AIDS Saskatoon and the 601 Outreach Centre have recently come under scrutiny for the services and programs we provide, and we would like to take this opportunity to address some of the inaccuracies, misinformation, and misconceptions being propagated by a small but vocal segment of the population and increase awareness of what we do, why we do it, and how it helps our community.
There are members of our community, the media, and public figures who perpetuate the fallacious notion that needle exchange and other harm reduction programs are not working and should be abandoned or are somehow dangerous to local citizens. As part of our harm reduction programming, AIDS Saskatoon does operate a small but essential needle exchange in the 601 Outreach Centre two hours a day, five days a week. This needle exchange is a partnership with the Saskatoon Health Region, and operates according to their guidelines and policies—as an exchange, with a 99.3% needle return rate (all of those needles safely disposed of and not on our streets)—by staff trained by SHR. Our exchange was created as a part of a public health and harm reduction response to a need for safe injection drug supplies in this neighbourhood by members of this community, to help them ensure they have the tools they need to be responsible for eliminating the transmission of HIV and Hepatitis C—new supplies, for each person, every time—and dispose of these supplies safely. People who use drugs were consulted because, to be effective, needle exchanges must be accessible to the people who need them.
There is a massive amount of scientific evidence supporting harm reduction programs, including needle exchange sites. Here are some basic facts from an extensive review by the World Health Organization: needle exchange programs reduce the transmission of HIV and there is increasing evidence that they decrease transmission of hepatitis C virus (HCV); they increase the uptake and success of HIV/HCV and addiction treatment services; and DO NOT lead to increased injection frequency, increased drug use, injection drug use recruitment, nor greater number of discarded used needles (Wodak and Cooney, 2004). Since the creation of our exchange, the number of needles found discarded in our community has decreased every year; in our annual spring needle clean-up, only 8 needles were found in the 601 neighbourhood (Idylwyld to Ave. G, 31st to 37th). Also, through education programs including those at AIDS Saskatoon, more people know how to safely discard of used needles and children are learning that if they find a stray needle, don’t touch and call an adult. We have also never had an HIV or HCV transmission in this city from a community needle stick injury.
As many people do not know, there is a massive need for more—not fewer—harm reduction programs, including needle exchanges, to respond to our HIV epidemic. In Saskatchewan, rates of HIV transmission are 2-3 times higher than the rest of Canada and appear to be rising; the rates are 15-20 per 100,000 people (Saskatchewan Ministry of Health, 2011)—and Saskatoon has the highest transmission rates in the province. Unique amongst most of North America, the group that carries the burden of HIV in Saskatchewan are people who use injection drugs. As such, the Saskatoon Health Region has expanded their harm reduction programs to help deal with this shameful epidemic (Plamondon and de Bruin, 2009). This includes expanding needle exchange programs to new sites, such as AIDS Saskatoon. People do not inject drugs because there is a needle exchange at AIDS Saskatoon; there is a needle exchange at AIDS Saskatoon because people in this community inject drugs. The community most at risk of HIV asked for a needle exchange in their community because they do not want to contract—or, if they are infected, transmit—HIV or Hepatitis C. And in this midst of an HIV epidemic, it is imperative that we respond.
