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Deadly Public Policy: What the Future Could Hold for the HIV Epidemic among Injection Drug Users in Vancouver

  • Behavioral Aspects of HIV Management (RJ DiClemente and JL Brown, Section Editors)
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Abstract

The scope and scale of the HIV outbreak that occurred among injection drug users in Vancouver in the late 1990s was unprecedented and resulted in some 2,000 new HIV infections, with incidence rates reaching 18 per 100 person-years. This outbreak, localized mainly in one neighbourhood, cost the Canadian health care system more than 1 billion dollars to diagnose, care and treat. A number of factors combined to stabilize HIV incidence: 1) HIV prevalence became saturated among those at highest risk; 2) several public health policies focused on drug users were implemented, including increased and additional decentralized needle exchange programs, expanded methadone maintenance services, better addiction treatment services, improved housing, and mental health programs; and 3) increased access and expansion of Highly Active Antiretroviral Therapy. To ensure that a similar outbreak never occurs again in Vancouver and other cities, future health policy must consider the political, psychosocial and socioeconomic factors that contributed to this outbreak. These policies must address the unintended adverse consequences of past policies and their repercussions for marginalized individuals living in this community and beyond.

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Acknowledgments

We would like to acknowledge and honor the memory of John Turvey, who helped in establishing the first needle exchange in Vancouver, and the many women who were murdered in the Downtown Eastside.

Disclosures

M. O’Shaughnessy: consultant to Saint Paul’s Hospital; R. Hogg: none; S. A. Strathdee: none; J. S. G. Montaner: none.

Author information

Authors and Affiliations

  1. BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    Michael V. O’Shaughnessy, Robert S. Hogg & Julio S. G. Montaner

  2. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada

    Robert S. Hogg

  3. Division of AIDS. Department of Medicine Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Julio S. G. Montaner

  4. Division of Global Public Health, The Department of Medicine, The University of California San Diego School of Medicine, La Jolla, USA

    Steffanie A. Strathdee

Authors
  1. Michael V. O’Shaughnessy
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  2. Robert S. Hogg
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  3. Steffanie A. Strathdee
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  4. Julio S. G. Montaner
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Corresponding author

Correspondence to Robert S. Hogg.

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O’Shaughnessy, M.V., Hogg, R.S., Strathdee, S.A. et al. Deadly Public Policy: What the Future Could Hold for the HIV Epidemic among Injection Drug Users in Vancouver. Curr HIV/AIDS Rep 9, 394–400 (2012). https://doi.org/10.1007/s11904-012-0130-z

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  • DOI: https://doi.org/10.1007/s11904-012-0130-z

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