Treatment as prevention – Vancouver Style?

On February 9, 2011, in HIV/AIDS, public health, by Karen Grepin

I spent a summer while in high school at UBC in Vancouver. The scenery was breathtakingly beautiful and the proximity to the beaches more than made up for the relentless drizzle that is summer in Vancouver. Strangely, one of my most vivid memories of this trip was finding half a dozen used syringes in the city parks and the syringe disposal kits that the city had installed throughout these parks – similar to the poopy bag disposal centers that New York City parks have installed. Clearly, Vancouver had a huge drug problem.

Fifteen years later, it is interesting to read about how Vancouver has been addressing this public health problem in a recent article in the New York Times. This article describes how the city has actually set up a center where drug addicts can come in and shoot up under the watchful supervision of nurses and other health professionals. The logic is not that this institutional arrangement condones and thus promotes the use of drugs but rather that by providing a safe location for drug users to inject drugs their risky behavior, such as re-using needles and using contaminated products, be minimized and if drug overdoses occur – as they do – that fatalities can be greatly reduced.

While the value of this clinic on its own is very interesting, the author of the article Donald McNeil goes on to argue that the existence of such a site is actually part of Vancouver’s strategy to reduce HIV, and a contributor to the success that the city has had at reducing prevalence rates. But he also argues that Vancouver has been applying a test-and-treat strategy and also claims that this is driving down the epidemic.

By offering clean needles and aggressively testing and treating those who may be infected with H.I.V., Vancouver is offering proof that an idea that was once controversial actually works: Widespread treatment, while expensive, protects not just individuals but the whole community.

There was not enough information in the article for me to try to evaluate these claims, but it is an interesting and compelling idea. Is what is going on in Vancouver evidence that the “test-and-treat” strategy actually works? And if it is true, to what extent can we generalize the Vancouver experience – a city that offers free health care, syringe disposal kits, supervised drug injection sites, and public nude beaches – to any other city in the world? If I had time, I would love to get into the evaluations of the Vancouver experience, but if anyone out there knows it already, I would love to hear from you.

That said, happy to hear that a Canadian city is at the forefront of such efforts. Thanks to Jack for forwarding the link.

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4 Responses to “Treatment as prevention – Vancouver Style?”

  1. Eric says:

    I live in the Vancouver area and work at UBC, and the supervised injection sites and general strategy do seem to be working (although I am not involved directly with either the science or the policy). However, it is enormously controversial, and has spawned a court case that is going to the Canadian Supreme Court. As with everything drug-related, the science and progress are clouded by politics. I think the statistics so far bear out the assertion that the approach is definitely not worse than alternatives, but how much “better” it is may depend on your political persuasion as well as the science.

    • admin says:

      Eric,

      Do you mean they are working as drug injection sites or working in terms of contributing to the declines of HIV?

      Karen

      • Eric says:

        I know they are working as safe injection sites, but there is a great deal of interest here to determine whether this can be correlated to lower HIV infection rates as well. I don’t know if such a correlation has been shown yet, but I do know that the HIV/AIDS community here (headed in large part by Dr. Julio Montaner and the BC Centre for Excellence in HIV/AIDS) has shown very convincingly that highly-active antiretroviral therapy works to dramatically lower infection rates (52% in last year’s Lancet paper). Also, see this paper for recent work on trying to link the two (safe injection sites and HIV/AIDS treatment with HAART):

        http://www.ncbi.nlm.nih.gov/pubmed/19747811

        Eric

  2. thomy tonia says:

    here in switzerland there are quite a few drug consumption rooms and needle exchange programs (either via machines, or in the pharmacies). heroin assisted treatment is also implemented since a few years. reports from the federal office of public health http://www.bag.admin.ch/themen/drogen/00042/00624/06044/07683/index.html?lang=en argue that these policies have contributed to the decline in drug use in switzerland the past years. unfortunately i could not find any link with HIV/AIDS infection rates.
    it would be interesting to see…

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