Update on HIV/sex worker issue
I noted a couple weeks ago a report on HIV/AIDS that had wrongly been presented in the media as being about all Vancouver sex workers, even though the study had actually involved only street-entrenched and addicted outdoor sex workers in the Downtown Eastside. Here's a March 14 letter from the authors of the study that sets things straight on that subject:
RE: Unintended results of research (14 March 2009)
by Druyts, Hogg, Montaner
British Columbia Centre for Excellence in HIV/AIDS
We thank Dr. Goodyear for his response to our article. We fully agree with
his concerns surrounding the recent coverage of our work on HIV prevalence
in British Columbia, Canada. Dr. Goodyear has expressed difficulty in
seeing how this study will benefit the individuals who participated in the
research. Of note, estimates of HIV prevalence among at-risk groups are
vital in planning for the development and provision of appropriate policy
and programmatic responses. We wish to affirm that it is our overarching
goal to ensure that there are adequate services for all individuals living
with HIV infection in Vancouver. The WHO has consistently shown that less
than 10% of sex workers have adequate access to HIV prevention and care
resources.
Our paper did not aim to highlight HIV infection among sex workers in
particular. Instead, we sought to model the estimate of HIV prevalence at
the city level and related gaps in services in Vancouver. Also of note,
all the studies considered in our paper received institutional ethical
approval.
We acknowledge that prevalence estimates are rarely perfect and are
limited by uncertainty surrounding population size and potential biases
inherent in source data. We would like to clarify that the estimate of HIV
prevalence among female sex workers in 2006 is based on data collected
among survival sex workers predominantly located in Vancouver’s Downtown
Eastside, who live in poverty and all who inject and/or smoke illicit
drugs. This estimate therefore does not reflect indoor sex workers, such
as sex workers in establishment-based venues, bars, or escort services. We
are fully aware that female sex workers in Vancouver do not constitute a
homogeneous group. This could have been further stressed in the published
paper.
Perhaps most importantly, we recognize that sex workers have been unfairly
stigmatized in the past by medical research as vectors of disease, and it
was not our intention to perpetuate this in any way. We have acknowledged
in our article that detailed data on sex work clients were not available.
As a global assessment of HIV prevention needs, our article did not seek
to review the factors that enhance vulnerability to HIV infection among
marginalized populations, such as survival sex workers. However, as
mentioned by Dr. Goodyear, we feel it is important to acknowledge that
many pivotal studies both in Canada, including some of our own, and
globally have demonstrated that criminalized sex work legislation,
enforcement-based strategies and violence greatly reduces sex workers’
ability to safely negotiate condom use with clients as well as other HIV
risk reduction strategies.
Finally, we concur with UNAIDS and WHO that structural approaches to HIV
prevention are crucial both for the health of sex workers and clients.
This includes policy changes such as the removal of criminal sanctions
targeting sex workers.
Eric Druyts, Robert Hogg and Julio Montaner
http://www.harmreductionjournal.com/content/6/1/5/comments
Wednesday, March 18, 2009
Friday, March 13, 2009
Detox rules work well for some - so let's do it both ways
Speaking up for the rights of one group invariably means stepping on those of another, as I was reminded following my recent column on the no-smoking policy at the new detox.
An old acquaintance of mine - I’ll call her Shelly - phoned me after the column appeared to tell me I was wrong to be critical of Vancouver Island Health Authority staff for prohibiting smoking at the detox. She’d arrived for a stay at the brand-new unit last month prepared to hate the prohibition, too, but instead quit smoking - for the first time in more than 40 years.
She was proudly 28 days nicotine-free when I met up with her last week at the Pembroke Street stabilization unit, which is where people fresh from detox ideally get to stay for a month while they work out the details of a life without drugs. Shelly had gone to detox primarily to get off heroin, valium, alcohol and cocaine, but was delighted to have gotten out from under her cigarette habit at the same time.
“I brought a carton with me when I came, because the word on the street was that you could smoke in the bathroom,” says Shelly, the fourth patient through the new detox after it opened in early February. “Then they told me no. I thought, God, I’m never going to be able to do this. I was asking for the [nicotine] patch within a couple hours. But then I did fine.”
