Canada: An HIV Strategy Invites Addicts In

By engaging high-risk populations and using antiretroviral therapy to suppress viral loads, thus inhibiting onward transmissions, health officials in Vancouver and British Columbia have helped curb HIV infection rates.

Vancouver's supervised injection facility, Insite, is one reason why the city has been able to lower its HIV infection rate, experts say. Staff nurses at Insite provide injection drug users with sterile needles, condoms, gynecological exams, HIV screening, STD testing and treatment, and drug treatment referrals.

"There are fewer overdose deaths, less open drug use on the street, and we know it's brought more people into detox," said Dr. Patricia Daly, chief public health officer for Vancouver Coastal Health.

The number of provincial residents receiving HIV treatment jumped more than six-fold between 1996 and 2009. Now an estimated 80 percent of those infected, or 5,413 patients, receive treatment. The province's test-and-treat policy has helped drive annual new infections down by 52 percent, even as both HIV testing rates and annual syphilis cases increased.

Similar results have been seen in San Francisco and Taiwan. In the United States, a three-year federal study of the test-and-treat model is being conducted in several locations, including the Bronx and District of Columbia.

"I went to the ministries of finance and health and told them: The best-kept secret in this field is that treatment is prevention," said Dr. Julio S.G. Montaner, director of the British Columbia Center for Excellence in HIV/AIDS. For $50 million (US $51 million) spent on providing antiretroviral treatment, 400 infections down the line are averted, saving $300 million (US $308 million), he said.

The 800 injections that take place at Insite each day represent about 5 percent of injections citywide, officials estimate. A lawsuit to determine whether Insite can continue operating goes to Canada's Supreme Court in May.

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