Overdose death underlines downtown heroin problem:
Frank Cromarty was one of 600 HIVpositive drug addicts cared for by just
two nurses.

By: Marina Jimenez

AIDS would likely have killed Frank Cromarty in the end, but his other
disease claimed him first. Last Wednesday afternoon he died of a heroin
overdose in a rooming house on the Downtown Eastside.

Usually his old friend Kathy Churchill one of two nurses with the
Vancouver Native Health Society's HIVAIDS outreach program would take
him out for coffee on welfare days and sit with him until his craving
subsided.

But Churchill was away that day. So Cromarty who'd been clean for
several days headed out the door in frustration, looking for a fix. His
brother Fred also an HIVpositive injectiondrug user bought heroin
with the money from his monthly welfare cheque.

``There is no doubt in my mind that if I had been there, he wouldn't have
been dead today,'' says Churchill, beginning to weep. ``He spent last
Christmas with my husband and me.''

Churchill and one other nurse serve the 600 HIVpositive, injectiondrug
addicts who are registered with the program.

Cromarty's death and the deaths this week of five other HIVpositive
injectiondrug users in the Downtown Eastside illustrate that existing
resources have failed to stop the AIDS epidemic that grips the city.

According to the B.C. Centre for Disease Control, the infection rate among
injectiondrug users is about 20 per cent a year the highest incidence
in the developed world. Last week the Vancouver/Richmond health board
called the problem a ``publichealth emergency''. Close to half the addicts
who frequent the Downtown Eastside estimated at 6,00010,000 are
believed to be infected with HIV.

The province has given the Vancouver/Richmond health board $3 million to
spend on the problem. Advocates working in the trenches say the money is
welcome, but comes too late. They say they have been warning public health
officials about the impending crisis for years and want an inquiry to
determine why they didn't respond adequately to the epidemic before now.

The needleexchange program, which began in 1988, had to fight for support
and at one point had to pull a van off the road because of a lack of funding.

There are just 42 detoxification beds available now in Vancouver. The
Pender DeTox Centre closed two years ago and hasn't been replaced.

Programs in the Downtown Eastside receive about $1.1 million of the
province's total $7million AIDS budget. Most of that $750,000 goes
to the needleexchange program.

There is only one program in the Downtown Eastside offering counselling and
medical support to HIVpositive injectiondrug users. ``If we had more
people to do counselling and the social workers necessary to keep people on
the straight and narrow, then we could do a better job stemming the
epidemic,'' says Lou Demerais, executive director of the Vancouver Native
Health Society.

Thirtyone people on his client list of 600 have died so far this year of
HIVrelated illnesses and/or drug overdoses.

Demerais' support program receives $150,000 in provincial funding. And the
client list is growing exponentially; so far this year, 153 HIVpositive
injectiondrug users signed up for help.

Clients often crowd into the dropin centre on East Hastings and join a
line of dozens who are waiting to see the two nurses. Many leave in
frustration.

Typically, the clients are a very needy group of people who often have low
selfesteem and a history of abuse, says Churchill. Cromarty, for example,
was an alcoholic, grew up in foster homes and was sexually abused.

``We don't have the resources to counsel them, or get them into detox
programs or find them proper housing, and those missing pieces in the
continuum of care really matter,'' said Demerais, who would like to hire
six more nurses and have extended hours.

Turvey adds: ``If addicts are sitting in the street gutter in despair,
they're not going to be persuaded not to share needles. People say, why
shouldn't I?''

Studies show proper housing would also help stem the epidemic. Now, many
injectiondrug users live in the 7,400 single rooms in the Downtown
Eastside, most of which are not selfcontained.

``That leads to people congregating outside, going to back alleys to shoot
up,'' said Frank Gilbert, with the Downtown Eastside Residents Association.

Gilbert says better housing wouldn't eliminate drug use, but would lead to
safer shooting practices such as the use of clean needles.

Moffatt Clarke, director of the Provincial AIDS Strategy, agrees the
government hasn't done enough. Part of the problem is the lack of
coordination among the ministries responsible for the different elements of
the AIDS epidemic: health; aboriginal affairs; municipal housing;
education; children and family services.

``The problem is the government is so big and the problem is so
multisectoral with many social components,'' said Clarke, who is working
to put a strategy in place by next March to better coordinate a speedier,
more consistent response.

In the meantime, Churchill says simply: ``We're just losing a lot of
people.''