My concerns with the no-smoking policy continue - and indeed, Shelly saw a fellow patient get kicked out of detox after being caught smoking. How crazy is it to deny people urgently needed health care just to make a point about the eventual dangers of cigarette smoking? There’s also a gap a mile wide in the system for adults addicted to cocaine or crystal meth, who for the most part are not accepted at the detox.
That said, far be it from me to deny Shelly the very positive experience she had at the detox, partly as a result of not being allowed to smoke. Being in a stable, smoke-free environment - lots of support, lots of nicotine patches - was really beneficial for Shelly, who looks happier and healthier than I’ve seen her look in years.
A solution, then: A medical detox, smoke-free, for people like Shelly - people whose primary drugs are opiates or alcohol and who need the more intense medical care the new detox provides. And a different kind of detox somewhere else, one where people can get help regardless of the drug they’re addicted to and not have to give up smoking at the same time. Nothing expensive or fancy - just a practical, safe place.
Shelly’s latest journey into recovery has been an exemplary one, and worth detailing for what it says about all the things that have to come together to help those overwhelmed by addiction.
It starts with Shelly, of course, because she was the one who went looking for change. But then she had the good fortune of connecting with outreach workers from the Umbrella Society, a very savvy little peer-led non-profit that helps people with addictions and mental-health issues. Shelly had the will, but it was the Umbrella Society that showed her the way.
“Gordon Harper is a large person in my life right now,” says Shelly of the society’s executive director. “I told him that he was going to have to decide where my next move was, because I didn’t have any brains anymore.
“So he set me up with this - detox, stabilization, a recovery home for at least three months, then to Aurora [treatment centre], then back to a recovery home. I’m expecting it will take me a year to do it, but that’s OK, seeing as I’ve wasted eight years using drugs.”
Other things went right as well. Shelly got a rare 18-day stretch in the new detox, almost three times as long as most get. Then she got a bed immediately in the stabilization unit, also not typical. With Harper on her side, she just might make it through the forms, waitlists, phone calls, intake processes, hard work, meltdowns and meetings that await those trying to get help with their addictions.
Shelly says the help is there for those who reach out for it. But I know too many others lost in the fractured system to see her story as the norm. I can’t imagine why we make it so hard.
Speaking up for the rights of one group invariably means stepping on those of another, as I was reminded following my recent column on the no-smoking policy at the new detox.
An old acquaintance of mine - I’ll call her Shelly - phoned me after the column appeared to tell me I was wrong to be critical of Vancouver Island Health Authority staff for prohibiting smoking at the detox. She’d arrived for a stay at the brand-new unit last month prepared to hate the prohibition, too, but instead quit smoking - for the first time in more than 40 years.
She was proudly 28 days nicotine-free when I met up with her last week at the Pembroke Street stabilization unit, which is where people fresh from detox ideally get to stay for a month while they work out the details of a life without drugs. Shelly had gone to detox primarily to get off heroin, valium, alcohol and cocaine, but was delighted to have gotten out from under her cigarette habit at the same time.
“I brought a carton with me when I came, because the word on the street was that you could smoke in the bathroom,” says Shelly, the fourth patient through the new detox after it opened in early February. “Then they told me no. I thought, God, I’m never going to be able to do this. I was asking for the [nicotine] patch within a couple hours. But then I did fine.”
My concerns with the no-smoking policy continue - and indeed, Shelly saw a fellow patient get kicked out of detox after being caught smoking. How crazy is it to deny people urgently needed health care just to make a point about the eventual dangers of cigarette smoking? There’s also a gap a mile wide in the system for adults addicted to cocaine or crystal meth, who for the most part are not accepted at the detox.
That said, far be it from me to deny Shelly the very positive experience she had at the detox, partly as a result of not being allowed to smoke. Being in a stable, smoke-free environment - lots of support, lots of nicotine patches - was really beneficial for Shelly, who looks happier and healthier than I’ve seen her look in years.
A solution, then: A medical detox, smoke-free, for people like Shelly - people whose primary drugs are opiates or alcohol and who need the more intense medical care the new detox provides. And a different kind of detox somewhere else, one where people can get help regardless of the drug they’re addicted to and not have to give up smoking at the same time. Nothing expensive or fancy - just a practical, safe place.
Shelly’s latest journey into recovery has been an exemplary one, and worth detailing for what it says about all the things that have to come together to help those overwhelmed by addiction.
