Drug use should be decriminalized to curb HIV epidemic, Julio Montaner says

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      An internationally recognized physician based in Vancouver says drug use should be decriminalized in order to help curb an “out of control” HIV/AIDS epidemic in Canada.

      Dr. Julio Montaner, the director of the British Columbia Centre for Excellence in HIV/AIDS, said closing supervised injection sites and pursuing legal action against them is “short-sighted, foolish and irresponsible on the part of the federal government.”

      “If we continue to criminalize, persecute and prosecute people who are either infected [with HIV] or at risk, these discriminatory practices will drive individuals underground and make it more difficult for us to access them,” he told the Straight by phone Monday (November 30).

      Montaner, the former president of the International AIDS Society, has recently been selected for a number of prestigious recognitions for his work, including the Order of British Columbia, the Albert Einstein World Award of Science and the Prix Galien Canada Research Award.

      On the eve of World AIDS Day, the Argentinian-born doctor is quick to point out the positive news - that the amount of new HIV infections in B.C. have decreased “significantly” and that over the last three years, there has been a 50 per cent decrease of new HIV diagnoses among injection drug users, a step forward he calls unprecedented.

      He credits this progress to the impact of expanded coverage under the highly-active antiretroviral therapy treatment model, or HAART.

      Montaner developed the concept of expanded HAART as “treatment as prevention”. The model advocates for the immediate treatment of clinically eligible people with HIV in order to reduce transmission of the virus and to reduce AIDS mortality rates.

      Montaner said HIV-infected drug users, one of the most difficult groups to access, should be embraced through public health initiatives like safe injection sites.

      “We have shown that by having a low-threshold environment where we embrace those that have drug addiction problems, we can work with them to improve the morbidity and mortality outcomes, at the same time that we increase”¦ drug cessation,” said Montaner.

      Despite the progress in reducing the number of new infections, he said the challenge is expanding access to HIV/AIDS testing and treatment, especially for the communities that have been the hardest to reach.

      The provincially-funded pilot initiative, Seek and Treat for Optimal Prevention of HIV/AIDS, or Stop HIV/AIDS, seeks to do just that.

      The project is designed to improve access to HIV testing, treatment and support services to individuals that face barriers to care, such as those facing mental health issues, addictions and homelessness. The pilot is operating for an initial four years in the Downtown Eastside and Prince George.

      “We’re currently working with our partners in the health authorities to implement a wider seek and treat program, which hopefully will encourage people to test for HIV more readily, and as a result, engage in proper care at the earliest possible time,” said Montaner.

      Another challenge to improving HIV treatment, according to the physician, is expanding the work that’s being done in B.C. to other parts of the country, where the number of HIV infections continues to grow.

      “In Canada, we have not been able to bring down the national rate of growth of the epidemic – and more importantly, there are clear signs of an epidemic that is out of control,” said Montaner.

      Of particular concern, he noted, are Canada’s aboriginal communities, where the number of people infected with HIV/AIDS is disproportionate to the rest of the population.

      According to research on the B.C. Centre for Excellence in HIV/AIDS web site, aboriginal people represent 3.8 per cent of the Canadian population, yet in 2006 they comprised 25 per cent of new HIV infections.

      Emma Palmantier, the chair of the Northern Aboriginal HIV/AIDS Taskforce, said there are currently just two physicians in northern B.C. who are able to treat patients with HIV/AIDS, one in Prince George and one in Smithers. For the residents of remote northern communities, many of them only accessible by plane or ferry, this means travelling to Vancouver for treatment.

      “There’s a lot of challenges and barriers that have been identified by our communities,” she said. “There is a lack of quality care service and treatment for our people, and it’s really difficult for them to get any treatment in their communities.”

      Palmantier said she would like to see HIV education initiatives expanded in northern B.C.

      “I’m really concerned about the youth,” she said, noting that young people make up the majority of the population in many northern communities. “There’s a need for education and awareness.”

      The task force is currently drafting a preliminary report and recommendations that will be sent to local health directors and community leaders.

      “Together, hand-in-hand with First Nations leadership, we should be able to find what are the elements that have to fall into place so that there is [an] increased rate of testing and increased rate of prevention and treatment in First Nations communities,” said Montaner.

      Montaner is also urging for other federal initiatives to curb HIV prevalence, including a national testing day, and the need for “over-arching standards” for HIV treatment, care and prevention.

      “To save money by not promoting HIV testing or by not having aggressive roll-out of antiretroviral therapy is foolish and short-sighted and counter-productive,” said Montaner.

      Staff from Canadian health minister Leona Aglukkaq’s office declined the Straight’s request for an interview.

      You can follow Yolande Cole on Twitter at twitter.com/yolandecole.