The World Health Organization has strongly endorsed safe injection sites like Vancouver's Insite as one of the "priority interventions" that countries should implement to slow the spread of HIV-AIDS, a view that was swiftly and firmly rejected by Canada's Health Minister.
"Allowing and/or encouraging people to inject heroin into their veins is not harm reduction, it is the opposite. … We believe it is a form of harm addition," Tony Clement said Tuesday in Mexico City, where he is attending the XVII International AIDS Conference.
While the minister's views on Insite are well known, Mr. Clement repeated them Tuesday at an event where he was endorsing and promoting a new WHO "how-to" guide on battling the epidemic, which promotes needle exchange and safe injection sites. The Health Minister's comments left officials from the agency flummoxed and red-faced.
Teguest Guerma, associate director of the HIV-AIDS department at the WHO, who was clearly uncomfortable about the exchange between the minister and reporters about the apparent contradiction in Canada's position, would only say: "The WHO supports harm reduction."
She repeated the phrase more than a dozen times, only once adding "including all interventions that benefit injecting drug users."
The WHO document, prepared in Q&A form, is far less equivocal. It asks: "What is the WHO position on safe injection sites?" The answer: "Safe injecting sites are not a new intervention but simply a repackaging of existing WHO-recommended interventions such as needle exchanges, etc."
"They enable known, WHO-recommended harm reduction interventions to be delivered and used in a safe environment with the aim of reaching the most marginalized and vulnerable of injecting drug users."
Mr. Clement, at a press conference held Tuesday in Mexico City, initially praised the new document and noted that "Canada is proud to be the largest contributor to the WHO."
He also said that the federal government supports various forms of harm reduction for intravenous drug users such as needle exchange, methadone treatment and rehabilitation, but rejected safe injection as illegitimate. "We're not prepared to allow people to die" by condoning their continued drug use, Mr. Clement said.
Mr. Clement has never clearly stated why the government supports needle exchange and rehab programs but so sternly opposes the existence of a facility where drug users can actually use the safe needles and be encouraged to enter rehab. The sticking point appears to be that, at Insite, drug users cannot be arrested and prosecuted.
Worldwide, an estimated 33 million people are infected with HIV-AIDS. Some 2.7 million people were newly infected last year.
Outside of sub-Saharan Africa, the epicentre of the epidemic, intravenous drug users account for almost one-third of new infections. In Canada, there are 58,000 people living with HIV-AIDS, including 12,110 current and former intravenous drug users - 21 per cent of the total.
Drug users, because they are often marginalized and treated as criminals, are among the least likely people with HIV-AIDS to get treatment and among the most likely to infect others, making them the focus of much research.
Abeeda Kamarulzaman, head professor of infectious diseases at the University of Malaya in Kuala Lumpur, said harm reduction measures such as needle exchange, methadone treatment and safe injection sites have all been shown as beneficial in slowing the spread of HIV-AIDS.
She said 77 countries have needle exchange programs, and 63 countries have drug substitution treatment programs. There are 49 safe injection sites across Europe, Australia and Canada, including Insite in Vancouver. The Quebec government has announced plans for a similar facility in Montreal.
"We need to stop arguing about the merits of harm reduction and just do it," Dr. Kamarulzaman told the conference.
Asked specifically about the merits of Insite, she said the "benefits of safe injection sites have been well demonstrated," but added that governments are reluctant to endorse such measures because "it may seem like they are legalizing heroin and other drugs, which they are not." (At Insite, drug users can inject themselves with clean needles under the supervision of health professionals should they require medical assistance, but they are not provided with drugs.) Peter Piot, the executive director of UNAIDS, was also clear in his backing of harm-reduction measures, including safe injection sites. "It is high time every country in the world resolutely embraced the full spectrum of harm reduction among injecting drug users. Not doing so will only perpetuate the spread of HIV," he said.
Insite opened as a pilot project in 2003 under a special exemption from federal drug laws, but Ottawa had refused to say whether it would extend the exemption when it expired in June. Before the deadline arrived, the B.C. Supreme Court ruled that parts of federal drug laws related to trafficking and possession are unconstitutional and gave the government a year to rewrite them. Mr. Justice Ian Pitfield said laws that prevent people suffering from the disease of addiction from accessing such a service infringe on their right to life, liberty and security of the person.
Mr. Clement said Ottawa will appeal the decision, meaning the fate of Insite will likely be decided by the Supreme Court of Canada.