NEEDLE STUDY BACKS B.C. EXPERIENCE

A Montreal study finds needleexchange participants are more likely to get
HIV, and experts here say the reason is more services are needed.

Lower Mainland health officials are not surprised by a new study that found
Montreal addicts using needle exchanges are twice as likely to become
infected with HIV than those who don't.

The study contradicts earlier findings that needleexchange programs are an
effective way of limiting the spread of HIV because they eliminate sharing
of infected syringes.

Vancouver/Richmond regional medical health officer Dr. John Blatherwick
said he has long known that, to be effective, needle exchanges have to be
backed up by other programs.

``Needle exchanges on their own, are not the solution,'' Blatherwick, who
had not seen the study, said Sunday.

Vancouver's needle exchange program recently expanded to include a range of
new services to HIV and intravenous drug users, such as the hiring of 42
more community nurses, street workers and counsellors.

``The needle exchange on its own means that's all the [services] addicts
have, so over time they will end up getting AIDS. So that will be the
impression that the needle exchange people have a higher percentage of
AIDS than nonusers,'' Blatherwick said. ``Basically what we've said,
though, is it isn't enough you have to have some treatment programs,
outreach programs, methadone alternatives, all the things we're about to do
in the Vancouver/Richmond health board.''

Published today as the lead report in the American Journal of Epidemiology,
the controversial St. Luc Hospital study says of 974 addicts studied
between September 1988 and January 1995 each year, 5.1 per cent got HIV.
The rate was highest for those in exchange programs 7.9 per cent,
compared with 3.3 per cent for those who didn't attend.

Recent studies published in New York and Baltimore credited 70percent
drops in new HIV cases thanks to exchange programs.

According to the study, Montreal proves an exception mainly because of a
big jump in cocaine over heroin as addicts' favourite drug to inject. Users
are more likely to use each other's HIVinfected syringes when their supply
of clean ones runs out or when they get too stoned to care.

``The problem is the patients using them 15 to 20 times a day, in runs of
five to six days in a row, fixing the entire time,'' Dr. Stan de Vlaming,
head of addictions medicine at St. Paul's Hospital, said. `` You can bet at
day two or day three they are not capable of making rational decisions.

`` The way to go is more treatment to primary problem of addiction.''

Lou Demerais, on the advisory committee of the Vancouver needleexchange
program, agreed.

``Maybe we're now talking along the lines of medically supervised
injection,'' said Demerais, also executive director of the Vancouver Native
Health Society. He suggested that with cleaner facilities, sleep and food,
the tendency for cocaine users to use dirty needles would be greatly
lessened.

``Part of the problem is also the inability of law enforcement to stop the
amount of stuff coming into places like Vancouver and other large
metropolitan centres,'' he said.

An American Journal of Epidemiology editorial and the St. Luc hospital
report's authors agree that the solution to Montreal's problem is an
increased number of needleexchange centres.

Principal author Julie Bruneau, a psychiatrist in St. Luc's detox centre,
said by not expanding the program earlier ``we may have created problems as
well.''

For example, there is the ``networking'' effect, whereby needleexchange
programs create meeting grounds for addicts. Without enough needles to go
around, those new friends could wind up sharing.

Dr. Patricia Daly, communicabledisease consultant with the
Vancouver/Richmond health board, has said needleexchange programs have one
central spot for distribution, and people get to know one another, creating
more opportunity for the virus to be transmitted.

But Judy McGuire, who manages the Downtown Eastside Youth Activities
Society's needleexchange program, and Montreal needleexchange director
Mario Bilodeau argue most of the clientele already know each other from the
street.