The Carillon (University of Regina)
Some are looking to Vancouver’s experience with Insite as inspiration for harm reduction techniques.
REGINA (CUP) — Saskatchewan has the highest HIV infection rates in all of Canada, and the number is growing.
According to the Ministry of Health, the province reported 186 new cases of HIV in 2011. That number is up eight per cent from 2010. 2011 saw an estimated 19.6 HIV cases per 100,000 individuals in Saskatchewan. The national average that year was 7.6 cases per 100,000.
HIV spreads through blood-to-blood contact. One of the most successful ways the virus is spread is through sharing of needles and other drug paraphernalia that has contacted blood. About 76 per cent of those who tested positive for HIV in 2011 in the province reported injection drug use as their likely exposure to the virus.
With these shockingly high numbers many are questioning what can be done to reduce HIV rates among drug users in the province. Some say harm reduction strategies are the answer.
Saskatchewan has the highest rates of HIV right now in Canada. We have double the national average.
– Alicia Slywka
Education and Outreach Coordinator, AIDS Program South Saskatchewan
Harm reduction, or harm minimization, refers to public health policies that are designed to reduce the harmful consequences of high-risk activities such as drug use. These policies are aimed at reducing harm for both the drug user and the overall community.
As part of the University of Regina’s Faculty of Arts annual Woodrow Lloyd lecture series, Vancouver-based activist and community organizer Ann Livingston spoke to a Regina audience Feb. 6 about her work implementing harm reduction strategies in Vancouver, and the effect this has had in building solidarity with drug users in the area.
As a co-founder of the grassroots group Vancouver Area Network of Drug Users, Livingston has dedicated the majority of her life to improving health care on a local, regional and national level for illegal drug users. Her advocacy for policies that will empower drug users to seek their rights as citizens has not been easy, but for Livingston, doing something was better than watching Vancouver’s HIV rates skyrocket and seeing drug users overdose daily. Action was needed, and harm reduction strategies helped mobilize the community to provide better health care to drug users.
HIV rates became a major concern for British Columbia in 1997, when there were 350 deaths related to the virus. Seeing a dormant provincial government, Livingston and other local community members formed VANDU and began engaging in civil disobedience by providing drug users with clean needles and creating spaces for the safe injection and use of drugs.
Civil disobedience is “like ignoring the law and taking action to save the lives of your neighbors and friends,” Livingston explained. “I think that people do this because there’s an obvious fundamental justice that’s being violated, and there really are well-researched, life-saving health initiatives that they know about that could be implemented [but] are being withheld from people, who then are damaged or die as a result.”
Instead of a top-down structure, where government or privileged individuals control the organization, VANDU operates through a grassroots, bottom-up approach. The group is made up of a general membership of close to 2,000 Vancouver-area drug users and is operated based on the recommendations and needs of this membership.
“This method will always work [because] the actions are owned by the actual victims of the social inequality, and not made up by more privileged organizers who are puzzled that the oppressed are not eager to march in their parade,” Livingston said.
Through this empowerment model, users are able to take charge and create the programs they believe will help them, and fight for the rights and policies they want to see implemented.
With the collective work of the user groups, B.C. saw the rate of new HIV diagnoses decrease in 2011, reaching its lowest point ever — 6.3 cases per 100,000. A main driver for the decrease has been credited to the decline in new diagnoses among injection drug users.
Saskatchewan and HIV
With an increasing number of HIV cases in the province, Alicia Slywka, education and outreach coordinator at AIDS Program South Saskatchewan, says not only is HIV a huge issue, but Saskatchewan is also far behind the other provinces in funding and applying grassroots harm reduction strategies.
“Saskatchewan has the highest rates of HIV right now in Canada,” Slywka said. “We have double the national average. I think Saskatchewan is very far behind other provinces, and behind B.C., and there’s a lot that we can do to improve it. Yes, our programs are good, but I still think there’s a whole bunch that needs to be done in order for things to be reversed and for HIV rates to go down.”
Currently, APSS runs a needle exchange program through its office and through the Regina Public Health Region. The program provides clean needles to drug users, reducing the risk of users sharing needles or injecting with dirty syringes. While the needle exchange program is just one harm reduction strategy in Regina, Slywka says public ignorance and lack of education has led to a lot of opposition.
“There is harm reduction programs happening, but there’s huge resistance to them in Saskatchewan…. The government does not like us [and] there’s some pretty vocal people that don’t like us as well,” Slywka said. Some say that “harm reduction and providing people with needles puts more needles on the streets… [that] it creates addicts. That’s not the case. People just don’t understand harm reduction.”
For instance, a 2012 survey conducted by the University of Saskatchewan titled “Taking the Pulse” asked Saskatchewan residents if they felt that HIV/AIDS was a problem in the community. Of the 1,750 respondents, 60 per cent disagreed that the province has an HIV problem.
Ignorance may be bliss, but as HIV rates in Saskatchewan continue to increase, Slywka says education is key to mobilizing individuals and creating change. VANDU, she says, is a great example of an organization this province can learn from.
Opposition to harm reduction programs is not just a problem in Saskatchewan. Livingston noted that VANDU experienced similar forms of resistance, and continues to do so, from both authority figures and the public.
One place this resistance and ignorance stems from, Livingston says, is the failure of the media to portray drug users in a positive and honest light.
“We have to realize that we have been insanely brainwashed. I don’t watch TV much now, but… they always show how the clever, wonderful detective grabs this conniving, skinny, roughed-up junkie, and slams him against the wall and asks him for information.
“Then he’ll sell out all his friends. We’ve had this ingrained into us,” she said.
Instead of creating these negative stereotypes, Livingston suggests a lesson in open-mindedness and a course in testing personal perceptions.
“It’s kind of surprising and shocking to people that drug users have the right to obtain, prepare and ingest drugs. But, if this sentence bothers you, you can say ‘the right to obtain, prepare and ingest wine,’ and you can see it’s a perfectly logical and normal sentence if you use wine. So, if the drug thing bothers you, you’ll have to get over it,” Livingston challenged.
Beyond just challenging these negative narratives, she says the VANDU model allows for drug users to gain autonomy and share their stories and lives with society at large. Instead of media and governments creating the popular conception of a drug user, users are able to share their own personal narratives.
“It’s such a privilege to work with people who have such an isolated life. They’re extremely vulnerable and they let me be a part of their life. To see their courage, most people would be weeping at the thought of trying to get through one of the days that they face. It is rough,” Livingston said. “I have a lot of admiration and I put that forward to them, and it goes a long way to treat people.”
Illustration: Donovan Thorimbert