SASK.’S HIV EPIDEMIC
Safe injection sites sought
Saskatchewan is the epicentre for HIV in Canada — and that has many questioning why the province doesn’t have supervised injection services.
Supervised injection sites are “absolutely critical in reaching people who are otherwise unreachable,” said Irene Goldstone, an adjunct professor at the University of British Columbia’s School of Nursing.
“They start to gain self-respect and build relationships with the staff, so if they say, ‘I don’t want to do this anymore. I need help,’ we can assist them to get into detox and treatment,” she said.
“On the other hand, if they’re committed to continuing use, we keep them as safe as possible ... There’s never been a death from an overdose at any supervised injection clinic in all of the world.”
Transmission of HIV through injection drug use is all about sharing — equipment and drugs, she said.
“If people are in a clinic kind of setting, using their drugs, they’re not going to die of it,” Goldstone said. “They are (going to die) if they’re injecting alone. That’s one of the things that’s happening in B.C. The majority of deaths occur when people have used alone.”
A street nurse program in Vancouver started doing needle exchanges before it was officially sanctioned in 1988. Goldstone was involved in the first supervised injection site in North America called Insite, which opened in 2003 in Vancouver.
She and Marilou Gagnon, an associate professor of nursing at the University of Ottawa, are presenting: Canadian Nurses Lead the Way in Harm Reduction: Then and Now — at the national conference of the Canadian Association of Nurses in HIV/AIDS Care (CANAC). The conference is being held in Regina until Saturday.
Everyone uses harm reduction in their daily lives, Gagnon said.
“If you’re going to ride your bike, wear your helmet — this is harm reduction,” she said. “The same thing with having sex. You can tell people to be abstinent, but chances are people are still going to have sex. The best message that we can put out there is, ‘If you’re going to have sex, do it in a safer way’ — which means using a condom.”
When you apply harm reduction to drug use, you can tell them to stop — but that’s not likely, Gagnon said.
“Is there a way to work with them and meet them in the middle? That often means, ‘You’re not ready to quit drugs so I’m going to help you inject in a safer way — I’m going to give you clean needles,’ ” she said.
Gagnon noted the opioid crisis is also linked to HIV.
Most people start taking opioids by ingesting them, but then move to injecting or smoking them, she said.
“As soon as someone is injecting or smoking, there’s a risk of contracting a blood-borne pathogen like Hep C and HIV,” she said.
The 25th annual CANAC conference is focusing on HIV work nurses have done in the past, present and will be doing in the future, said Debbie Rodger, one of the conference organizers.
“CANAC is a network of nurses across the country who support each other through education, knowledge exchange and sharing,” Rodger said.
HIV is considered a chronic illness so the group’s focus will expand to the opioid epidemic, she said.
The province has had higher HIV rates than anywhere else in Canada for about the past 12 years, said Greg Riehl, board director of the Canadian AIDS Society.
Groups such as indigenous people, injection drug users and men who have sex with men are overrepresented, he said.
“In Saskatchewan, our rates are probably three, four or five times higher (than the national average),” Riehl said.
He’s lobbying for all HIV medications to be covered.
“Right now, there’s a very confusing system, whether you’re First Nations, Metis, you’re on welfare — there’s so many levels of how HIV medications are either covered or not covered,” Riehl said. “Some provinces cover all HIV medications — like B.C. — and we’ve seen excellent results there.”