Best Practices in Harm Reduction?

1. Best Practices in Harm Reduction? Prepared for: The Summer Learning Institute in Interdisciplinary HIV Research July 15, 2009

2. A Brief History of Harm Reduction In Victoria • AVI is started by 5 gay men in 1986 • Needle exchange was initially was started by two people who used injection drugs through a ministry employment grant • 1988 NX gets handed to AVI to employ someone to do mobile needle exchange. • Prior to that, a poverty action group was doing some needle exchange out of what is now Wildfire bakery. • AVI’s NEX, known as Street Outreach Services (SOS), moves to 609 Johnson Street in 1992.

3. More history… • July 1996 – SOS moves to Commercial Alley and in that year (1996-97) SOS distributes over 130,000 needles. • 2001– AVI moves all their services to 1601 Blanshard Street, bringing support, prevention and harm reduction services under one roof. • 2005-2006 – distributed 830,000 syringes to 1560 active clients who used SOS services on approximately 25,000 separate occasions.

4. To this…

5. AVI Press conference late February 2007 to get support and to encourage action and beginning of good neighbour agreement process • June, 2007 Neighbours file injunction to close down service – it names the landlord, VIHA, and AVI in the lawsuit

6. Fall 2007 VIHA third party review and action plan. • October 31, 2007 AVI is served a notice of termination of lease and given 6 months to find new location for NEX. • AVI negotiates with landlords to keep the lease for the rest of AVI’s services but to move the needle exchange.

7. Increased funding and changes starting to have a positive impact when impending closure is announced for May 31, 2008. March 2008 VIHA purchases St. Johns Ambulance Building on Pandora to house the NEX and other services. Neigbours to that building, including St. Andrews School, organize against the relocation. VIHA purchases building but agrees to not locate NEX there. NEX is left without a place to go May 31.

8. June 1, 2008 • Needle exchange services cease at 1601 Blanshard • Mobile services by foot and vehicle commence • Result in a reduction in access (hours, site and referrals) and a drop in exchange rate

9. What happened on Cormorant Street?

10. Challenges… • Increase in clients from 200 to 1500 over 8 years • Increase in yearly syringe distribution from 200,000 to almost 1 million by 2007 • No increase in funding since 1993 until late 2007 • Inadequate staffing due to lack of resources • Inappropriate facilities due to lack of resources • Difficulty in managing the service outside the exchange

11. Challenges cont… • Significant increases in homelessness, drug addiction and mental illness in the Greater Victoria area • Changes in welfare policies excluding people who use substances and making it more difficult for people to get assistance • Lack of other services including evening drop-in, housing, health services etc. • Change in nature and patterns of drug use

12. Outreach Worker Observations: • ↑ abscesses & other preventable health problems • ↑ # of hospitalizations and length of stay • ↑ re-use/sharing of rigs • Confusion and difficulty in accessing supplies • Disconnection from support and family • Difficultly contacting clients (re: test results)

13. “No Go Zone” • SOS staff estimate that over 85% of people “will not follow”

14. SOS Stats 2008 Distributed Recovered Monthly Average (Jan-April) 34 900 24 400 June 16 700 7500 July 25 000 19 000 August 27 000 10 700 September 24 473 21 647 (1 client brought 10 000) October 22 096 7966 December 14 725 5902 January 2009 16 256 10 139

15. Implications of Current Situation: • Public health crisis – HIV Outbreak • Increasing inequities in health and social conditions for people who use drugs • Loss of Human Life: • Drug Overdose is leading cause of death among those who are homeless In B.C. • Women in B.C. who use drugs and are Homeless die at 50 times the rate of women in B.C.

16. When Science meets Ideology: Let the Evidence Accumulate….

17. Evidence…. • Numerous studies have recommended and increase in HR services in Victoria, including the establishment of supervised consumption sites. • 2002 – Missed Opportunities: Putting a Face on Injection Drug Use and HIV/AIDS in the Capital Health Region - VIHA study acknowledges lack of services for drug users • 2003 - City of Victoria, VIHA, and the Victoria Police Department's Downtown Health Initiative Action Plan included an investigation of the feasibility of SIS • 2005 - Fitting the Pieces Together: Towards an Integrated Harm Reduction Response to Illicit Intravenous Drug Use in Victoria, BC – recommends 24/7 access to NX and supplies and pilot distribution of free crack pipes • 2005 - I-track study – In Victoria people report the most common place for them to inject is the street – it also has the highest rate of of Hep C (79.3 per cent compared to 54.3 per cent in Toronto) – this study recommended a safe injection site and a crack pipe distribution program • 2006 - VIHA’s strategic plan – Closing the Gap • 2007 - Mayor’s Task Force on Breaking the Cycle of Mental Illness, Addictions and Homelessness • 2007 - Homeless Needs Survey • 2007 - CARBC Supervised Drug Consumption Options in the City of Victoria, commissioned by the City of Victoria and VIHA

18. All of this to discover:

19. Prior and Post Closure CBR Initiatives – Research to Generate Solutions • Dr. Eric Roth, from the University of Victoria, successfully co-applies for a Vancouver Foundation Grant with AVI staff to gather data on Personal Use Behaviours in Victoria. • Reaching Out: Evaluation of NEX (MacNeil and Pauly, 2008) • Peer Intervention/Distribution Group • GEAR – Getting Everyone Access To Resources – funded by the Vancouver Foundation • POC Study – UVic, Cool-Aid Health Centre, AVI joint research project with tests donated from the BC Centre of Excellence

20. Questions? erin.gibson@avi.org