AIDS Saskatoon, as its name implies, is an organization designed to help those infected with HIV/AIDS and those who are at increased risk of HIV/AIDS. As a community based organization, we morph and change to meet the needs of the people we serve. The initial focus of our agency was support and care for people with HIV/AIDS (when HIV infection led only to death from AIDS) and prevention of HIV transmission, predominantly amongst men who have sex with men (MSM). Over the past decade, HIV transmission amongst MSM in Saskatoon has decreased and shifted exponentially to people who inject drugs; thus, to remain relevant and effective, the focus of AIDS Saskatoon shifted, too. As explicated in Saskatchewan’s HIV Strategy 2010-2014 (Ministry of Health), “The social determinants of health that impact risks of acquiring HIV, especially injection drug use, include factors such as poverty, inadequate housing, lack of education or job training, child abuse and family violence. Addressing the social determinants of health, injection drug use, and HIV requires a concerted effort, and a coordinated and multisectoral commitment.” Our myriad education, outreach, advocacy, and support services, including creation of our 601 Outreach Centre at Avenue F and 33rd Street, reflect our humane, harm reduction-based contribution to addressing these conditions that produce and reproduce HIV. Therefore, the 601 is open to all and does not require disclosure of HIV status, positive or negative, because—like all harm reduction programs—one of the imperatives is prevention. People who access services choose what to disclose to whom, including their names. While much has been made of the fact that we do not require names to access our needle exchange (according to SHR guidelines), most people ultimately and willingly provide their names, health card numbers, DOB; those who do not still exchange using an alias, protecting their right to anonymity while ensuring the needle for needle policy applies. There is also no blatant “AIDS” signage on the drop-in exterior (there is unobtrusive AIDS Saskatoon on the side door, leading into our agency), to mitigate the stigma that continues to surround HIV/AIDS while ensuring one and all can access the 601. Contrary to some current misinformation, this is not an effort to hide what we are doing inside; rather, it is to reduce the potential stigma and increase the accessibility for people who access or need to access services, HIV positive or negative, drug user or not, living in poverty or not, MSM or not, etc. Why would we only offer education, support, services, male and female condoms, and safe injection supplies to HIV positive people and abandon those who are HIV negative (and would like to stay that way)? Rather, we provide a safe, non-judgemental space in which anyone can access these services, alongside basic things most of us take for granted: basic nutrition, coffee, a clean bathroom, laundry facilities, a safe space, companionship. If people feel safe and cared for in the space, they are more likely to ask for help when they need it and trust the people who provide it (i.e. at the 601, we know that a cup of coffee today can lead to HIV transmission prevention tonight). That’s harm reduction. And, speaking to those who are concerned with taxpayer dollars, the prevention of HIV is much more cost effective compared to HIV treatment and exponentially more cost effective than treatment of AIDS. Taking into account loss of productivity, impact on quality of life, and actual health care costs, the Canadian AIDS Society (2011) estimates HIV/AIDS is costing Canadians $1.3 million per new diagnosis. If you cannot find empathy for those affected by or at risk of HIV/AIDS, perhaps an interest in saving $1.3 million per infection can.
Our needle exchange is, indeed, a health care service. In its decision in support of Vancouver’s Insite (Safe Injection Site) in 2011, the Supreme Court of Canada argued that its closure “would have prevented injection drug users from accessing the health services offered by Insite, threatening their health and indeed their lives” (BC Centre for Excellence in HIV/AIDS, 2011). Addiction, injection drug use, and HIV transmission are not moral issues, although the widespread (and seemingly acceptable, in some circles) defamation of “junkies” continues to stymie efforts to address what is actually (as reams of research demonstrate) a public health issue. The term junkie dehumanizes people who use drugs, which objectifies them and transforms them from human beings into things. At best, it makes it far easier for people in our community to ignore the HIV epidemic that is ravaging them; at worst, it substantiates the abominable belief that nothing should be done to stop the spread of HIV amongst people who use drugs as they are not worth the effort, given their less-than-human status. There are no “junkies” in, at, or outside the 601 or AIDS Saskatoon: only human beings, the people who access our services and whom we proudly work with, share with, learn from, support, and serve.
As Edgar Allan Poe writes, ““I have absolutely no pleasure in the stimulants in which I sometimes so madly indulge. It has not been in the pursuit of pleasure that I have periled life and reputation and reason. It has been the desperate attempt to escape from torturing memories, from a sense of insupportable loneliness and a dread of some strange impending doom.” Would we deny Poe services that would save his life because he was a “junkie”? Of course not. So why do we insist on perpetuating and increasing the harm and pain to those who are already in pain? From our long history in supporting people infected with, at risk of, and affected by HIV/AIDS—including the first wave of predominantly stigmatized gay men to our current epidemic adversely affecting people who inject drugs—we know that the majority of the people in this community are caring and compassionate human beings who, given the education and tools required to address fear and ignorance, have the moral and political will to aid us in our mandate and, in the end, save lives when we can, support and advocate for people who are sick, and help people live and die with dignity and care.
Plamondon and de Bruin (2009). Bridging services with community voices around injection drug use: Results and recommendations from an assessment of harm reduction needs in the Saskatoon area. Saskatoon Health Region.
Wodak and Cooney (2004). “Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users.” World Health Organization.