It starts with Shelly, of course, because she was the one who went looking for change. But then she had the good fortune of connecting with outreach workers from the Umbrella Society, a very savvy little peer-led non-profit that helps people with addictions and mental-health issues. Shelly had the will, but it was the Umbrella Society that showed her the way.
“Gordon Harper is a large person in my life right now,” says Shelly of the society’s executive director. “I told him that he was going to have to decide where my next move was, because I didn’t have any brains anymore.
“So he set me up with this - detox, stabilization, a recovery home for at least three months, then to Aurora [treatment centre], then back to a recovery home. I’m expecting it will take me a year to do it, but that’s OK, seeing as I’ve wasted eight years using drugs.”
Other things went right as well. Shelly got a rare 18-day stretch in the new detox, almost three times as long as most get. Then she got a bed immediately in the stabilization unit, also not typical. With Harper on her side, she just might make it through the forms, waitlists, phone calls, intake processes, hard work, meltdowns and meetings that await those trying to get help with their addictions.
Shelly says the help is there for those who reach out for it. But I know too many others lost in the fractured system to see her story as the norm. I can’t imagine why we make it so hard.
Friday, March 06, 2009
Sadly, I've had to give up some of my regular Friday columns, due to cutbacks to the freelance budget at the Times Colonist. I won't be writing for the first Friday of the month anymore.
It's bothering me more than I would have expected, but so it goes. Change always ends up being a positive thing, in my experience, but that's not to say it ever starts out pleasantly.
I've never seen the media industry in such a state. Where's it all going? Nowhere good for the immediate future, and for the industry as it currently exists. But something new will rise from the ashes, and perhaps it's time.
My wish would be for a return to smaller, locally owned media. I never got to experience that during my career, because the Thompson corporation owned all the small papers I was working at in my early years, and since then it's been Southam, Hollinger and Canwest in rapid succession. But I've always thought that would be the model with the most potential for understanding the kind of news that a particular community needs to know.
If there does end up being a fire sale of Canadian media properties, what's stopping a few locals from coming together to start their own media outlet? The business is still profitable for the most part. I can see from the chaos in the industry that things are really going to have to change, but the business of media is far from a lost cause.
People are always going to need information. Communities are always going to need a way for their citizens to talk to each other about issues of shared concern. The Internet is a marvelous place, but it can't meet all our needs. I've always thought the best thing about a good newspaper is that it tells you about things you didn't know you wanted to know about, something that a self-directed Internet news search simply isn't as likely to do.
I've met a lot of young people who don't read any news media. That scares me. But at the same time, I'm as tired of "the news" as anybody else.
Mostly that's because it's the wrong news for me. If it were up to me, I wouldn't choose to be kept up to date on every death, fire, car crash, grotesque act, and tragic turn of event in Canada. I get that I need to know about foreign wars and politics, but surely there's a better way of doing it.
But in between the irrelevant stories, I still find great, compelling, important information in our media. I still love newspapers. So I'm sure hoping that what comes out of all of this crashing about in the industry at the end of the day is more of what's great about it and much, much less of what's not.
Anyway. Hang in for the transformation.
It's bothering me more than I would have expected, but so it goes. Change always ends up being a positive thing, in my experience, but that's not to say it ever starts out pleasantly.
I've never seen the media industry in such a state. Where's it all going? Nowhere good for the immediate future, and for the industry as it currently exists. But something new will rise from the ashes, and perhaps it's time.
My wish would be for a return to smaller, locally owned media. I never got to experience that during my career, because the Thompson corporation owned all the small papers I was working at in my early years, and since then it's been Southam, Hollinger and Canwest in rapid succession. But I've always thought that would be the model with the most potential for understanding the kind of news that a particular community needs to know.
If there does end up being a fire sale of Canadian media properties, what's stopping a few locals from coming together to start their own media outlet? The business is still profitable for the most part. I can see from the chaos in the industry that things are really going to have to change, but the business of media is far from a lost cause.
People are always going to need information. Communities are always going to need a way for their citizens to talk to each other about issues of shared concern. The Internet is a marvelous place, but it can't meet all our needs. I've always thought the best thing about a good newspaper is that it tells you about things you didn't know you wanted to know about, something that a self-directed Internet news search simply isn't as likely to do.
