Wednesday, May 20, 2009

fighting aids in hard places


an open assignment can be great fun, if you can dream up an interesting angle or person. for metro canada's next workology series, we're writing health, and i was tasked with writing about a doctor.

i wanted to write about a doc caring for sex workers - i wrote about related fields in a big article for the daily news a couple of years ago - but couldn't find a doc willing to talk. after checking in with my local contacts, i wound up talking to dr. julio montaner in BC. he is a global HIV-AIDS expert and, being in BC, part of his work is the notorious downtown eastside, with its drug addicts, homeless people and survival street sex workers. or, from his point of view, people who have bigger problems than dealing with an infection that causes no problems on a day-to-day basis. why worry about something that might kill you in 10 years when starvation or the elements will get you today?

as he told me, hiv is his priority, not theirs.

he said with modern treatment, an hiv-positive person can live a long life - long enough that they are now starting to find out what kills hiv-positive people longterm. treatment also greatly reduces the presence of the virus in body fluids - so hiv+ people have such low levels that passing it on becomes unlikely. in fact, they've basically eliminated transmission from hiv+ mother to unborn baby, when the mother has treatment.

without treatment, the epidemic spreads and spreads.

i've pasted the article below.


By Jon Tattrie
For Metro Canada
Most doctors have no trouble finding patients: they just go to the waiting room. But for doctors who have chosen to work with troubled, vulnerable people, even reaching their patients can be extremely difficult.
Dr. Julio Montaner, director of the B.C. Centre for Excellence, is one of the world’s leading HIV-AIDS experts. Part of his work includes combating the disease in Vancouver’s impoverished Downtown Eastside.
He says people on the streets have seemingly bigger problems than treating HIV.
Finding food, shelter, staying safe, dealing with mental-health problems and getting the next hit all take precedence over an invisible infection that hurts little in the early stages.
“They need places they can get services that are the number one priority for them, so that eventually … you can start addressing other issues. I always say, ‘HIV is my priority, but it is not your priority,’” Montaner explains.
“The number one priority is to help these people live a better life. The second priority is to stop the stigma and discrimination that makes it so difficult to work with these individuals.”
Part of that is decriminalizing drug use, he argues. “We can’t continue to try to help these people because they have a drug problem and on the other hand, chase them around because they have five grams of marijuana in their pocket. We’re working at odds with each other; we need to get our priorities straight.”
Supervised injection sites and the medicinal use of heroin can help, too, he says.
“If we can give people the opportunity to engage in HIV treatment, these become life saving for them,” he says. The treatment also vastly lowers the presence of the disease in the body, meaning it is much less likely they will transmit the disease. “Unless we do that, we are not going to be able to control the epidemic.”
But many street people don’t get treatment, meaning they get sick and die after being infected for many high-risk years. Montaner calls it a “reservoir of highly infectious cases that is not controlled.”
“People are telling us that treatment for HIV is expensive; we’re saying not to bring treatment to these people … is not only unethical, but it’s actually stupid. It’s more expensive not to do it.”

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