One way to keep HIV at bay

In a few weeks, more than 20,000 scientists, health professionals, community workers and activists from around the world will descend on Toronto for the 16th International AIDS Conference.

While the giant health forum is an economic bonanza for the city, its presence in Canada will also draw welcome attention to this country's successes and failures in dealing with our tiny part of the HIV-AIDS pandemic.

The program that will likely attract the most scrutiny is Insite, North America's first supervised safe-injection facility. Located in a non-descript building in Vancouver's Downtown Eastside, the facility provides a safe place for intravenous drug users to inject themselves, usually with heroin.

About 600 drug addicts visit Insite every day. They are provided with clean needles and have access to nurses to treat their health woes, and to detoxification programs if they want to trying kicking the habit.

Although possession of heroin and other illicit drugs remains illegal in Canada, people taking drugs intravenously can use drugs openly in the facility. That is because Insite is a research program that operates under an exemption from section 56 of the Controlled Drugs and Substances Act.

That three-year exemption expires on Sept. 12, and it remains unclear whether federal Health Minister Tony Clement will renew it and allow the experiment to continue.

During the federal election campaign, Stephen Harper spoke out against the project, saying that, if elected, his government would "not use taxpayers' money to fund drug use."

Aside from the technical matter that Insite is actually funded by the province, Mr. Harper's government would do well to change its tune.

Nobody wants to encourage drug use, particularly the horror that is heroin addiction. But the alternative, a law-and-order crackdown on junkies, has proven, time and time again, to be a failure.

Insite and dozens of other safe injection sites around the world operate on the pragmatic premise that a core of drug addicts will exist regardless and the most sound public health strategy is to limit the damage that they do to themselves and others.

This philosophy, known as harm reduction, has a sound scientific basis. It also has supporters across the political spectrum: At the recent National Harm Reduction Awards dinner, sponsored by the Kaiser Foundation, Conservative stalwart John Reynolds sat alongside former B.C. New Democratic leader Joy MacPhail.

Insite has a similarly eclectic range of supporters, including Vancouver Mayor Sam Sullivan and former mayor Larry Campbell, bitter political foes.

What they all recognize is that Insite has science on its side.

Research shows that the safe injection site cut the spread of HIV-AIDS and hepatitis C among drug users. Having junkies shoot up in the facility keeps them out of back alleys, cutting down on public disorder.

There is also evidence that IV drug users who turn to the facility cut down their drug use which, in turn, reduces crime. (Addicts commit a lot of petty crime to fuel their habit, which has led some, including Mr. Sullivan, to suggest that Insite provide addicts with drugs as well, an idea that has a lot of merit.)

Having nurses on site cuts back markedly on use of emergency rooms by IV drug users, who tend to have a lot of health problems and are known to be "frequent fliers" in ERs. It also reduces deaths, because IV drug users tend to overdose.

Opponents of safe injection sites - and there are many - argue that the state should not be an "enabler" of illegal drug use and that facilities actually promote drug use. That argument does not hold much water - it's not as if being a skid row addict actually holds a lot of attraction.

As Mr. Campbell said in one of his wonderful turns of phrase: "Consumption sites cause addiction like flies cause garbage."

Addiction is a health issue, not a criminal matter.

As a society, we should be doing a lot more to provide care and support to those trying to escape the clutches of addiction, be it to street drugs, prescription drugs, alcohol or cigarettes.

But the challenge of the seemingly intractable, hard-core addicts remains and the best hope we seem to have is harm-reduction measures such as safe injection facilities.

There is no place for self-righteousness and faux morality in this discussion.

The federal government should not only give the green light for the Vancouver Insite project to continue, it should be funding the expansion to other cities such as Montreal and Toronto, which have significant numbers of IV drug users.

Doing so would not amount to spending tax dollars funding drug use, but rather spending tax dollars on public-policy measures that promote health and safety.

Doing so, Mr. Prime Minister, would do Canada proud. apicard@globeandmail.com