I've met a lot of young people who don't read any news media. That scares me. But at the same time, I'm as tired of "the news" as anybody else.
Mostly that's because it's the wrong news for me. If it were up to me, I wouldn't choose to be kept up to date on every death, fire, car crash, grotesque act, and tragic turn of event in Canada. I get that I need to know about foreign wars and politics, but surely there's a better way of doing it.
But in between the irrelevant stories, I still find great, compelling, important information in our media. I still love newspapers. So I'm sure hoping that what comes out of all of this crashing about in the industry at the end of the day is more of what's great about it and much, much less of what's not.
Anyway. Hang in for the transformation.
Thursday, March 05, 2009
If you see this Vancouver Sun article in YOUR local paper, please write a letter to the editor!
I'm an advocate for the rights of sex workers, and one of the biggest problems out there is that all the study, research and reporting is almost exclusively about the experiences of marginalized "survival" sex workers - who make up just 10-20 per cent of all sex workers - yet is presumed to be the experience of all sex workers.
Case in point: an article from the March 4 Vancouver Sun, a shorter version of which ran in the Victoria Times Colonist and Edmonton Journal today (and perhaps other publications - those are just the ones I'm aware of) on HIV/AIDS prevalence among "female sex workers" in Vancouver. I tracked down the original study and the error begins there, as the information they wrote about came from three studies of survival sex workers in the Downtown Eastside, yet the language they use makes it sound as though the findings are representative of Vancouver sex workers overall.
So here's my letter to the editor that I've fired off in various directions this morning, followed by the Sun article. I've got the original study as well if anyone wants me to send them a copy - e-mail me at patersoncommunications@gmail.com. Thanks for caring.
Letter to the editor
Re: “One quarter of female prostitutes HIV-positive,” March 5
I’m writing to correct a blatant error in the reporting of findings from a B.C. Excellence in HIV/AIDS study.
This study was essentially a review of existing literature around HIV/AIDS prevalence among high-risk populations in Vancouver, including survival sex workers in the Downtown Eastside. However, the reporting of it wrongly extrapolated its findings to include all sex workers - the vast majority of whom are indoor workers (escorts, erotic massage, independents) who were never among the groups studied.
One of the primary myths around sex work is that those who do the work are vectors of disease. For those who work in the frequently miserable conditions of outdoor survival sex work, HIV/AIDS is obviously a risk due to high addiction rates and perhaps more unwillingness to turn away customers who refuse to use a condom.
Indoor sex work is a very different industry, however - one that has gone virtually unstudied and unreported on in Canada.
An estimated 80-90 per cent of Canadian sex workers are indoor workers. The limited studies that have been done on the tens of thousands of Canadians who work in the indoor industry have found dramatically lower rates of HIV/AIDS, violence, coercion and misery. Yet this group of workers is routinely lumped in with survival street workers for the purpose of sweeping statements on the fate and health of sex workers overall.
Sex workers are extremely stigmatized as it is, and feel the tremendous impact of that on their lives every single day. Research and reporting that overlooks the numerous differences between indoor and outdoor sex work can only perpetuate that.
Jody Paterson
Victoria, B.C.
Original article from Vancouver Sun, March 4
One-quarter of Vancouver’s female sex trade workers infected with HIV
Pamela Fayerman, Vancouver Sun
Published: Wednesday, March 04, 2009
VANCOUVER - Twenty-six per cent of Vancouver's female sex trade workers are infected with HIV, as are 17 per cent of the city's injection-drug users, a new B.C. study shows.
The study, by researchers at the B.C. Centre for Excellence in HIV/AIDS and published in the Harm Reduction Journal, is the first in Canada to estimate the per-capita prevalence ranges for high risk groups, using United Nations/World Health Organization software, 2006 Statistics Canada data and other sources such as population surveys.
Gay men, the local population of which is said to be 20,000, including male sex trade workers, have an estimated HIV prevalence rate of 15 per cent.
The overall prevalence of HIV in Vancouver is about 1.21 per cent, six times higher than the national rate.
"Drugs and sex are the preferred routes for transmission. Female sex trade workers get paid more money for having unprotected sex with johns," explained co-author Dr. Julio Montaner, who is president of the International AIDS Society and head of the division of HIV/AIDS at the University of B.C.
