Pubdate: Wed, 04 Jul 2012
Source: Regina Leader-Post (CN SN)
Copyright: 2012 The Leader-Post Ltd.
Author: Pamela Cowan
Cited: Global Commission on 
Drug Policy


The province's chief medical health officer says well funded public 
health programs work in reducing the spread of HIV.

That begs the question: Should Saskatchewan follow British Columbia's 
lead and set up safe injection sites?

British Columbia is the only Canadian jurisdiction where the rates of 
HIV and AIDS are declining. The decline is attributed to methadone 
programs, syringe exchanges, Vancouver's In site supervised injection 
site and an ongoing heroin prescription trial.

"The other factor is that it is fairly aggressive treatment - not 
just for the individual, but to reduce transmission in the 
community," said Dr. Moira McKinnon. "They have an aim of getting 
every HIV-positive person on treatment and compliant with treatment."

She notes there are many differences between Saskatchewan and B.C. 
The Saskatchewan epidemic is cocaine driven and intergenerational, she said.

"It's very much accepted by some certain families so it may not be 
that an Insite injecting place is appropriate for Saskatchewan or 
would work here, but we probably need, as time goes on, to have that 
discussion," McKinnon said.

A recent report by the Global Commission on Drug Policy maintains 
that HIV/ AIDs has spread because the war on drugs has not reduced 
drug supply and is driving the rapid spread of HIV among drug users 
and their sexual partners.

"The two big pieces of information that come through that report and 
through many other sources as well is that drugs are more freely 
available and more potent now in the U.S.," McKinnon said. "It's 
clear the law enforcement there hasn't worked.

"Evidence from countries in Europe - particularly Portugal, but also 
Switzerland and Germany are showing that the public health programs 
do work and B.C. is an example here that public health programs do 
work if they have the resources behind them."

Although most HIV transmission among drug users occurs in their 
communities, the report identified mass incarceration as a 
significant factor in the epidemic.

There is no mandatory HIV testing on inmates at Saskatchewan's 
correctional centres in accordance with the Health Information 
Protection Act (HIPA), said Judy Orthner, executive director of 
communications with the Ministry of Corrections and Policing.

"Under the Correctional Services Act, we haven't enshrined any kind 
of mandatory testing largely because of concerns over following 
HIPA," Orthner said.

Inmates who self-disclose they have HIV or demonstrate symptoms of a 
communicable disease are segregated from the rest of the population and tested.

"We use the same protocols for HIV as we would use for other 
communicable diseases like tuberculosis or hepatitis," Orthner said.

The Regina Correctional Centre has 504 beds for remand and sentenced 
prisoners. At any given time, the jail houses an additional 20 inmates.

"If it's an illness, we can segregate them in a medical unit," Orthner said.

"When we talk about overcrowding, we don't include the medical units 
in those figures."

Prior to entering a correctional facility, inmates fill out a 
questionnaire and are asked to indicate if they have any communicable diseases.

If an inmate has an altercation with another inmate or with a 
corrections worker who is trying to subdue them, there could be the 
possibility of exposure to body fluids such as blood or spit.

Corrections staff follow universal precautions such as wearing gloves 
when touching blood or body fluids, washing hands immediately after 
attending to an inmate and avoiding needle sticks.

Orthner said the incidence of needle sticks is rare.

Across the province, the number of new HIV cases has plateaued.

"We're testing a lot more and the percentage of tests that are 
positive are less," McKinnon said. "We had around 179 new cases last 
year and we're probably going to have similar (numbers) to that this 
year. The other good news is that people are turning up at clinics. 
Before the doctors would get frustrated because they'd have 20 people 
booked and no one would turn up ... We're getting tremendous 
compliance, particularly from pregnant women, with their medication."

There's also been a phenomenal change in the number of HIV-positive 
women attending prenatal classes. Since the end of 2009, no cases of 
HIV have been transmitted from mother to child, McKinnon said.

Despite the success, much work remains.

Intravenous drug users are difficult to connect with because they're 
wary of the law, McKinnon said.

"To get an effective public health program going, there's a lot of 
work that has to be done in terms of trust and getting them involved 
and engaged in the system to enable the reduction in transmission and 
also to improve their health," she said.
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