Canadian Health Minister Clement Criticizes WHO’s Endorsement of Drug-Injection Facilities
Canadian Health Minister Tony Clement on Tuesday at the XVII International AIDS Conference in Mexico City criticized the World Health Organization's endorsement of safe drug-injection facilities like Insite in Vancouver, British Columbia, Toronto's Globe and Mail reports (Picard, Globe and Mail, 8/6).
Insite, which is funded by the British Columbia provincial government and has received research funding from the Canadian government, includes 12 booths for injection drug users to inject drugs as well as a "chill-out" room, in which users can be monitored for overdoses. Vancouver has one of the highest illegal drug use rates in North America, with as many as 12,000 IDUs in the Vancouver metropolitan area, 30% of whom are HIV-positive and 90% of whom have hepatitis C. When the facility opened in September 2003, it received a three-year exemption from the Controlled Drugs and Substances Act, which bans heroin use, to conduct a pilot study on the site's role in reducing drug use and crime in Vancouver's Downtown Eastside.
Health Canada, the country's health ministry, in October of last year announced it would extend the exemption until June 2008. An independent scientific body advised Health Canada in 2006 to recommend that funding for the project be extended and that similar programs be established in other cities. However, Clement said he could not approve the recommendations, citing inadequate research and unsound public health policy. The government later offered grants to further research the effectiveness of drug-injection sites in preventing HIV, under the condition that investigators not release their findings until after the exemption expires (Kaiser Daily HIV/AIDS Report, 5/2). According to the Globe and Mail, there are 49 safe-injection sites across Australia, Canada and Europe. Quebec provincial officials are planning a safe-injection site in Montreal.
WHO Guidelines, Clement Reaction
WHO on Tuesday at the AIDS conference released new guidelines that aim to reduce the spread of HIV among IDUs. In the guidelines, WHO said facilities such as Insite are one of the "priority interventions" countries should implement to curb the spread of HIV among IDUs. According to the guidelines, such facilities "are not a new intervention but simply a repackaging of existing WHO-recommended interventions such as needle exchanges" and "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 IDUs.
Clement criticized the guidelines, saying that "[a]llowing and/or encouraging people to inject heroin into their veins is not harm reduction ... it is a form of harm addition." He added that the Canadian government supports some harm reduction measures -- such as needle-exchange programs, methadone treatment and rehabilitation programs -- but opposes safe-injection sites (Globe and Mail, 8/6).
Clement during an interview at the conference said the Canadian government wants to close Insite because it has become necessary to "draw a line" determining which harm reduction measures are appropriate. "There are already people saying injection sites aren't enough, that true harm reduction is giving out heroin for free," Clement said, adding, "You have to draw the line somewhere, and we feel we're drawing the line in a place Canadians are comfortable." Clement added that it is up to each country to determine which harm reduction measures are appropriate, adding, "It's not my job to kowtow to orthodoxy."
According to Clement, preventing the spread of HIV among IDUs requires a combination of prevention, treatment and enforcement measures. Clement said he believes Canada has a good balance between enforcement and prevention measures, adding, "I believe I'm on the side of compassion and on the side of the angels" (Picard, Globe and Mail, 8/7). When asked about Clement's comments, Teguest Guerma, associate director of WHO's HIV/AIDS Department, said, "The WHO supports harm reduction." Abeeda Kamarulzaman, head professor of infectious diseases at the University of Malaya, said at the conference that safe-injection sites, needle exchanges, methadone treatment and other harm reduction measures have all been shown to curb the spread of HIV, adding, "We need to stop arguing about the merits of harm reduction and just do it" (Globe and Mail, 8/6).
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