There are up to 520 female sex trade workers in Vancouver. Montaner, asked if the high HIV prevalence among prostitutes should trigger a warning to visitors during the 2010 Olympics, said:
"I don't want to jump on the Olympics bandwagon with this. There should be public advisories everywhere about this, not just because of the Olympics. People who avail themselves to this industry should know you better watch out.
"At home, tourists and transients may behave like star citizens and then, when people go to places like Vancouver, Vegas or Thailand, they party it up," he said.
Dr. Patricia Daly, chief medical health officer for Vancouver Coastal Health, said she had not yet read the report, so she couldn't say whether a targeted public health campaign for those who pay or trade for sex is required.
"Our message has always been that you should assume sex trade workers are HIV positive," Daly said.
"It is a high-risk activity for all kinds of infections and therefore you need to practise safe sex.
"During the Olympics, we are going to be distributing 100,000 condoms to athletes and hotels along with educational information. Whether it will specifically mention the sex trade I cannot say at this point," she said.
The high prevalence of HIV among female sex-trade workers is an emerging trend, given that in the 1980s, most infections were among gay men and in the second wave of the epidemic, injection drug users were hit hard.
"We always knew we had a significant problem, because of factors like our benign climate causing people to drift here, being a port city, and having so much poverty and so many homeless people on the Downtown Eastside," Montaner said, adding that it is difficult to know if men who buy sex from infected prostitutes are also getting infected.
"We don't have any way of accessing the johns to ask them those questions," he said. "And if we see them in our clinics, it's not like they volunteer if they got it that way. They would be more likely to report that they got it through having casual sex, or with multiple partners."
Montaner said HIV experts have made a pitch to the provincial government to "seek out and treat" HIV-infected individuals who are not on medications. It's estimated there are about 13,000 B.C. residents infected with HIV - 11,000 males and 2,000 females - but fewer than a third of them are taking such medications.
Montaner believes the number on medications should be more like 7,500. He said that would reduce the number of new infections each year from 400 to 300.
"The premier, the health minister and other government officials have been very supportive about this kind of progressive approach.
"But now with the economic downturn, we are in a waiting mode. We need an outreach program that brings treatment to the people, to make it more accessible," he said, referring to his vision of clinics in high-risk neighborhoods where such medications would be distributed.
Currently, the drugs are not taken by HIV-infected patients until their immune systems have deteriorated to a certain level. The delay-until-you-can-no-longer-delay approach is intended to save money and stall the potentially unpleasant side effects of medications. But it also means that untreated HIV patients can transmit infections.
Under another proposed strategy by Montaner's group, the "highly active antiretroviral therapy" (HAART) medications would be taken by infected patients far earlier in their disease process, so they wouldn't get the opportunity to transmit the disease.
HAART is said to be nearly 100-per-cent effective at preventing HIV by suppressing viral loads to undetectable levels and preventing people from developing full-blown AIDS by boosting the immune system. A report from the B.C. Centre for Disease Control shows that in 2007, there were only 61 full-blown AIDS cases in B.C, the lowest number since 1994, largely because of the availability of such lifesaving medications.
Sun Health Issues Reporter
pfayerman@vancouversun.com
I'm an advocate for the rights of sex workers, and one of the biggest problems out there is that all the study, research and reporting is almost exclusively about the experiences of marginalized "survival" sex workers - who make up just 10-20 per cent of all sex workers - yet is presumed to be the experience of all sex workers.
Case in point: an article from the March 4 Vancouver Sun, a shorter version of which ran in the Victoria Times Colonist and Edmonton Journal today (and perhaps other publications - those are just the ones I'm aware of) on HIV/AIDS prevalence among "female sex workers" in Vancouver. I tracked down the original study and the error begins there, as the information they wrote about came from three studies of survival sex workers in the Downtown Eastside, yet the language they use makes it sound as though the findings are representative of Vancouver sex workers overall.
So here's my letter to the editor that I've fired off in various directions this morning, followed by the Sun article. I've got the original study as well if anyone wants me to send them a copy - e-mail me at patersoncommunications@gmail.com. Thanks for caring.
