Past and Present: HIV/AIDS in Vancouver

Introduction

HIV (human immunodeficiency virus) is a viral infection which causes a series of symptoms spread over a prolonged amount of time, with different symptoms and time-gaps occurring at unpredictable intervals. Later, once the virus has reached a certain point in the body, the disease transitions into what is referred to as AIDS (acquired immune deficiency syndrome). AIDS weakens the human immune system to a point in which a suffering individual is highly susceptible to different kinds of infections and cancers. HIV is most commonly spread when infected blood comes into contact with the blood of an uninfected person. Common modes of transmission include unprotected sexual intercourse, contaminated blood transfusions, sharing contaminated hypodermic needles, and mother to child transmission during pregnancy, childbirth, or breastfeeding.

The disease was first identified in the early 1980s, and since then has been the target of much activism, awareness, and research. Because the disease is considered a global pandemic, the history of HIV/AIDS takes on different qualities depending on what geographic location one is examining it. Different levels and qualities of treatment exist wherever HIV/AIDS is found. This page will examine HIV/AIDS in relation to Vancouver, British Columbia, in an effort to understand how the disease has effected the city in the past and how it continues to do so in the present.

History of HIV/AIDS in Vancouver

The prevalence of HIV/AIDS in Vancouver is often categorized into two distinct periods of rapid increase. The first period occurred during the mid-1980s, when the majority of HIV infections were a result of unprotected sex between men who have sex with other men. The second period of increase occurred during the mid-1990s, as a result of high levels of injection drug use. By the end of the 1980s the transmission of HIV within the homosexual community began to stabilize as a result of increased knowledge over how the disease was transmitted, as well as increased awareness on the severe and deadly nature of AIDS. This dissemination of AIDS information was a result of the formation of different non-profit organizations devoted to increasing AIDS awareness and offering support to those suffering from the disease. And though HIV transmission between homosexual men had stabilized, this does not mean that infections ceased. The significant spike had plateaued, and though infections continued, they did so at a reduced rate.

The second significant spike in HIV infection in Vancouver occurred during the mid-1990s, with the largest number of infections occurring between 1996-1997. In fact, this outbreak was so significant it classifies as one of the highest documented HIV outbreaks to have occurred in a high-income country. At its peak, and on a per-capita basis, this outbreak compared to HIV transmission rates in parts of sub-Saharan Africa. The reasons behind this outbreak are largely attributed to shifting drug use patterns. Vancouver’s IDU (injection drug user) population was experiencing a shift from heroin to cocaine injection. With heroin an individual may inject once or twice daily, whereas the short high associated with cocaine encourages users to inject upwards of 40 times per day. This ‘drug binging’ caused a significant shortage of sterile needles in a place where sterile needles were already hard to come by and resulted in the use, re-use, and sharing of needles.

This outbreak was further complicated by a variety of other problems. Socio-economic and political factors had pushed Vancouver’s IDU population to the city’s poorest neighborhood, the Downtown Eastside. This further complicated the HIV pandemic, as unaffordable housing conditions necessitated that multiple individuals pooled their income together in order to secure single room housing. Sharing money and space in this way facilitated the sharing of drugs and needles within high-density living conditions.

Significant Vancouver HIV/AIDS Organizations

AIDS Vancouver

AIDS Vancouver was founded in 1983, when there were only six known cases of AIDS in Vancouver. The organization was the first AIDS service organization in Canada. Their goal has always been to create a community with no new HIV infections, while continuing to support those who have been affected. Over the years they have continuously provided support, public education, and community based research.

Dr. Peter AIDS Foundation

Dr. Peter Jepson-Young was a Vancouver physician who was diagnosed with advanced AIDS in 1985. Once the disease had progressed to a point which prevented him from practicing medicine, Dr. Peter sought to inform and educate the public about HIV/AIDS using his own experience with the disease as an example. Over the course of two years and 111 episodes, Dr. Peter televised his experience with the disease in a CBC series titled The Dr. Peter Diaries. After his death in 1992, the Dr. Peter AIDS Foundation was formed with the goal of carrying on Peter’s legacy of HIV/AIDS awareness and support.

