By Curt Cherewayko
If Julio Montaner had his way, incarnations of the safe injection site in Vancouver’s Downtown Eastside (DTES) would be established in skid rows and drug-stricken neighbourhoods in cities around the world.
The federal government has made it clear, however, that it disagrees with the Insite program and some of the methods that Montaner, one of the world’s leading HIV/AIDS researchers, is using to combat drug addiction and treat the HIV-infected.
The federal government has said it would rather address Canada’s drug epidemic through crime prevention mechanisms such as tougher drug laws.
Montaner, director of the B.C. Centre for Excellence in HIV/AIDS (BC-CfE) and president of the International AIDS Society, has become one of Insite’s most vocal proponents and cuts a large swathe in his approach to addressing drug addiction.
As is the case with cities around the world that have international port traffic and mild climates, Vancouver has a higher per-capita HIV rate than other cities in the nation.
HIV rates, poverty and drug addiction go hand in hand, as is evident in Vancouver’s DTES.
Montaner believes there’s more to solving that unholy trinity than simply strengthening crime laws and advising the HIV-infected to access the health services that are available to all Canadians.
“I have four children in their 20s, and so the last thing I want to see is the promotion or enablement of drugs,” Montaner said from his office in St. Paul’s Hospital.
He believes that before drug addicts, many of whom are infected with HIV, can be helped by the health-care system, the system must go to them.
Take Insite as an example.
According to Montaner, Insite, which is funded by the B.C. government through Vancouver Costal Health, is the only connection to the health-care system that many DTES residents have.
But getting addicts through the front door of Insite, even if it’s simply to shoot drugs, can lead to further and more meaningful interaction between them and the health-care system.
“When addicts are ready to ask for help at other levels, the discussion can start,” said Montaner.
The BC-CfE released a study last Friday at an international HIV/AIDS conference in San Francisco validating both Montaner’s and Insite’s approach.
The study showed that treating addicts in B.C. with highly active antiretroviral therapy (HAART) contributed to a 50% decrease in new yearly HIV infections among injection drug users.
The centre’s study partly attributed that decrease to Insite’s outreach efforts.
Montaner led trials of HAART at St. Paul’s Hospital and abroad in the 1990s.
Since 1996, the three-drug cocktail has been the standard treatment for HIV/AIDS around the world.
B.C. was ground zero for the invention and distribution of HAART.
Montaner recalled that B.C. recorded an 85% decrease in the death rate among the HIV-infected in the first year of HAART’s availability.
With proper distribution of HAART, medical professionals like Montaner have not only prolonged the life of the infected, but also reduced the spread of HIV.
HAART is as much a treatment as it is a prevention method because it reduces and caps the viral load in HIV patients, making the virus less contagious.
When HAART was first introduced in 1996, it reduced the spread of HIV in the homosexual population, which was the first group to be hit by the HIV epidemic.
Because of HAART, HIV in other populations has also been contained.
For example, the likelihood that HIV-infected pregnant women pass the virus to their offspring is drastically reduced when they’re treated with HAART. And as HAART halts the replication of the virus in the body, it also stops the virus’ evolution into new drug-resistant forms.
Issues such as social instability have prompted debate in the medical community about the effectiveness of HAART treatment among addicts.
As a result, on a global scale, drug users are less likely to be prescribed HAART.
The BC-CfE’s study is a major victory for Montaner and others who want HAART distributed to all HIV-infected people, including injection drug users.
With new proof from the BC-CfE that drug users can benefit from HAART, the B.C. government recently increased its support for Montaner’s approach.
On February 4, the government announced a new $48 million, four-year program (Seek and Treat to Optimize Prevention of HIV and AIDS) to make HAART accessible to hard-to-reach populations in B.C.
The program will deliver HIV treatment to infected residents, including injection drug users in the DTES and Prince George.
The project is essentially taking Insite’s novel approach a proactive step further by not only opening the door to the health-care system to the high-risk and marginalized, but delivering it directly to them.
Other organizations are getting behind Seek and Treat.
The World Heath Organization has endorsed the program, and this Friday, the executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), will endorse it at an international HIV/AIDS forum in Vancouver.
The forum, which is being held at the University of British Columbia, will attempt to shine some of the international spotlight that is on Vancouver for the 2010 Olympic Games on the global epidemic.
According to Montaner, his efforts to communicate with the federal government have resulted in formal response letters that proclaim the government’s lack of interest in his approach.
“The Conservative government has not been willing to come to the table to have an open discussion with the HIV/AIDS medical leadership,” said Montaner.
“There is no dialogue.”
The federal government said this month that it plans to ask the Supreme Court of Canada to overturn a B.C. ruling that allowed the safe-injection site to remain open. •
cgc@biv.com
This article from Business in Vancouver February 23-March 1, 2010; issue 1061
Business in Vancouver (www.biv.com) has been publishing in-depth local business news, analysis and commentary since 1989. The newspaper also produces a weekly ranked list of the biggest companies and players in a wide range of B.C. industries and commercial sectors, monthly features and industry-focused sections that arm its subscribers with a complete package of local business intelligence each week.