Letter to the editor
Re: “One quarter of female prostitutes HIV-positive,” March 5
I’m writing to correct a blatant error in the reporting of findings from a B.C. Excellence in HIV/AIDS study.
This study was essentially a review of existing literature around HIV/AIDS prevalence among high-risk populations in Vancouver, including survival sex workers in the Downtown Eastside. However, the reporting of it wrongly extrapolated its findings to include all sex workers - the vast majority of whom are indoor workers (escorts, erotic massage, independents) who were never among the groups studied.
One of the primary myths around sex work is that those who do the work are vectors of disease. For those who work in the frequently miserable conditions of outdoor survival sex work, HIV/AIDS is obviously a risk due to high addiction rates and perhaps more unwillingness to turn away customers who refuse to use a condom.
Indoor sex work is a very different industry, however - one that has gone virtually unstudied and unreported on in Canada.
An estimated 80-90 per cent of Canadian sex workers are indoor workers. The limited studies that have been done on the tens of thousands of Canadians who work in the indoor industry have found dramatically lower rates of HIV/AIDS, violence, coercion and misery. Yet this group of workers is routinely lumped in with survival street workers for the purpose of sweeping statements on the fate and health of sex workers overall.
Sex workers are extremely stigmatized as it is, and feel the tremendous impact of that on their lives every single day. Research and reporting that overlooks the numerous differences between indoor and outdoor sex work can only perpetuate that.
Jody Paterson
Victoria, B.C.
Original article from Vancouver Sun, March 4
One-quarter of Vancouver’s female sex trade workers infected with HIV
Pamela Fayerman, Vancouver Sun
Published: Wednesday, March 04, 2009
VANCOUVER - Twenty-six per cent of Vancouver's female sex trade workers are infected with HIV, as are 17 per cent of the city's injection-drug users, a new B.C. study shows.
The study, by researchers at the B.C. Centre for Excellence in HIV/AIDS and published in the Harm Reduction Journal, is the first in Canada to estimate the per-capita prevalence ranges for high risk groups, using United Nations/World Health Organization software, 2006 Statistics Canada data and other sources such as population surveys.
Gay men, the local population of which is said to be 20,000, including male sex trade workers, have an estimated HIV prevalence rate of 15 per cent.
The overall prevalence of HIV in Vancouver is about 1.21 per cent, six times higher than the national rate.
"Drugs and sex are the preferred routes for transmission. Female sex trade workers get paid more money for having unprotected sex with johns," explained co-author Dr. Julio Montaner, who is president of the International AIDS Society and head of the division of HIV/AIDS at the University of B.C.
There are up to 520 female sex trade workers in Vancouver. Montaner, asked if the high HIV prevalence among prostitutes should trigger a warning to visitors during the 2010 Olympics, said:
"I don't want to jump on the Olympics bandwagon with this. There should be public advisories everywhere about this, not just because of the Olympics. People who avail themselves to this industry should know you better watch out.
"At home, tourists and transients may behave like star citizens and then, when people go to places like Vancouver, Vegas or Thailand, they party it up," he said.
Dr. Patricia Daly, chief medical health officer for Vancouver Coastal Health, said she had not yet read the report, so she couldn't say whether a targeted public health campaign for those who pay or trade for sex is required.
"Our message has always been that you should assume sex trade workers are HIV positive," Daly said.
"It is a high-risk activity for all kinds of infections and therefore you need to practise safe sex.
"During the Olympics, we are going to be distributing 100,000 condoms to athletes and hotels along with educational information. Whether it will specifically mention the sex trade I cannot say at this point," she said.
The high prevalence of HIV among female sex-trade workers is an emerging trend, given that in the 1980s, most infections were among gay men and in the second wave of the epidemic, injection drug users were hit hard.
"We always knew we had a significant problem, because of factors like our benign climate causing people to drift here, being a port city, and having so much poverty and so many homeless people on the Downtown Eastside," Montaner said, adding that it is difficult to know if men who buy sex from infected prostitutes are also getting infected.
"We don't have any way of accessing the johns to ask them those questions," he said. "And if we see them in our clinics, it's not like they volunteer if they got it that way. They would be more likely to report that they got it through having casual sex, or with multiple partners."
