better account now being taken of education and prevention? We always ask the same two questions regarding our programs for children aged five and younger: What competencies should parents have in order to ensure that sex education meets the children s needs and how can we support parents to make them feel capable of fulfilling this role? I am now looking after these concerns through the application and delivery of programs for our youths in the areas of sex education, and drug use & abuse. We also ensure that our messages in prevention are coherent and that actions are carried out with at-risk youths or those who have already adopted at-risk behaviours. We must therefore take advantage of the time they spend at the youth centre and assist them in acquiring a healthy and responsible form of sexuality. What is the link with your youth protection mission? There is a very close link because our mandate is precisely to increase youths competencies so that they can learn how to protect themselves against various forms of sexual exploitation. In this way, we are seeking to prevent different problems related to sexuality

10 10 Continued: The youth centres and the combat against STBBIs and to reduce the negative consequences for their sexual and psychological health, seeing that we have many youths who already present at-risk behaviours. We are also trying to limit the impacts on youths who have been sexually abused and need support for that reason. In short, we have three objectives: reduce sexual abuse and at-risk sexual behaviour; improve youths competencies for achieving balanced and responsible sexuality; and reduce the impacts of previous ill treatment, e.g. a traumatic sexual experience. Sex education and prevention are thus closely linked to our mandate and mission; they are not entrusted solely to institutions responsible for prevention such as the CLSC and DSP. We have youths who present significant at-risk sexual behaviours that could harm their physical and psychological health. We need to give our attention to this matter and adapt our interventions accordingly. At stake are real needs being presented by our clients, not problems that can be brushed aside. STBBI screening for youths Interview with Jason Champagne and Dominique Harvey, who are respectively the director and the STBBI program coordinator, at CSSS Jeanne-Mance: These two managers were invited to speak at the ID-STBBI conference on the theme of promoting youths access to screening services. They also gave an interview at the time of the conference to Espace ITSS. Jason Champagne and Dominique Harvey of CSSS Jeanne-Mance Among the activities at your health and social services centre are ones for the yearolds. Tell us about the challenges you face in this regard. Jason Champagne The main challenge is the decrease in the number of visits to our youth clinic on Rue Sanguinet in Montreal. With each passing year, fewer youths are coming to the clinic. But one of the mandates of the youth clinic is to promote sexual health among youths. Thanks to the participation of IPCDC (knowledge sharing and skills development initiative), we have been able to look closely at our populational responsibility towards youths. The drop in the number of visits to the clinic means it is difficult to build awareness among youths concerning their sexual health and to talk with them about that subject. We looked at other ways to reach them, and this led us to plan a blitz awareness campaign for the year-olds, specifically regarding gonorrhea and chlamydia. Dominique Harvey It should be noted that the territory covered by CSSS Jeanne-Mance presents the highest prevalence rates of gonorrhea and chlamydia in Quebec. For example, statistics show that the rate of gonorrhea per 100,000 inhabitants is 23.7 overall in Quebec, versus in CSSS Jeanne-Mance. That s seven times higher! And because youths don t use our services, or come to see us less and less, we need to find other ways which will be effective in reaching them. What actions and activities did your findings lead you to? Dominique Harvey Because we wanted to reach youths in their environment, we decided to organize services in the schools and CÉGEPS, which are the places youths go to. They wouldn t come to us, so we would go to them, in other words, leave the clinic and meet them on their turf. The idea at the outset was to carry out massive screening blitzes with simplified practices allowing us to see many youths quickly. We needed to become more efficient so that we could be faster at screening youths and telling them about their sexual health and the forms of STBBI transmission. This meant implementing a new model for screening youths on a massive scale, with limited resources. What have been the results and your main conclusions? Dominique Harvey We visited a CÉGEP, a school for adults where immigrants learn French, four high schools, and four organizations working to support youths experiencing difficulties or involved in a social reintegration process. A total of 653 youths took part in our STBBI awareness sessions; 348 were tested; 122 were referred; and 11 tested positive. The first major conclusion concerns the adaptation of tools provided by the MSSS. It wasn t easy to transform these tools, which are designed for individual interventions, into simple tools that could be used for mass interventions.

