Pubdate: 8 Oct 1998
Source: Eye, The (Canada)
Author: P.F. McGrath


Needle exchanges were supposed to slow the spread of HIV among addicts, but
infection rates are still rising. We need more than a quick fix

It's hard not to feel intimidated walking up to Seaton House. A man smokes
crack in the back alley, and the dealers on the corner fall silent, their
eyes locking on me as I walk by. It's a Saturday afternoon, but even on
weekdays the threadbare yard is so packed with men they spill out onto
George Street. Someone behind me tauntingly yells, "Look at 'is shoes, look
at 'em shine." A few of them laugh.

To the men packed six to a room it's called Satan's House -- poverty's
prison. Wedged between the botanical gardens to the north and Moss Park to
the south, the three-storey homeless shelter for men is in the heart of
Toronto's drug district. There are six needle exchanges within a 20-minute

"Something's gonna happen tonight. I can smell it -- like rain," one of the
residents says to Victor, the front door guard. Victor shrugs as if to say
something happens here every night. The shelter houses society's problems:
ex-cons, homeless men, the insane, drug addicts and, increasingly, AIDS.

"There are 682 guys in here, and every one of them has got AIDS or soon
will," Victor says as I wait on the steps for Paul, the man that I've come
to meet.

Paul is a typical resident in most ways. He's an addict with a violent
history. He's been abusing hard drugs for a long time. He's gone through
two habits and more than a dozen stints in jail. But as he limps and jerks
down the front steps, I wonder if he realizes he's luckier than many. Paul
has dodged AIDS.

HIV infection rates among intravenous drug users have more than doubled
since Toronto Public Health authorities began a needle exchange program to
try to contain the problem in 1989. The idea was simple: give away clean
20-cent needles and intravenous drug users would be less likely to share
their old, used needles -- and their diseases with them. But it turns out
it's not that simple.

When The Works, Toronto Public Health's largest needle exchange, opened in
1989, 4.6 per cent of its clients were HIV positive. The rate reached 9.6
per cent over the winter, and by all indications it's still climbing.

The woman trying to hold back the tide is Shaun Humpkins, manager at The
Works. HIV infection "has gone up enough that we are somewhat concerned,"
she says. "But it's not that simple to say that there is a needle exchange
program and we are seeing an increase so we should blame it on the
program." She points to changes in crack cocaine use, with injection
becoming more popular.

Every year in Toronto, eight needle exchanges hand out more than 200,000
hypodermic syringes -- and The Works wants to distribute many more. This
fall Humpkins will present a proposal to city council that would double the
number of exchanges in the GTA.

But needle exchanges, even those that are considered successful, don't
reduce HIV infection rates, because they can't address problems that spawn
drug addiction, problems that haunt the halls of places like Seaton House:
abuse, violence, poverty, prostitution, psychological problems,
unemployment, homelessness.

Criminologists say places like Seaton House drive up drug use simply
because they bring so many users together, introducing everyone to everyone
else's habits. They say a shelter of this size, ringed by needle exchanges,
creates a marketplace that draws dealers, raises crime and prostitution and
destroys neighborhoods.

This process is what is driving up HIV infection rates in the area. It's
what Humpkins and other needle exchange workers are up against, and by all
accounts, they're losing.


Back on George Street, Paul and I are walking toward one of Toronto's
busiest illicit drug marketplaces, the east end of the botanical gardens.

"Now don't be asking me all these questions like you been asking me
before," Paul says as we head north through Allan Gardens. "If someone
hears you here, it'll come back to me."

Traffic slides by on Jarvis as the dealers keep a steady eye on Paul. If he
nodded, they would casually get up and follow him. What? How much? Money?
Dope? Get the hypes, go down an alley, fix it, smash it, done. Forty
minutes later you're looking for the next fix.

"See that guy?" Paul asks. "He's a cookie monster. He's grinding" -- the
term for crack addicts looking for more crack. "He just fixed his last rock
and now he's trying to figure out how he's going to get more."

"How do you know?" I ask, watching the teenager stumble across Jarvis.

"Because I know that guy."

The teenager makes it to the other side of the street as traffic starts
past him. "They think they're untouchable," he says. "They're playing
Russian roulette and they don't care."

A study released by the Addiction Research Foundation in 1997 stated:
"Cocaine has become the number one problem of abuse for young clients. The
bulk of treatment is for crack addiction." Among street youth interviewed
in 1992, the last time such a study was done, 31 per cent had used crack in
the last year. For adults the figure was one per cent.

The resurgence of crack's popularity, especially among younger users, is
extremely worrisome for public health authorities. One very good reason to
worry is the growing practice of injecting crack cocaine.


Crack is made by mixing baking powder and cocaine. Chemically, it's a base,
which means to break it down into a powder, you need an acid.

