This article appeared in Xtra West on November 26, 1998.
by Tom Yeung
The face of HIV is changing, again.
The number of new infections among Vancouver-area injection drug users has fallen to closer match those of gay and bisexual men.
Meanwhile, AIDS agencies are bracing themselves for a third wave of infections.
Since 1995, the number of new infections among injection drug users has outnumbered that of gay and bisexual men. Almost all new public health initiatives since then have focused on tracking and preventing the spread of HIV in the Downtown Eastside.
However, injection rates for the first half of 1998 show the number of IDUs testing positive has fallen to levels close to that of gay and bisexual men.
In statistics obtained by Xtra West, the BC Centre for Disease Control reports that injecting drug users made up 31 percent of 262 new infections among both men and women, compared with gay and bisexual men at 27 percent.
The numbers report people testing positive for HIV between Jan 1 and June 30 this year.
And when men alone are examined, the vast majority of new HIV infections, are among gay and bisexual men actually outnumbering injection drug users.
According to Dr. David Patrick, the centre's associate director of STD/AIDS control, the change is significant because while IDU infections are declining, rates for gay and bisexual men are leveling off and not decreasing as dramatically as in the past three years.
"I think you're seeing we're no longer making progress with the status quo among men who have sex with men," says Patrick. "Its time for us in the community groups and health institutions to retool our efforts to bring about prevention."
The statistics do not show an increase in the number of new infections from previous years. According to the coordinator of the Vanguard Project, it is common for a wave of infections targeting a specific group to decline or plateau after an increase.
Steve Martindale credits the jump in IDU infections in 1995 and 96 to a push in drug users to get tested, owing in part to a study at the time which paid IDUs to get tested.
"As with any outbreak it reaches a saturation point. You only seroconvert once," says Martindale.
Says Patrick: "I don't think we can see the decline of IDUs as a triumph of public health."
But many AIDS agencies, such as AIDS
Vancouver and the BC Persons with AIDS Societies, are concerned
that the Vancouver regional health board has concentrated its
efforts on testing and prevention among drug users at the expense
of other risk groups.
AIDS Vancouver director Andrew Johnson says the Vancouver/Richmond
Health Board and its agencies has lost its focus on gay men. While
he says the attention paid to drug users is well-deserved, he
points out gay and bisexual men still make up the majority of
people living with HIV and AIDS.
"In some ways our government responds in a knee jerk way and they lose sight of balance," says Johnson. "They're always quick fixing, to use a pun, and never seem to carry a vision which holds the big picture."
While Patrick says health authorities never intended to exclude gay men, he says it's time to enhance the focus back to men having sex with men.
The BC Centre for Disease Control became
an agency of the regional health board in 1996.
A predicted new wave of infections among young gay and bisexual
men, predicted in a Vanguard Project study in 1997, has yet to
manifest among those tested.
But according to BCPWA chair Wayne Campbell, gay youth are showing up in the numbers. Some young people are not comfortable expressing their sexuality, and they tend to show up in the "Risk Unkown" category of HIV infections. In the 1988 numbers, the unknown risk group accounted for 18 percent of new infections.
"There is the large unknown factor there, which may comprise young men having sex with men," says Campbell.
Campbell also predicts a third wave of infections to hit women, who currently form a small fraction of new infections. Women are generally not viewed as a high risk group, rarely get tested and are often misdiagnosed, he says.
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