Transcript Document

Best Practices in Harm Reduction?
Prepared for: The Summer Learning Institute in Interdisciplinary HIV Research
July 15, 2009
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.
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.
To this…
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
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.
•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.
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
What happened on Cormorant
Street?
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
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
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)
“No Go Zone”
•SOS staff estimate
that over 85% of
people “will not
follow”
SOS Stats
2008
Monthly Average
(Jan-April)
June
July
August
September
Distributed
Recovered
34 900
16 700
25 000
27 000
24 473
24 400
7500
19 000
10 700
21 647
22 096
14 725
16 256
7966
5902
10 139
(1 client brought 10 000)
October
December
January 2009
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.
When Science meets Ideology: Let
the Evidence Accumulate….
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
All of this to discover:
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
Questions?
[email protected]