Vancouver's raging HIV epidemic most rampant in developed world: Nearly
half the 6,000 to 10,000 addicts in Downtown Eastside are infected, AIDS
expert says.

By: Margaret Munro

Illustration:
Color Photo: Bill Keay, Vancouver Sun / GRIM WARNING: Dr. Dave Patrick, who
is charting the HIV epidemic in Vancouver, stands behind Carnegie Centre at
Main and Hastings where sign on door says it all. Nearly 50 per cent of
city's injection drug users are believed infected.

The HIV epidemic raging in the heart of Vancouver is now considered to
be the most rampant in the developed world.

Close to half the 6,000 to 10,000 addicts who frequent the seedy hotels and
back alleys in the Downtown Eastside are believed to be infected with the
AIDScausing virus, which passes from drug user to drug user on the tips of
used syringes.

Thousands more in Surrey and New Westminster, where the virus is known
to be spreading, are also threatened, as are native Indian communities
around the province and young street people.

``Basically, I don't think it gets any worse,'' said veteran AIDS
researcher Dr. Martin Schechter, whose team is documenting how a potent
mixture of drugs, despair and poverty is fueling the epidemic.

According to studies at the B.C. Centre for Excellence in HIV/AIDS, the
infection rate among injection drug users in Vancouver has been running at
close to 20 per cent per year. ``What that means is that out of every 1,000
people who are negative at the beginning of the year, 200 will become
infected by the end of the year,'' said Schechter, who is codirector of
the centre.

``This is the highest incident rate we know of in the developed world.''

Bangkok, Edinburgh, and New York likely experienced similar infection rates
when the virus swept through their injection drugusing communities, but he
said Vancouver's rate is highest now.

``It's not a very good way to get well known,'' said Schechter, referring
to the way the Vancouver epidemic is attracting attention from around the
world.

People with new infections, if untreated, will go on to develop AIDS in
five to 10 years.

``People can't believe what's happening here,'' said Steffanie Strathdee,
who has been documenting the epidemic for the centre with a study involving
1,006 injection drug users.

She said she has been fielding inquiries from as far away as Australia
about the epidemic, which has occurred despite Vancouver's celebrated
needle exchange program.

More than two million needles are exchanged each year by the program,
which started in 1988 and is the biggest in North America. The clean
needles kept the lid on the epidemic for a few years and the program
was held up as a model for other communities to follow.

But even as the needle exchange was being praised, the virus was quietly
spreading like wildfire among downtown injection drug users.

``The simple fact is that we've gone from a one to twopercent [rate
of infection] in 1990 to 25percent in 1995 to 50percent now in the
injection drug users,'' said Dr. David Patrick, of the B.C. Centre for
Disease Control Society, who tracks the virus for the province.

When Vancouver drug users altered their drug habits in 1992, the epidemic
started to explode, the researchers say. Instead of injecting heroin into
their veins two or three times a day, the drug users started injecting
cocaine up to 20 times a day with disastrous consequences. During the often
frenzied activities, drug users started sharing and reusing needles with
growing frequency.

``That's what fanned the flames,'' Patrick said.

Making things even worse, Schechter said, is the fact that newly infected
people, who don't usually know they are infected, are much more infectious
that people who have been harboring the virus for a long time.

``They are 100 times more infectious,'' said Schechter, explaining
that the virus level in the blood spikes in the first few months of
infection before settling down to a much lower level.

``When you get a certain number of people who are in this primary phase of
infection, they set off a chain reaction,'' he said. ``And it spreads like
fire. And that's what we think happened''

The epidemic is so bad that the VancouverRichmond health board last week
declared a public health emergency in the Downtown Eastside.

The move came none to soon for the AIDS specialists and activists who have
been alarmed about the soaring HIVrates in the Downtown Eastside since
1994.

``It has been an emergency for three years,'' said Patrick. Like many
people who have been working overtime to curb the spread of the virus,
Patrick said he is heartened by the board's decision to declare an
emergency. But he wants to see action before he gets too excited

His sentiments are shared by many, including David Levi, who chairs the
health board that has been discussing the need for ``urgent action'' for
more than 18 months.

While the board talked about programs that could be put in place to curb
the spread of HIV, ``we've had 700 more people infected,'' Levi said.

Declaring it an emergency should speed things up considerably, he said.
``We can not stand around anymore, we're got to do something. This isn't
just a health issue. This is a crisis, it's an epidemic.''

Levi's board has asked its staff to come back with a bold and
comprehensive ``action plan'' by the end of October.

Expanded outreach programs, needle exchanges, addiction treatment, detox
programs and safe houses will likely be included. Longerterm plans could
see dilapidated rooming houses converted into livable apartments, Levi said.

Medical officials and AIDS specialists are also worried about the epidemic
spreading to native Indian communities around the province that are home to
the hundreds of HIVpositive Indian people who frequent Vancouver's Skid
Road area.

``It's not a closed epidemic,'' said Patrick, who is also concerned with
the way street kids from across Canada continue to show up in the Downtown
Eastside and get into injection drug use.''We have to look at good
prevention and outreach to get new people off the street or away from the
dangerous parts of the street,'' he said.

Strathdee said she is aware of people infecting themselves with HIV in a
bid to collect more benefits from the government. She also said there are
plenty of people knowingly using dirty needles, even though clean ones are
available to them.

``It shows the level of despair in the community,'' she says. ``We need to
say to these people, `You matter and we can help you.'''

Like many working in the Downtown Eastside, Strathdee is struck by the
public's apathy toward the epidemic.

``In general, people don't seem to care about drug users and wish they
would just go away,'' Strathdee said. ``If everyone in the Downtown
Eastside died tomorrow, I think the rest of Vancouver would go. `Phew,
there's that problem solved.'''

Levi makes the same point.

``Morally we cannot say these are the inevitable victims who cannot
succeed in our society,'' he said. ``We have a responsibility. not only
morally, but from a health perspective. These people exist, they are not
invisible.''

To people who say they don't care about drug addicts, Levi has this to
say: ``People have to realize that the Downtown Eastside is visited by an
enormous number of people who pretend not to know it exists.'' Men come
from across the Lower Mainland to buy the services of prostitutes working
in the area, he said.

``There's somebody in your neighborhood that's been down there in the last
month.''