Montaner said HIV experts have made a pitch to the provincial government to "seek out and treat" HIV-infected individuals who are not on medications. It's estimated there are about 13,000 B.C. residents infected with HIV - 11,000 males and 2,000 females - but fewer than a third of them are taking such medications.
Montaner believes the number on medications should be more like 7,500. He said that would reduce the number of new infections each year from 400 to 300.
"The premier, the health minister and other government officials have been very supportive about this kind of progressive approach.
"But now with the economic downturn, we are in a waiting mode. We need an outreach program that brings treatment to the people, to make it more accessible," he said, referring to his vision of clinics in high-risk neighborhoods where such medications would be distributed.
Currently, the drugs are not taken by HIV-infected patients until their immune systems have deteriorated to a certain level. The delay-until-you-can-no-longer-delay approach is intended to save money and stall the potentially unpleasant side effects of medications. But it also means that untreated HIV patients can transmit infections.
Under another proposed strategy by Montaner's group, the "highly active antiretroviral therapy" (HAART) medications would be taken by infected patients far earlier in their disease process, so they wouldn't get the opportunity to transmit the disease.
HAART is said to be nearly 100-per-cent effective at preventing HIV by suppressing viral loads to undetectable levels and preventing people from developing full-blown AIDS by boosting the immune system. A report from the B.C. Centre for Disease Control shows that in 2007, there were only 61 full-blown AIDS cases in B.C, the lowest number since 1994, largely because of the availability of such lifesaving medications.
Sun Health Issues Reporter
pfayerman@vancouversun.com
Monday, March 02, 2009
Health authority's detox rules block access for street users
We met over coffee last week, each with our own reasons for being there.
I was there to find out why the region’s new 14-bed detox unit is virtually unavailable to people from the street community. He wanted to know why the media always fixate on the negative.
We talked for an hour and a half. I’m not sure that either of us fully understood the other one’s points by the end of it all. But at least we heard each other out, and I appreciated his frankness.
As the director of addiction services for the Vancouver Island Health Authority, Dr. Laurence Bosley is an important man when it comes to addressing some of the immense problems on our streets.
Addiction certainly isn’t the only reason why people end up homelessness. But it’s a major reason for why they get stuck out there. So when the health authority opens a new detox with policies that essentially exclude most of the several hundred people with addictions on our streets, I’d like to understand why.
But first to Dr. Bosley’s point about the media, because I do get what he means. We desperately needed the new detox and seven “stabilization” beds that opened this month, and it’s a beautiful facility in a time of scarce resource.
So I understand Bosley’s unhappiness at having media hone in on two “negative” angles on the story: That the facility isn’t available for stimulant users (people addicted to cocaine or crystal meth); and that it goes against the health authority’s own addiction-treatment policy by prohibiting smoking anywhere on site.
But like I told an audience of young activists at the youth-organized Change Conference this past weekend, you don’t fix a hole in the roof by talking about the 90 per cent of it that isn’t leaking. We won’t address what’s wrong in this world without talking about the problems.
Detox is the first step in getting out from under an addiction. It’s essentially five to seven days of care and prescription-drug therapy to help people through the most immediate withdrawal effects of whatever drug they were using.
Bosley rightly notes that it’s a pretty minor step, all things considered. But it’s the first one nonetheless. None of the steps that come after - treatment; spiritual healing; finding new ways to cope; drug-free housing; new friends and places to go; the hard, hard work of staying sober - can begin without detox.
So when policies at the new detox shut out the most prominently addicted people in our region, that’s one heck of a leak in the roof. The dominant drugs on the street right now are crack cocaine and crystal meth, so the no-stimulants rule alone has huge implications. But add in the no-smoking policy for a population for whom tobacco is the sole saving grace of life, and you’ve shut out the people who most need the help.
Bosley applies a cost-benefit analysis to the issue. The health authority has a limited amount of money to spend, and unrelenting demand for all its services. It’s making choices all the time in terms of who’s getting care.
On the detox front, Bosley points out that withdrawing from heroin or alcohol can kill you, and must be done under medical supervision. Withdrawing from cocaine or crystal meth is unpleasant, but not life-threatening. VIHA’s mandate is to provide medical care, not to give away expensive beds to people who really just need a place to lie down and sweat it out.
