NEEDLE EXCHANGE PROVIDES A VITAL LINK

Facility A Part Of Broad Approach To Protecting Health Of Drug Users

On March 10, Victoria city council announced seven priorities for
immediate action. Homelessness and harm reduction were identified as
two of the seven.

We applaud council. Everyone should have access to safe and
affordable housing and necessary supports.

Needle exchange programs play an important role in reducing health
risks to the community and facilitate access to housing and other services.

Last fall, we had the opportunity to interview 33 people who use
needle exchange services on Vancouver Island as part of a
collaborative research project to determine how access to exchange
services could be improved.

From Port Hardy to Victoria, the stories that rung in our ears were
ones of trauma and abuse, pain, drugs and an amazing capacity for
survival. In the weeks that followed these interviews, we were
haunted by the stories that were entrusted to us and continue to compel us.

We were also left with evidence that the network of needle exchange
programs meant to stop the transmission of HIV and hepatitis C is
full of holes.

The basic services of providing people living with addictions with
the tools they need to address health needs are being denied. Many of
the people we interviewed told us that they did not have a safe place
to live and few safe places to go, except for the needle exchange.
They lived outdoors, under bridges, in tents and in trailers, never
knowing when they would have to move on. Research nationally and
internationally has identified that lack of stable housing is
associated with increased HIV risk, potential for multiple health
problems and premature death.

We found that needle exchanges facilitate access to services for
people who often have difficulty getting access to health care and
that they go hand in hand with access to other essential services
that can improve health and well being.

Through provision of clean supplies, information and education,
access to needle exchange services helps to reduce risk behaviours
associated with HIV and hepatitis C and keeps communities safe.
Access to needle exchange services can facilitate access to nursing
services for wound care, medication counselling, management of common
health concerns and referrals.

Needle exchanges can open the door to other services that can end
homelessness -- like counselling, treatment, income support and housing.

Often most importantly, needle exchange services provide a lifeline
to compassionate and humane care that can counter negative attitudes
often experienced by people who use drugs. A humane approach can be
an antidote to feelings of worthlessness and exclusion from society
that affect health and effectively prevent change.

In 1988, AIDS Vancouver Island initiated a needle exchange in
downtown Victoria. Over the years, services expanded to include three
up-Island sites that now serve more than 8,000 clients on Vancouver
Island. In 2001, a study of injection drug use in Victoria
recommended that mobile needle exchange services be added to, but not
replace, existing fixed services.

Today, we find ourselves in an odd situation in which we have
replaced fixed services with mobile services. Mobile sites, while
important to reach people in need of clean supplies and immediate
health concerns, cannot provide the confidentiality and access to
other necessary health and social services.

In 2007, the mayor's task force on "Breaking the Cycle of Mental
Illness, Addictions and Homelessness" recommended the strengthening
of needle exchange services and supervised injection services. In
that same year, a feasibility study conducted for the City of
Victoria recommended three supervised injection sites.

The findings of our research are consistent with these earlier
reports. One fixed site in a city the size of Victoria is inadequate
to effectively deliver harm-reduction services.

In their March 10 announcement, councillors also endorsed the need
for a distributed model of needle exchange services. Needle exchange
services are most successful when they are integrated into existing
primary health-care services.

As we look back at the stories shared with us by people who use
needle exchange services on Vancouver Island, it becomes hard to
understand the "why" of the current gap in services.

When the World Health Organization, studies by the City of Victoria
and many, many other research projects have illustrated the need for
supervised consumption sites and comprehensive needle exchange
programs, why are we having such a difficult time implementing these services?

The stories of missed opportunities and lack of access to basic
health services say loud and clear that we are leaving people out in the cold.

Needle exchange services are part of a comprehensive approach to
protecting the health of everyone in our community and part of a plan
to end homelessness.

Bernadette (Bernie) Pauly and Joan MacNeil are both assistant
professors in the School of Nursing at the University of Victoria.