politics | the right to health, a new approach to drug use and hiv

An H.I.V. Strategy Invites Addicts In

VANCOUVER, British Columbia — At 12 tables, in front of 12 mirrors, a dozen people are fussing intently in raptures of self-absorption, like chorus line members applying makeup in a dressing room.
But these people are drug addicts, injecting themselves with whatever they just bought on the street — under the eyes of a nurse here at Insite, the only “safe injection site” in North America.

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By offering clean needles and aggressively testing and treating those who may be infected with H.I.V., Vancouver is offering proof that an idea that was once controversial actually works: Widespread treatment, while expensive, protects not just individuals but the whole community.

Because antiretroviral medications lower the amount of virus in the blood, those taking them are estimated to be 90 percent less infective.

Pioneering work by the British Columbia Center for Excellence in H.I.V./AIDS at St. Paul’s Hospital here demonstrated that getting most of the infected onto medication could drive down the whole community’s rate of new infections.

According to one of the center’s studies, financed by the United States National Institutes of Health, from 1996 to 2009 the number of British Columbians taking the medication increased more than sixfold — to 5,413, an estimated 80 percent of those with H.I.V. The number of annual new infections dropped by 52 percent. This happened even as testing increased and syphilis rates kept rising, indicating that people were not switching in droves to condoms or abstinence.

Studies in San Francisco and Taiwan found similar results. So last July the United Nations’ AIDS-fighting agency made “test and treat” its official goal — although it acknowledged that it is only a dream, since global AIDS budgets aren’t big enough to buy medication even for all those hovering near death.

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Dr. Montaner also pushed for the creation of Insite. There, addicts get clean needles, which they are not allowed to share with anyone else.

In return, they are safe from robbery, which is common on the streets outside, and from arrest. Insite has a special exemption from Canada’s narcotics laws.
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I didn't know that Canada had a right to health as part of their constitution.

A ‘Safe’ Drug Injection Site in Vancouver
Ed Ou grew up in Vancouver, British Columbia. In his last assignment as a New York Times intern, he returned recently to photograph an article for Science Times. Now represented by ">Reportage by Getty Images, Mr. Ou is shooting for The Times in Egypt. (“Getting Into Cairo’s Byways,” Jan. 31.) On Monday, he spoke by phone from Cairo with James Estrin and Kerri MacDonald. Following are his remarks, edited and condensed.

I grew up in Vancouver and left when I was finished high school, so I had never worked as a photographer there before. It was disorienting working there, because it felt like my professional world and this ideal that I had of home — which had been pretty much untouched — had collided.
It was easy to work there because I knew the lay of the land. I got to eliminate all other variables but photography. I knew when the sun set. I knew when the sun rose. I knew what streets to park on, what buses to take. It made me realize that 90 percent of photography is dealing with crazy bureaucracy. It was refreshing to do a story where none of that was an issue.
That said, it was a pretty hard story to do, being about drugs and drug users. It challenged my view of this ideal of home.