Pubdate: Wed, 04 Jul 2012 Source: Regina Leader-Post (CN SN) Copyright: 2012 The Leader-Post Ltd. Contact: http://www.leaderpost.com/opinion/letters/letters-to-the-editor.html Website: http://www.leaderpost.com/ Details: http://www.mapinc.org/media/361 Author: Pamela Cowan Cited: http://www.globalcommissionondrugs.org/ Global Commission on Drug Policy HIV STRATEGY MAY REQUIRE LOCAL PERSPECTIVE 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. - --- MAP posted-by: Jay Bergstrom