On a rooftop off a service alley on Yonge, I find the typical paraphernalia
of hard drug use. Pop cans with small clusters of holes punched in them,
empty lighters, hundreds of spent matches, a couple of syringes. In a
corner behind an exhaust vent, I find an empty vinegar packet from
Harvey's. Vinegar is three per cent acetic acid. It dissolves crack into a
powder fine enough to inject.

The problem is that if you want to inject the crack, then you also have to
inject the vinegar. Vinegar also dissolves the cell walls in veins. The
result: junkies with infections and abscesses.

About two months ago, staff at The Works began noticing an increase in the
number of infections they were treating. When they found out clients were
using vinegar or lime juice to dissolve the crack, they started packaging
Vitamin C in little zip-lock bags to cut down on vinegar thefts at local
fast food restaurants.

The recipe on the back of the pack says: "Mix Your Crack With Vitamin C.
Put $20 worth of crack in a spoon. Add a pinch of Vitamin C powder equal to
1/4 the size of the rock. Add 60 units of sterilized water and crush
together. Add more water if needed. For a $10 rock, cut the recipe in half."

"When we started we couldn't give them away," says Leah Boelhouer, a
counsellor at The Works. "Now, six weeks later, we're giving away between
25 and 50 a night."

Only some of Toronto's intravenous drug users get their gear from The
Works, and of those who do, not all will use the vitamin C, or even know
about it. But the existence of the packs indicates a substantial shift in
drug use in the city. It is exactly this shift that has destroyed the
Downtown Eastside in Vancouver and threatens to do the same here.

Detective Courtland Booth is with the Metropolitan Toronto Police. He says
the major difference between heroin and crack is that heroin slows you down
- -- "puts you on the nod," he says, referring to the sluggishness
experienced after using the drug. "But crack heightens your activity.
You're very hyper; it overstimulates the synaptic response of the brain. It
becomes an overwhelming need. Prostitution, robbery, selling the drug
itself -- addicts will do just about anything to get more."

This kind of obsessed behavior is driving some of the most alarming
increases in new AIDS cases. Between 1989 and 1996, the proportion of new
AIDS cases that were reported among Canadian drug users rose, among men,
from one per cent to five per cent. The proportion of new AIDS cases among
female drug users rose from six per cent in 1989 to 15 per cent in 1992 and
reached 24 per cent by 1996. The psychological imperative created by crack
helps push many high-risk women into prostitution, at which point they can
become receptacles for every disease on the street.

Another symptom of the shift toward crack surfaces at The Works. "We
started seeing clients coming in asking for one needle, many times a day,"
Humpkins says. A heroin high typically last 10 to 12 hours. With crack it's
20 minutes. When crack addicts are going on a run, a multiple-day binge,
they will inject up to 30 times a day -- which means re-using or sharing
dirty needles when the supply of free ones runs out.

"They don't eat, sleep or take care of themselves," Humpkins says. "Then
they are more at risk. Crack injections are not that planned."


Paul's getting tired. He's 46 years old and weights 114 pounds. He walks
with a limp from the arthritis caused by sleeping on the streets for five
years. "It's destroyed the best part of my life," he says.

He sits down on a windowsill and slurps back the last of his Pepsi. He's
been clean for over a month now, and it's taken its toll. Every morning he
rolls out of bed onto the floor, crawls over to the wall and forces his
arthritic legs upright. In the mornings, especially if it's damp, the
10-minute walk to the drugstore to get his methadone takes much longer.
Still, he usually makes it by 7 a.m.

I can't help thinking that the methadone fix is the easiest, that all the
problems that were there 30 years ago are still there. That rebuilding a
life, re-establishing contact with his family, finding a job and
self-esteem, some worth, making money, dealing with all of this, that's
when it really gets tough.

"I don't want to end up being nothing," he says.

"You'll have help. There's some good people out there."

"Yeah, there's still a couple of us left," he says, shaking my hand.

I tell him I want to see him again, I want to show him the article. He
smiles for the first time in two days. He doesn't answer, though.

"You have yourself a good evening," he says, with a mock formality that
makes me laugh as he fades up the stairs.

Not 10 minutes later, a police cruiser pulls up in front of Seaton House.
Two officers pull out a roll of yellow plastic tape and cordon off the
front of the residence. A bunch of guys gather to watch. I ask somebody
what happened. Some guy stabbed another guy with a bottle.

"Hit 'im right in de ribs, and he just drop," a man says.

"Hey, you looking for t'ings?" he says, propositioning me, indicating a bag
of something in his pocket, "cuz t'ings still around, right."

He's standing 20 feet from the police cruiser. At that moment it all seems
so hopeless.

A fire truck comes careening around the corner, followed by two ambulances.
I watch a huddle of paramedics load a body onto a gurney. I hear a police
officer saying, "There's a bottle of pure vodka and pills too... I guess
you want that now, right?" 
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Checked-by: Mike Gogulski