Vancouver, Insite and HIV infection rates

I recently stumbled onto this blog post with a very interesting observation about Vancouver, Insite and HIV infection rates.

Vancouver has seen a marked decrease in the incidence of AIDS/HIV and those who promote harm reduction sites point to the injection site called Insite as proof of success but they are wrong. The reduction of HIV/AIDS in British Columbia is because it is the only province that offers highly active anti-retroviral therapy (HAART)  free of charge and aggressively promotes its use.

“. . . the most compelling data to date demonstrating the soundness of the “treatment as prevention” theory, an approach conceived at the B.C. Centre for Excellence in HIV-AIDS and now being embraced worldwide.

“Treatment as prevention . . . is so successful, from Zimbabwe to Abbottsford, that policy-makers now talk openly about the possibility of freezing the epidemic in its tracks and creating an AIDS-free generation.”

I don’t agree with all the sentiments on this blog post, and I don’t understand the writer’s concept of “redistributing harm”, but , with all the discussion of Insite and Vancouver, I’ve never seen anyone discuss HAART and it’s impact on infection rates.
Read more at http://abearsrant.com/2013/10/redistributing-harm-isnt-harm-reduction.html#UYifT0odx6xWC204.99

The surgery was a success, but…

Public health workers are declaring their harm reduction approach a success:

Harm reduction — not a war on drugs — has reduced illicit drug use and improved public safety in what was once Ground Zero for an HIV and overdose epidemic that cost many lives, says a 15-year study of drug use in Vancouver’s impoverished Downtown Eastside.

The report by the B.C. Centre for Excellence in HIV/AIDS found that from 1996 to 2011, fewer people were using drugs and, of those who were, fewer were injecting drugs, said Dr. Thomas Kerr, co-author of the report and co-director of the centre’s Urban Health Research Initiative.

“A public health emergency was declared here because we saw the highest rates of HIV infection ever seen outside of sub-Saharan Africa — in this community. At the same time, the community was being levelled by an overdose epidemic,” Kerr said after presenting his findings to members of the group affected at a community centre in the heart of the neighbourhood.

Vancouver took a public health approach to the crisis, opening the country’s first supervised injection site in 2003, and Kerr said the statistics show that approach was successful.

Kerr goes on to pull the scientific evidence card, casting critics as stupid, unethical and indifferent to death:

“We have a federal government that ignores science in favour of ideology, and people are sick and dying as a result,” Kerr said.

“When we’re dealing with matters such as life and death, I think we’re obligated to base our decisions on the best available scientific evidence. I think it’s unethical to do otherwise.”

However:

There was some disappointing news for health officials in the study.

There has been only a slight drop in mortality rates among the city’s illicit drug users, who have a death rate eight times higher than the general population.

What’s that saying? The surgery was a success, but the patient died.

Now, I’m not saying that law enforcement is a better approach and I’m not saying that reduced disease and crime are unimportant, they are important. However, one of my concerns about public health approaches is that they are often designed to serve the public rather than the individual. When the death rate is only slightly affected, and addicts are still using and homeless, who’s best served by these outcomes of reduced disease and crime?

Harm reduction is not enough. In and of itself, it is not bad.

It’s just bad when the public and professionals declare victory while addicts continue to suffer terrible quality of life.

How much money was spent to achieve these outcomes? How else might that money have been spent?

Why not recovery?

Related articles

• Harm reduction makes for safer streets: study (globalnews.ca)
• Vancouver’s supervised injection site will survive new federal rules, supporter say (vancouversun.com)

Prohibition strikes back

InSite, Vancouver’s safe injection center has formed an alliance with residents in a retirement home to lobby for exemptions from the non-smoking policy of a shared funding source.

Ironies abound.