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This article was published 18/6/2014 (1105 days ago), so information in it may no longer be current.
THOMPSON -- When a blood test pinpointed HIV as the root of her fatigue, sleeplessness and inexplicable pains, Heather was terrified.
"It scared the crap out of me," she says.
Now that Heather (not her real name) has her drug-battered virus under control, a new fear has taken hold: maintaining anonymity.
In Thompson, as in every other northern Manitoba community, the small-town adage that everybody knows everybody is largely true.
For Heather, a 40-something working mom, that has meant keeping a tight lid on her status.
I reach her by phone, our interview having been arranged with the help of the Northern Health Region. I can hear both distress and resolve in her voice.
Heather worries about what would happen if people knew she is HIV-positive. She imagines they wouldn't care that her virus is now basically idle, or that HIV is not the same as AIDS.
"Living up here, it's a pretty small area (and) there is not a whole lot of anonymity," Heather says.
"If I ever thought it got to the point where I thought that people might find out, or people did... then I would probably move away, which is pretty sad."
Much of the stigma that agonizes Heather stems from a lack of knowledge around HIV, an information deficit fuelled by the rarity of the virus.
In 2012, the last year for which statistics are available, just five new cases of HIV were diagnosed in northern Manitoba.
That accounted for seven per cent of the 74 cases across Manitoba, so the north's rate was on par with its share of the provincial population.
Between 1985, the year reporting began, and 2012, northern Manitoba reported 48 HIV cases. Most came from the former Burntwood Regional Health Authority, covering a vast swath of land around Thompson.
Manitoba has yet to release infection rates for 2013, but in Heather, there was at least one northern diagnosis.
She acquired the virus in Thompson, through sexual contact in a long-term relationship with a man who was unknowingly positive.
"He was using needles and I had no idea," says Heather. "Then when I found out, I was done."
Heather had been out of that relationship for three or four years when she was diagnosed, having fallen ill from a weakened immune system.
If she lived in a big city where she could be nameless, Heather knows she would be more involved with support programs.
For now, she is grateful to have an excellent nurse on her side.
"Having her to talk to is good," Heather says. "(But) the more people I talk to is the more people I have to tell, and I understand they're under a certain code (to maintain confidentiality), but people don't necessarily follow codes. And this is something that will not just affect my life, but this will affect how my kids get treated."
Northerners such as Heather who are diagnosed with HIV are initially encouraged to establish care with the experts at the Winnipeg-based Manitoba HIV Program.
From there, the Northern Health Region works with both the Manitoba HIV Program and the patient to provide longer-term care.
While there hasn't been anything like an explosion of HIV across the north, the conditions are ripe for such a tragedy.
Several factors that amplify HIV risk -- poverty, substance use, aboriginal heritage and lessened access to health care -- are more prevalent in northern Manitoba than elsewhere in the province.
As health officials work to curb HIV, they point to education as an essential tool.
Heather would like to see more well-informed people not only in terms of HIV prevention, but in understanding the virus.
Having come of age in the HIV hysteria of the 1980s, she admits her own knowledge of her condition was narrow when she was diagnosed.
"I didn't know that I wasn't going to die," she says.
Indeed, Heather has responded so successfully to a treatment of six pills once a day, her HIV is now "asleep," as she puts it.
"I'm much healthier than I was, for sure," she says.
Jonathon Naylor is editor of the Reminder newspaper in Flin Flon.