11 11 A great deal of effort from care staff (nurses and managers) was required to make this possible. We worked on these tools with the goal of reaching a compromise: offer a quality service that would address individual needs and at the same time allow us to meet a large number of people in a structured but simplified way. Does this bear promise for the future? Will you continue in this vein? Dominique Harvey The tools we implemented have been validated and we intend to reproduce them. Our plan has been to systematically reach, every year, the yearolds we serve. We are now planning to continue with these actions in the youths normal environment. Jason Champagne That s the stage we are at now, that of preparing an action plan to put these methods into place for the long term. My challenge as director is to organize these services. We need to inform and mobilize the various decision-makers, because the strength of this project is that we are going to make use of the resources involved, e.g., nurses at schools, resources working with youths in difficulties, the youth clinic, the SIDEP (screening) team and ongoing services. We have created a critical mass, which makes us able to do screening blitzes using several resources found in youths regular environments. My challenge is to allow the choices involved to take root over the long-term and to ensure this becomes a priority for the managers I work with. Dominique Harvey This project has truly allowed the different teams involved to share their expertise. Some teams were very comfortable to break free of the usual boundaries, others less so. It was a genuine experience of sharing and incredible collaboration. Do you think this work method can be exported to other health and social services agencies? Dominique Harvey Yes and it s what we want to do. We see in it a solution not just to an individual problem, but to a collective one. The work done in this regard thus offers a response better adapted to our reality and the reality of our clienteles. For example, the MSSS could reproduce and support this experience by giving guidelines for mass screenings. Source: Any alcohol use linked to increased liver damage for people with Hep C and HIV coinfection People with Hep C alone or HIV alone were more likely to have advanced liver damage if they drank more alcohol but people with both Hep C and HIV had a greater risk of advanced liver damage with any alcohol use, reported researchers in Clinical Infectious Diseases. Participants, who were drawn from the U.S. Veterans Aging Cohort Study, were grouped into the following categories: People with HIV (1410 participants) People with Hep C (296 participants) People coinfected with Hep C and HIV (701 participants) People who do not have HIV or Hep C (1158 participants) Alcohol use was categorized into nonhazardous drinking, hazardous or binge drinking and diagnoses of alcohol abuse or alcoholism. Within each group, the rate of advanced liver damage increased with each alcohol use category. For all categories, advanced liver damage was more common among HIVpositive versus HIV-negative people and for Hep C-positive versus Hep C-negative people. However, people coinfected with Hep C and HIV were 14 times more likely than people without Hep C or HIV to be at risk for developing advanced liver damage, even for those whose drinking was considered non-hazardous. This was a large cross-sectional study. In a cross-sectional study the data is collected at only one point in time and cannot be used to make the connection between cause and effect. However, it can suggest links and areas for further study. (HIVandhepatitis. com, May 2014, in English) To read the entire study, get the article in Clinical Infectious Diseases: Clin Infect Dis. (2014) 58 (10): Source: In CATIE s HepCInfo Update 5.9 for April 26 - May 9, 2014.

12 First Nations Quebec and Labrador Health and Social Services Commission Our mission Improve the physical, mental, emotional and spiritual well being of First Nation and Inuits individuals, families and communities in respect of their local autonomy and culture. By helping the communities that wish to initiate, develop and promote comprehensive health & social programs and services as designed by First Nations and Inuits organizations recognized by our First Nations and Inuits. The role of the FNQLHSSC is to assist Quebec and Labrador First Nations and Inuits communities and organiza tions in the defence, maintenance and the exercise of their inherent rights IN HEALTH AND SOCIAL SERVICES as well as to help them in the realization (delivery) and the development of THESE programs. 1 4 To ensure services shall be available to assist as requested by First Nations and Inuits communities and MEMBER organizations of the FNQLHSSC in exercising our inherent rights and autonomy to design and control health and social services delivery to members of our respective nations. To promote, facilitate and support the exchange of information and ideas between First Nations and Inuits communities and MEMBER organizations of the FNQLHSSC on all aspects of health and social services development initiatives. 2 5 You may, at any time, address your comments or suggestions concerning the Newsletter s content at First Nations Quebec and Labrador Health and Social Services Commission 250, Place Chef Michel Laveau, suite 102 Wendake, Quebec, G0A 4V0 Tel: Fax: info@cssspnql.com It will also be our pleasure to publish your messages, articles or advertisement! Upon request from First Nations and Inuits communities to promote SUCCESSFUL community models and to provide technical support to First Nations and Inuits organizations for health and social services innovative and traditional practices, research, development and training. In respect of existing community practices and needs, to maintain AND IMPROVE communication and consultation with First Nations and Inuits communities and MEMBER organizations of THE FNQLHSSC in order to ensure that health and social services programs are adapted to our needs. Upon request, to support and assist First Nations and Inuits communities and MEMBER organizations of the FNQLHSSC to ensure recognition of our full jurisdiction and\or authority over health and social services. 3 6 To support the development of capacity building within First Nations and Inuits communities and member organizations of the FNQLHSSC to be able to take on increased health and social services responsibilities at the community level. The FNQLHSSC would like to thank the ministère de la Santé et des Services sociaux du Québec for their financial contribution to the Circle of Hope.