by David Kosub
VANCOUVER
- Doctors and public health officials fear the high incidence
rates of HIV infection among drug injection users here may be
more widespread than originally thought and compounded by a jump
in the infection rate among young gay men.
Results of a study released by the B.C. Centre for Excellence
in HIV/AIDS last month showed the HIV infection rate among injection
drug users in the city's east side to be running at nearly 20%
annually, the "highest incidence rate" of any in the
developed world according to Centre co-director Dr. Martin Schechter.
That prompted a call from public health-care officials and front
line primary-care doctors for a rebooting of Vancouver's outreach
programs, including development of safe houses where drug users
would be able to inject their drugs under hygienic conditions.
EPIDEMIC SPREADING
Now it appears the epidemic may be spreading to other communities
outside downtown Vancouver, including the municipalities of Surrey
and New Westminster and many of B.C.'s aboriginal communities.
Even Seattle public health officials have expressed concerns about
a possible migration of Vancouver's high HIV incidence rate south
of the Canada/U.S. border.
Added to this is bad news from the community
of young gay men in Vancouver, aged 18 to 30. Results of a second
study by the Centre released at the B.C. HIV/AIDS Conference recently
show an HIV infection rate for this group of about 3%, compared
with 1% to 2% rates in major U.S. cities.
"That might sound relatively small on an incremental scale,"
says Dr. Steffanie Strathdee, the Centre's program director of
epidemiology, "but when you consider that homosexuals make
a larger proportion of the population compared to injection drug
users, this could represent hundreds or thousands of new infections
occurring on an annual basis."
Last year, the study's preliminary findings indicated that half
the participants reported having at least one episode of unprotected
anal sex. While this came as a surprise, it wasn't until data
on the actual infection rate was released this month that the
real dangers of an apparent attitude change toward unprotected
sex hit home.
"We've also heard anecdotal reports of a relapse to unsafe
sex in the community. And that's from the doctors who make up
the contingent of those who are seeing the HIV-positive patients
in the city."
Most are at a loss as to why young gay men are disregarding conventional
wisdom about the dangers of unsafe sex. Dr. Strathdee says it
may have something to do with a false sense of comfort which the
"cocktail" treatment for AIDS gives some in the gay
community.
"But the fact that we have seen a relapse to unsafe sex one
year later among the first 300 participants who have returned
for their follow-up visit suggests that the work is not done in
this community and that targeted prevention efforts are urgently
required."
Meantime, calls went out during the conference for a more concerted
effort by aboriginal leaders to stem the tide of HIV infection
in native communities.
Dr. Strathdee describes this group as "very transient"
and worries that the HIV/AIDS epidemic will become worse as aboriginals
travel from the cities to very remote rural reserves.
"That means you don't expect injection drug users to come
to you. You have mobile vans that deliver primary health care,
you have people on foot delivering needles to shooting galleries
and you have street nurses who are actually doing HIV testing
on the street. We stopped doing that at a critical period when
the HIV infection rates were likely taking off."
Not everyone agrees. Dr. Stan de Vlaming who treats HIV infected
injection drug users at his Gastown Medical Clinic says something
more immediate than safe houses is needed.
"By stabilizing their housing you're not necessarily going
to stabilize their addiction. I argue that outreach is used to
engage people into treatment. But I'm already turning away two
to three patients a day who are coming to me desperately seeking
methadone treatment that I cannot provide them. We need more treatment
options, not more outreach options."
For more information, contact:
Bonnie Devlin
Vanguard Project Coordinator
608 - 1081 Burrard Street
Vancouver, BC, Canada, V6Z 1Y6
Tel: (604)806-8306
Fax: (604)806-9044