CITY'S ADDICTS NEED MORE BASIC HEALTH CARE

Needle Exchange Won't Keep HIV Cases In Check: MD

EDMONTON - Dan Poulton sits in a vinyl chair at a downtown community health
clinic, eyes droopy from the downers he's taking to keep himself from
getting sick.

His arms are surprisingly free of the markings one expects to see on a man
who has been addicted to drugs for about 15 years. It's his hands that
betray him: the tips of his thumbs and forefingers are almost black.

Though he has been off crack for a couple of weeks, he's still shooting up,
mostly synthetic heroin, which brings him to the downtown community health
clinic almost every day to exchange his dirty needles.

Poulton says the exchange program and other health-care services
Streetworks provides are paramount in the fight to keep people who lead
high-risk lifestyles from adding to the growing hepatitis C and HIV cases
in the province.

Dr. Stan Houston, an infectious disease specialist and the director of the
northern Alberta HIV program, agrees and says a program like Streetworks,
which practises what is known as harm reduction, is essential for stopping
new HIV cases in Edmonton.

There are over 800 HIV patients in northern Alberta, with a significant
portion of cases in Edmonton, Houston says.

In 1998, there were 131 new infections in the province, 176 the following
year, 185 in 2000, 171 in 2001 and 172 in 2002.

While figures show HIV infection rates remain stable, Houston says as with
all diseases, the medical community must work to reduce the rates of
infection. "Stable is terrible," he says. "It should be going down. And in
Uganda and Thailand, Third World countries with vastly less resources than
we have, it's going down."

But those who work on the front lines of community health fear the
infection rates won't go down because government funding doesn't come close
to meeting the demands of treating these individuals. While groups such as
Streetworks receive money from Capital Health and Alberta Health and
Wellness, holes in the budget are filled with short-term grants that leave
administrators scrambling to meet operating costs.

"I could spend my whole day writing proposals for $5,000 grants,"
Streetworks' Marliss Taylor says. "And while they can be very helpful,
that's gone and I have do it again. It would be nice to have something
that's more sustainable."

That's what Streetworks is looking for after 14 years as a needle-exchange
program and expanding to provide basic primary health-care services. Three
years ago, the program got a grant from the province's Health Innovation
Fund, which awarded $900,000 over three years to community health
organizations.

Streetworks used the extra money to buy dressings and Band-aids, conduct
immunizations and blood work, and provide advocacy and counselling
services. Combined with the needle exchange, primary health services are
crucial in the fight against further HIV and hepatitis C infections among
high-risk members of the community, such as intravenous drug users.

About 1,600 people used the program in July and an average of 55,000 to
60,000 needles are exchanged every month. Most clients also receive some
health-care service and condom distribution is a significant part of the
program.

New HIV cases among intravenous drug users and their partners outnumber
those among gay men, says Houston. In the 1980s, HIV infection rates were
higher in Calgary than in Edmonton; now the reverse is true. Houston says
the only way to stem the tide is by making funding for harm reduction-based
health care a priority

But after the Health Innovation Fund grant ran out in June, Streetworks has
had to reduce some of its staff and services. Administrators are making do
without a health budget, which would cover things such as bandages, and
have cut back to five the number of nights the needle-exchange van patrols
the inner city.

Houston says when a program is proven to benefit residents, the regional
health authority should make room in its budget to continue funding. He
points out that primary health-care services decreased the number of
emergency room visits by Streetworks clients.

However, Capital Health says that while it would like to offer more
assistance to Streetworks beyond the $100,000 it provides annually, it is
facing a $20.8-million budget deficit.

"We certainly recognize the value of Streetworks," said Ed Greenberg, a
spokesman for Capital Health.

Greenberg and David Dear, a spokesman with Alberta Health, confirm the
region and the province are discussing ideas for a new, primary health-care
strategy which would include methods for helping people leading high-risk
lifestyles.

In the meantime, the lobbying will continue.

He would like to see funding increased so the entire city can be covered by
Streetworks and its van to promote harm reduction beyond the inner city,
especially to youths who are at risk of falling into high-risk lifestyles.

Poulton echoes Houston's sentiments.

"The way they figure they're cutting costs now, it's going to end up
costing them in the long run, you know? Where they can get a little nursing
here they don't have to go to the emergency room and tie up the emergency
room, which costs a lot of money.

"Nip it in the bud, so to speak, you know?"