On the brink of a déjà vu

High HIV rates in the province leave many demanding harm reduction strategies

Taouba Khelifa
News Editor

Saskatchewan doesn’t rank first in many things, but studies show that we have the highest HIV rates in all of Canada – and the number is growing.

According to the Ministry of Health, the province reported 186 cases of HIV in 2011, up 8 per cent from 2010. On average, 2011 saw an estimated 19.6 HIV cases per 100,000 individuals in Saskatchewan. The national average that year was 7.6 cases per 100,000 Canadians.

HIV can spread through blood-to-blood contact. One of the most reported risk exposures to the virus has been through sharing of needles and other drug paraphernalia that has contacted blood. About 76 per cent of HIV cases in 2011 reported injection drug use as their main exposure to the virus.

While these numbers are shockingly high, many question what can be done to reduce HIV rates amongst drug users in the province. Harm reduction strategies, some say, may be the answer.

Harm reduction, or harm minimization, refers to public health policies that are designed to reduce the harmful consequences of high-risk activities, such as drug use. These policies are aimed at reducing harm for both the drug user and the overall community.

As part of the Faculty of Arts annual Woodrow Lloyd lecture series, Vancouver-based activist and community organizer, Ann Livingston, spoke to a Regina audience on Wednesday Feb. 6 about her work in bringing and implementing harm reduction strategies to Vancouver, and the effect that this has had in building solidarity with drug users in the area.

Lloyd Legacy

The Woodrow Lloyd lecture series is an annual event hosted every winter by the University. Aimed at bringing the campus and community together, the series features a national or international scholar, writer, thinker or activist who speaks on current social and community issues relevant to Saskatchewan.

A former provincial Premier and Minister of Education, Lloyd played a formative role in developing Saskatchewan’s education system, and was an important individual in establishing the Regina Campus on College Avenue. Throughout his life, Lloyd believed that university and education held an important role in creating social change and healthy communities. The annual lecture series celebrates this educational belief, allowing Lloyd’s legacy to live on.

Despite the series’ success, however, many academics and community members have been disappointed with the speakers chosen for the lectures in the past two years.

“If we’re thinking of the legacy of [Lloyd], it should be somebody that’s working in the area of education, public health, social justice. Those should be the things that that person is doing. It shouldn’t be anyone who is engaged in hate mongering, or anybody who is engaged in hate speech. It should be somebody who speaks with the community, not speaks at or about other communities,” explained U of R professor Michelle Stewart.

Last year, committee members invited Canadian academic Margaret Somerville to speak on the role of health care and religion. Known for her controversial stance against abortion, and strong opposition to same-sex marriage, many felt that Somerville did little justice in creating the healthy community the lecture series promoted. Prior to this, the committee invited Canadian politician Preston Manning, best known as the founder of the Reform Party, which later merged into today’s Conservative Party of Canada.

“He isn’t oriented towards social justice … and his mandate, as far as I can tell, is certainly not grassroots in terms of community. It’s a top-down approach,” University professor Darlene Juschka said, referring to Manning. “This isn’t just any old speaker series. This actually has a very definite focus, and that focus is community and well-being of the community. Health and social justice themes are big aspects of that.”

Disappointed in how the lecture series evolved over the past two years, Stewart and Juschka decided to join the organizing committee in 2012, in hopes of reestablishing the true purpose of the series. After consulting with faculty members, Livingston was chosen as the 2013 Woodrow Lloyd lecturer.

VANDU

As a co-founder of the grassroots group Vancouver Area Network of Drug Users (VANDU), Livingston has dedicated a majority of her life working to improve health care for people who use illegal drugs on a local, regional and national level. Her work in advocating for policies that can empower drug users to seek their rights as citizens has not been easy, but for Livingston, doing something was better than watching Vancouver's HIV rates skyrocket, and seeing drug users overdose daily. Action was needed, and harm reduction strategies helped mobilize the community to push for better healthcare for drug users.

And, while Vancouver and Regina may be many miles away, Regina is currently on the edge of a déjà vu – what was once an HIV epidemic in Vancouver has now become an HIV epidemic in the Queen City.

HIV rates became a major concern for British Colombia in 1997, when death rates from the virus went up to 350 deaths per year. Seeing a dormant provincial government, Livingston and other local community members formed VANDU and began engaging in civil disobedience by providing drug users with clean needles, or creating spaces for the safe injection and use of drugs.

“[Civil disobedience is] more like ignoring the law, and taking action to save the lives of your neighbors and friends,” explained Livingston. “I think that people do this because there’s an obvious fundamental justice that’s being violated, and there really are well researched life-saving health initiatives that they know about that could be implemented, [but] are being withheld from people, who then are damaged or die as a result.”

Instead of a top-down approach, where the government or privileged individuals control the organization, VANDU operates through a very grassroots bottom-up approach. The group is made up of a general membership of close to 2000 Vancouver area drug users, and is operated based on the recommendations and needs of this general membership.

“This method will always work [because] the actions are owned by the actual victims of the social inequality, and not made up by more privileged organizers who are puzzled that the oppressed are not eager to march in their parade,” said Livingston.

Through this empowerment model, the users are able to take charge and create the programs they believe will help them, and fight for the rights and policies they want to see implemented.