Except people on the street don’t have a place to lie down. No bed to sleep in for five straight days, that’s for sure. No way to get away from the sellers and the users. No place to detox, and thus no way to even begin the long journey out of addiction.
Bosley also notes that it makes little sense to give someone who’s homeless a detox bed for five nights and then just release them back to the streets. On that point we definitely agree. He wonders if we try too hard to “cure” everyone, when some people’s problems simply may not be curable.
I would argue that we’ve barely tried at all in terms of the street community. The significant successes of the three VIHA-led integrated outreach teams in keeping people supported and housed this past year underline how much can be accomplished when we do get down to the business of dealing with people’s real needs.
As for smoking, Bosley says he can’t believe anyone is surprised at that decision: “That’s just good clinical care.” I guess I see it as picking your battles. What good can come of denying people care for their addiction just because they can’t quit smoking?
We met over coffee last week, each with our own reasons for being there.
I was there to find out why the region’s new 14-bed detox unit is virtually unavailable to people from the street community. He wanted to know why the media always fixate on the negative.
We talked for an hour and a half. I’m not sure that either of us fully understood the other one’s points by the end of it all. But at least we heard each other out, and I appreciated his frankness.
As the director of addiction services for the Vancouver Island Health Authority, Dr. Laurence Bosley is an important man when it comes to addressing some of the immense problems on our streets.
Addiction certainly isn’t the only reason why people end up homelessness. But it’s a major reason for why they get stuck out there. So when the health authority opens a new detox with policies that essentially exclude most of the several hundred people with addictions on our streets, I’d like to understand why.
But first to Dr. Bosley’s point about the media, because I do get what he means. We desperately needed the new detox and seven “stabilization” beds that opened this month, and it’s a beautiful facility in a time of scarce resource.
So I understand Bosley’s unhappiness at having media hone in on two “negative” angles on the story: That the facility isn’t available for stimulant users (people addicted to cocaine or crystal meth); and that it goes against the health authority’s own addiction-treatment policy by prohibiting smoking anywhere on site.
But like I told an audience of young activists at the youth-organized Change Conference this past weekend, you don’t fix a hole in the roof by talking about the 90 per cent of it that isn’t leaking. We won’t address what’s wrong in this world without talking about the problems.
Detox is the first step in getting out from under an addiction. It’s essentially five to seven days of care and prescription-drug therapy to help people through the most immediate withdrawal effects of whatever drug they were using.
Bosley rightly notes that it’s a pretty minor step, all things considered. But it’s the first one nonetheless. None of the steps that come after - treatment; spiritual healing; finding new ways to cope; drug-free housing; new friends and places to go; the hard, hard work of staying sober - can begin without detox.
So when policies at the new detox shut out the most prominently addicted people in our region, that’s one heck of a leak in the roof. The dominant drugs on the street right now are crack cocaine and crystal meth, so the no-stimulants rule alone has huge implications. But add in the no-smoking policy for a population for whom tobacco is the sole saving grace of life, and you’ve shut out the people who most need the help.
Bosley applies a cost-benefit analysis to the issue. The health authority has a limited amount of money to spend, and unrelenting demand for all its services. It’s making choices all the time in terms of who’s getting care.
On the detox front, Bosley points out that withdrawing from heroin or alcohol can kill you, and must be done under medical supervision. Withdrawing from cocaine or crystal meth is unpleasant, but not life-threatening. VIHA’s mandate is to provide medical care, not to give away expensive beds to people who really just need a place to lie down and sweat it out.
Except people on the street don’t have a place to lie down. No bed to sleep in for five straight days, that’s for sure. No way to get away from the sellers and the users. No place to detox, and thus no way to even begin the long journey out of addiction.
Bosley also notes that it makes little sense to give someone who’s homeless a detox bed for five nights and then just release them back to the streets. On that point we definitely agree. He wonders if we try too hard to “cure” everyone, when some people’s problems simply may not be curable.
I would argue that we’ve barely tried at all in terms of the street community. The significant successes of the three VIHA-led integrated outreach teams in keeping people supported and housed this past year underline how much can be accomplished when we do get down to the business of dealing with people’s real needs.
As for smoking, Bosley says he can’t believe anyone is surprised at that decision: “That’s just good clinical care.” I guess I see it as picking your battles. What good can come of denying people care for their addiction just because they can’t quit smoking?
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