Pubdate: Fri, 31 May 2013
Source: Globe and Mail (Canada)
Copyright: 2013 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Andrea Woo
Cited: B.C. Centre for Excellence in HIV/AIDS: http://www.cfenet.ubc.ca/

HITTING DRUGS WHERE THEY LIVE

Anti-drug campaigns for general public don't work when intravenous 
use is concentrated in high-risk areas, study's authors argue

A six-year study on the drug-use habits of Vancouver youth lends 
credence to the idea that prevention works best when targeted at 
high-risk areas.

At-risk youth who live in neighbourhoods where injection drug use is 
prevalent are significantly more likely to start injecting drugs 
themselves, lending support to the idea that prevention and 
intervention measures are most effective when targeted at high-risk areas.

The finding is the takeaway message from a new six-year study by 
B.C.'s Centre of Excellence in HIV/AIDS. The study, which focused on 
Vancouver, found "street-involved youth" who lived in the Downtown 
Eastside were more than twice as likely to start injecting 
intravenous drugs than those who lived elsewhere in the city.

Evan Wood, senior author of the study and Canada Research Chair in 
Inner City Medicine at the University of British Columbia, says it 
supports the idea that prevention and intervention strategies that 
target the general population simply don't work.

"[It shows] the shotgun approach to having someone come into high 
schools, or having advertisements on television, really, that those 
things have been proven ineffective," he said. "We need to start 
looking at high-risk populations and evidence-based interventions 
that can be employed to try and prevent this type of really 
problematic behaviour."

The study included 422 participants between the ages of 14 and 26, 
who spent a significant amount of time on the street but were not 
necessarily homeless, Dr. Wood said. At the start of the study, in 
September, 2005, all of these participants were using drugs other 
than marijuana and alcohol - but none had injected drugs. (More than 
500 other youths who were recruited were ultimately excluded either 
because they had previously injected or failed to return for 
follow-up visits.) Of the 422 participants, 98 reported living in the 
Downtown Eastside, while the remaining 324 lived elsewhere in the city.

By the end of the study period, in November, 2011, investigators 
found 43.8 per cent of participants living in the Downtown Eastside 
had injected drugs, compared to 19.7 per cent of those living 
elsewhere in the city.

"The takeaway message from this is, clearly, that youth that are 
living in the Downtown Eastside are transitioning into drug injecting 
at a much higher rate, despite the overall high-risk profile and, to 
be frank, the very high-risk environments that exist on the street 
outside of the Downtown Eastside," said Dr. Wood, noting the need for 
physicians with specialized training in such areas.

The study results also suggest there is value in not clustering 
supportive housing in high-risk neighbourhoods.

"I think you need to be strategic with housing and where you're 
placing people that are vulnerable as a result of their addiction," 
Dr. Wood said. "Certainly, for people who are early in their careers 
as being addicted to drugs or alcohol, getting them away from 
environments where drugs are so freely and easily available just makes sense."

Injection drug use is a major risk factor in the transmission of 
hepatitis C and HIV. While there remains a considerable problem with 
the smoking of crack cocaine in Vancouver's Downtown Eastside, Dr. 
Wood said new cases of HIV have dropped by more than 90 per cent 
since the late 1990s due to various interventions, including the 
distribution of clean needles.

Last week, three injection drug users filed a lawsuit over an 
Abbotsford bylaw that forbids harm-reduction measures including 
needle exchange programs and supervised injection sites. Councillors 
had agreed in 2010 to review the bylaw, approved five years earlier, 
and in March, directed staff to prepare a draft bylaw. It is not 
known when that might return to council.
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MAP posted-by: Jay Bergstrom