With the collective work of the user groups, British Columbia was able to see the rate of new HIV diagnoses decrease in 2011, reaching the lowest point they have ever been at 6.3 cases per 100,000 population. A main driver for the decrease has been credited to the decline in new diagnoses among injection drug users.

Saskatchewan and HIV

With an increasing number of HIV cases in the province, Alicia Slywka, education and outreach coordinator at AIDS Program South Saskatchewan (APSS), says not only is HIV a huge issue, but Saskatchewan is far behind the other provinces in funding and applying grassroots harm reduction strategies.

“Saskatchewan has the highest rates of HIV right now in Canada. We have double the national average. I think Saskatchewan is very far behind other provinces, and behind BC, and there’s a lot that we can do to improve it. Yes, our programs are good, but I still think there’s a whole bunch that needs to be done in order for things to be reversed, and for HIV rates to go down,” Slywka said.

“It’s such a privilege to work with people who have such an isolated life. They’re extremely vulnerable, and they let me be a part of their life. To see their courage, most people would be weeping at the thought of trying to get through one of the days that they face. It is rough. I have a lot of admiration and I put that forward to them, and it goes a long way to treat people.” – Ann Livingston

Currently, APSS runs a needle exchange program through their office and through the Regina Public Health Region. The program provides clean needles to drug users, reducing the risk of users sharing needles, or injecting with dirty syringes. While the needle exchange program is one harm reduction strategy in Regina, Slywka says public ignorance and lack of education has led to a lot of opposition.

“There is harm reduction programs happening, but there’s huge resistance to them in Saskatchewan…The government does not like us [and] there’s some pretty vocal people that don’t like us as well … [Some say that] harm reduction and providing people with needles puts more needles on the streets…it creates addicts. That’s not the case. People just don’t understand harm reduction… so there’s misconceptions about it,” Slywka explained.

For instance, a 2012 survey conducted by the University of Saskatchewan titled “Taking the Pulse” asked Saskatchewan residents if they felt that HIV/AIDS was a problem in the community. Of the 1,750 respondents, 60 per cent of individuals disagreed that the province had an HIV problem.

Ignorance may be bliss, but as HIV rates in Saskatchewan continue to increase. Slywka says education is key to mobilizing individuals and creating a change. VANDU, she points, is a great example of an organization that this province can learn from.

Misconceptions

Opposition towards harm reduction programs is not just a Saskatchewan problem. Livingston noted that VANDU experienced similar forms of resistance, and continues to face resistance, both from authority figures and from the public.

One place this resistance and ignorance stems from, says Livingston, is the failure of the media to portray drug users in a positive and honest light.

“We have to realize is that we have been insanely brainwashed. I don’t watch TV much now, but…they always show the clever, wonderful detective grabs this conniving, skinny, roughed up junkie, and slams him against the wall, and asks him for information. Then, he’ll sell out all his friends. We’ve had this ingrained into us,” she said.

Instead of creating these negative narratives, Livingston suggests a lesson in open-mindedness, and a course in testing personal perceptions.

“It’s kind of surprising and shocking to people that drug users have the right to obtain, prepare, and ingest drugs. But, if this sentence bothers you, you can say ‘the right to obtain, prepare and ingest wine,’ and you can see it’s a perfectly logical and normal sentence if you use wine. So, if the drug thing bothers you, you’ll have to get over it,” challenged Livingston.

Beyond just [challenging] these negative narratives, she points that the VANDU model allows for drug users to gain autonomy, and share their stories and lives with society at large. Instead of media and governments creating the narratives of the drug user, the users are able to write their own personal narratives.

Resisting the Resistance

While Livingston has been advocating for more social acceptance and public understanding around drug use and harm reduction strategies, she says the biggest barrier to success has been the law.

Instead of treating the HIV rate and drug problem in the province as a public health issue, British Columbia, like Saskatchewan, continues to treat the problem as a legal issue.

Law enforcement in Vancouver has been going on a ticketing frenzy, says Livingston, giving tickets to users for the most minor offenses – from jaywalking to expired bus tickets. Even worse, she says, the province has started building private prisons, the “new homes for the poor.”

“We did experiment with private prisons in Ontario once, and they found that the recidivism and the cost effectiveness was poor, but now we’re going full-blown back to it. I think it’s just meant for some billionaires to make some more billions,” argued Livingston.

But, building private prisons and declaring a war on drugs is not the answer, Livingston explains. Most drug users in jail are there because of minor procedural offenses – failure to appear in court, breach of probation – and not because of serious criminal charges. Instead of locking users up, Livingston calls on communities to challenge the public discourse, and work towards patiently treating drug users instead.

“The prison system is not about public safety. This whole idea of dehumanizing people and saying that we have so much crime…the drug war is used as a way to jail people…The irony of it is if you take people and destroy their family life, and ctheir fabric…these are the kinds of damages that cause the roots of addiction,” she said.

Resisting the resistance, a motto that Livingston lives by, revives the purpose and legacy of the Woodrow Lloyd lecture series. At the 1951 Canadian Education Association Convention, Lloyd said that, “Education needs courage. The very fact that education, if it is vital, leads to purposeful change, indicates the need for courage on the part of those who lead, because even purposeful change is always opposed. It is opposed by those who do not understand.”

Photo courtesy of VANDU/ Graph: Sask Ministry of Health.