BC Centre for Excellence in HIV/AIDS

Opened in 1992, the BC Centre for Excellence in HIV/AIDS was the first centre worldwide to pioneer province-wide testing and roll-out antiretroviral drugs, using the treatment-as-prevention strategy. (3-1) At the time, the province had the worst HIV epidemic in Canada, with two new HIV diagnoses and one AIDS death every day. (3-2) Today, after years of developing and implementing HIV treatment, the organization transfers the lessons they have learned to combat other infectious diseases like Hepatitis C. The centre also known for its work on drug addiction, as well as its close collaboration with InSite.

InSite

InSite is the first supervised injection facility in North America, established in Vancouver in response to the 1996-1997 HIV outbreak experienced by IDUs. (2-3) At InSite, IDU can inject illicit substances under nurse supervision with access to sterile needles. Between the years of 2003-2012 the site reported over 1.8 million visits. In 2010, 221 overdoses occurred at InSite with zero fatalities. Evaluations of InSite consistently demonstrate its beneficial impact on the safety of IDUs as well as the local community. Reductions in injection-related refuse, improved health status of IDUs, and increased number of IDUs entering drug treatment are all attributed to the site’s continued influence – despite consistent efforts on the part of the federal Conservative government to shut it down.

HIV/AIDS in Vancouver Today

HIV/AIDS in Vancouver is not confined to history, but continues to be a reality experienced by many people in the city. It is estimated that only 50% of eligible HIV-positive individuals are currently accessing therapy. The most vulnerable individuals are those within the Indigenous population, IDUs, female sex workers, and street youth. In Vancouver, these individuals are largely located within the Downtown Eastside, a neighborhood with numerous ongoing problems which require significant and immediate attention.

A disproportionate number of Indigenous people are over-represented among the city’s IDUs. These marginalized people are often victims of poverty, some living with the abuse experienced in the residential school system, others inheriting this pain as a result of cross-generational trauma.

However, it is vitally important to remember not to stigmatize those who live in Vancouver’s Downtown Eastside. HIV/AIDS services are often located in this neighborhood, as well as organizations which provide food, shelter, and access to health related services, which further concentrates those individuals who require such organizations. These people are forced into a way of life by a system and a city which has disadvantaged them. While the concentration of beneficial services reaches a larger amount of people through this concentration, it also reinforces the physical segregation of these people as well as the social stigma that these issues exist in a specific neighborhood for a reason. It is often assumed that poverty leads to injection drug use, which then results in HIV/AIDS infection – whereas the opposite may also be true – that injection drug causes HIV/AIDS infection which then affects the individual’s economic status and results in poverty. HIV/AIDS organizations must continue to address the various issues which result in HIV/AIDS susceptibility in Vancouver’s most vulnerable people.

By: Lucas Kling

References

• Kirby, Tony. "Profile: British Columbia Centre for Excellence in HIV/AIDS." The Lancet, 386, 2015.
• Lima, Viviane D., et al. "Regional and Temporal Trends in Migration among People Living with HIV/AIDS in British Columbia, 1993-2005." Canadian Journal of Public Health, 101:1, 2010.
• McInnes, Colin, et al. "HIV/AIDS in Vancouver, British Columbia: A Growing Epidemic." Harm Reduction Journal, 6:5, 2009.
• O'Shaughnessy, Robert, et al. "Deadly Public Policy: What the Future Could Hold for the HIV Epidemic among Injection Drug Users in Vancouver." Current HIV/AIDS Report, 9:394, 2012.
• Woolford, Andrew. "Tainted Space: Representation of Injection Drug-use and HIV/AIDS in Vancouver's Downtown Eastside." BC Studies, 129, 2001.