HOUSING POLICIES COULD HELP PREVENT AIDS

Research on B.C. needle drug users links homelessness to unsafe sex
and persistent addiction.

If you shoot illegal narcotics into your veins in British Columbia's
capital city, you have plenty to fear. Injection drug use is a
driving factor in the spread of infectious blood borne diseases like
HIV/AIDS and Hepatitis C in North America. But your biggest worry,
according to a newly published study, is just finding a place to stay
where you won't be robbed.

Injection drug users told Victoria researchers they rank security
issues such as shelter and physical safety above concerns about
catching a deadly illness. And that, say researchers, means we need
to rethink how we tackle AIDS prevention.

The findings, recently published in the Harm Reduction Journal, don't
surprise Aid Vancouver Island staffer Erin Gibson, who was part of
the research team. For a decade now Gibson has worked with AIDS
patients and drug users at AIDS Vancouver Island, and she says the
desperate conditions of life on the street make it hard to entertain
long-term worries about viral infections that might affect you years
in the future.

"You don't have time to worry about HIV if your basic survival needs
aren't being met," Gibson told the Tyee in phone interview from her
Victoria office. "It can be minute to minute out there, day to day.
It's only after people have secure housing that I see them reduce
their drug use and volunteer in programs. The things they think about
then are different."

Condom use lower among homeless

Gibson and her colleagues suggest that their research findings have
implications for public policy. Among their paper's conclusions:

Worried Users: The Victoria Study

'Worry as a window into the lives of people who use injection drugs'
looks at the role of worry in the lives of injection drug users in
Victoria, B.C. during April and May of 2008. The researchers analyzed
survey responses from 105 clients of the city's clean-needle
exchange, who were asked to score 14 possible worries on a scale of
one to five, with five indicating "worries all the time."

The highest mean score (3.11) was for worries about having a place to
stay and the second highest (2.91) was for concerns about being
robbed. (Slightly more than half the people who responded to this
research were homeless and another 10 per cent were living in
shelters in 2008.)

Infection with Hepatitis C drew a mean score for worry of 2.89 and
worries about HIV/AIDS were close behind with a mean score of 2.84.

Worries about getting clean needles scored a mean of 1.72. The study
was conducted when Victoria had a well-established needle exchange
program. Since then, a neighbourhood lawsuit has since forced the
exchange to leave its permanent address.

- - Tom Sandborn

PWUID ( People Who Use Injection Drugs) in this study not only worry
about HIV/AIDS but also about stressful factors in their daily life,
which have been linked to both increased HIV/AIDS risk behaviour and
decreased anti-retroviral treatment adherence. The importance PWUID
give to this broad range of worry/concerns emphasizes the need to
place HIV/AIDS intervention, education, and treatment programs within
a broader harm-reduction framework that incorporates their
perspectives on both worry and risk."

Other recent research found that homeless needle-based drug users are
less likely to use a condom during sex than users who have a place to live.

Thomas Kerr of Vancouver's B.C. Centre for Excellence on HIV/AIDS,
working with other researchers, studied the relationship between
homelessness and risk behaviours for HIV/AIDS transmission among
street-involved youth. They found that "homelessness was inversely
associated with consistent condom use .. while unstable housing was
positively associated with greater numbers of sex partners."

The team suggested the need for new policies "which modify
environmental factors that drive risk among young street-involved populations."

'People need secure housing': VANDU's Livingston

Ann Livingston, a long time activist in Vancouver with the Vancouver
Network of Drug Users, agrees that housing can be a key issue in
preventing AIDS infection. She told the Tyee that homelessness was
the strongest single predictor that a person in Vancouver would
contract HIV/AIDS.

However, she cautioned that it was important not to be too
simplistic. The kind of housing available makes a big difference.
"Food and shelter and dope can be higher priorities than preventing
infection," she said, "but housing that is so strict that you get
thrown out if you are using isn't helpful. People need secure housing."

Laura Track, a housing campaigner with Pivot Legal, an organization
dedicated to serving the needs of homeless and otherwise marginalized
populations in Vancouver, also agrees that the Victoria worry
research matches her observations. Like Livingston, she emphasizes
the need not just for housing, but for housing that is secure and
supportive for people battling with addictions.

"The research is accurate. People without housing worry about day to
day survival. To imagine that anyone can overcome a barrier as
significant as addiction without secure housing is foolish. For
people to get well, secure, barrier-free housing is necessary."

Basic necessities come first

AIDS Vancouver Executive Director David Swan says his organization's
experience is consistent with the Victoria worry research and Dr.
Kerr's findings about how secure housing seems to reduce risk
behaviours. He told the Tyee that secure housing not only works to
help prevent HIV infection -- it also is an important variable in
supporting self-care and medical treatment co-operation among people
who are HIV positive.

Swan underscored the importance of safe, secure, barrier free housing
as a public health issue.

"This is why we talk so much about the social determinates of
health," Swan said. "At AIDS Vancouver, as much as 60 to 70 per cent
of staff time goes to helping clients with basic survival needs like
housing and food. If people don't have adequate access to these
basics, other concerns can go to the back burner."

Fiona Gold, a street nurse in Vancouver with the BC Centre for
Disease Control, said that she completely agrees with the Victoria
research. Her experience on the street, she said, confirms the
Victoria findings about housing as a primary concern.

"When you see someone become homeless, you see their life spinning
out of control," Gold said. "We need much more supportive housing in
Vancouver, with trained staff to help people navigate their
challenges. Housing can bring stability that supports recovery. The
'housing first' approach makes sense to me."

This article first appeared 24 August 2009, on TheTyee.ca

Tom Sandborn is a Tyee contributing editor focusing on health policy
and labour. He welcomes feedback and story tips at tos@infinet.net