Housing Policies Could Help Prevent AIDS, Says Study
Research on B.C. needle drug users links homelessness to unsafe sex and persistent addiction.
Needle drug users rated their top worries.
If you shoot illegal narcotics into your veins in British Columbia's capital city, you have plenty to fear. Injection drug use is a driving factor in the spread of infectious blood borne diseases like HIV/AIDS and Hepatitis C in North America. But your biggest worry, according to a newly published study, is just finding a place to stay where you won't be robbed.
Injection drug users told Victoria researchers they rank security issues such as shelter and physical safety above concerns about catching a deadly illness. And that, say researchers, means we need to rethink how we tackle AIDS prevention.
The findings, recently published in the Harm Reduction Journal, don't surprise Aid Vancouver Island staffer Erin Gibson, who was part of the research team. For a decade now Gibson has worked with AIDS patients and drug users at AIDS Vancouver Island, and she says the desperate conditions of life on the street make it hard to entertain long-term worries about viral infections that might affect you years in the future.
"You don't have time to worry about HIV if your basic survival needs aren't being met," Gibson told the Tyee in phone interview from her Victoria office. "It can be minute to minute out there, day to day. It's only after people have secure housing that I see them reduce their drug use and volunteer in programs. The things they think about then are different."
Condom use lower among homeless
Gibson and her colleagues suggest that their research findings have implications for public policy. Among their paper's conclusions:
Worried Users: The Victoria Study
'Worry as a window into the lives of people who use injection drugs' looks at the role of worry in the lives of injection drug users in Victoria, B.C. during April and May of 2008. The researchers analyzed survey responses from 105 clients of the city's clean-needle exchange, who were asked to score 14 possible worries on a scale of one to five, with five indicating "worries all the time."
The highest mean score (3.11) was for worries about having a place to stay and the second highest (2.91) was for concerns about being robbed. (Slightly more than half the people who responded to this research were homeless and another 10 per cent were living in shelters in 2008.)
Infection with Hepatitis C drew a mean score for worry of 2.89 and worries about HIV/AIDS were close behind with a mean score of 2.84.
Worries about getting clean needles scored a mean of 1.72. The study was conducted when Victoria had a well-established needle exchange program. Since then, a neighbourhood lawsuit has since forced the exchange to leave its permanent address.
-- Tom Sandborn"PWUID ( People Who Use Injection Drugs) in this study not only worry about HIV/AIDS but also about stressful factors in their daily life, which have been linked to both increased HIV/AIDS risk behaviour and decreased anti-retroviral treatment adherence. The importance PWUID give to this broad range of worry/concerns emphasizes the need to place HIV/AIDS intervention, education, and treatment programs within a broader harm-reduction framework that incorporates their perspectives on both worry and risk."
Other recent research found that homeless needle-based drug users are less likely to use a condom during sex than users who have a place to live.
Thomas Kerr of Vancouver's B.C. Centre for Excellence on HIV/AIDS, working with other researchers, studied the relationship between homelessness and risk behaviours for HIV/AIDS transmission among street-involved youth. They found that "homelessness was inversely associated with consistent condom use ... while unstable housing was positively associated with greater numbers of sex partners."
The team suggested the need for new policies "which modify environmental factors that drive risk among young street-involved populations."
'People need secure housing': VANDU's Livingston
Ann Livingston, a long time activist in Vancouver with the Vancouver Network of Drug Users, agrees that housing can be a key issue in preventing AIDS infection. She told the Tyee that homelessness was the strongest single predictor that a person in Vancouver would contract HIV/AIDS.
However, she cautioned that it was important not to be too simplistic. The kind of housing available makes a big difference. "Food and shelter and dope can be higher priorities than preventing infection," she said, "but housing that is so strict that you get thrown out if you are using isn't helpful. People need secure housing."
Laura Track, a housing campaigner with Pivot Legal, an organization dedicated to serving the needs of homeless and otherwise marginalized populations in Vancouver, also agrees that the Victoria worry research matches her observations. Like Livingston, she emphasizes the need not just for housing, but for housing that is secure and supportive for people battling with addictions.
"The research is accurate. People without housing worry about day to day survival. To imagine that anyone can overcome a barrier as significant as addiction without secure housing is foolish. For people to get well, secure, barrier-free housing is necessary."
Basic necessities come first
AIDS Vancouver Executive Director David Swan says his organization's experience is consistent with the Victoria worry research and Dr. Kerr's findings about how secure housing seems to reduce risk behaviours. He told the Tyee that secure housing not only works to help prevent HIV infection -- it also is an important variable in supporting self-care and medical treatment co-operation among people who are HIV positive.
Swan underscored the importance of safe, secure, barrier free housing as a public health issue.
"This is why we talk so much about the social determinates of health," Swan said. "At AIDS Vancouver, as much as 60 to 70 per cent of staff time goes to helping clients with basic survival needs like housing and food. If people don't have adequate access to these basics, other concerns can go to the back burner."
Fiona Gold, a street nurse in Vancouver with the BC Centre for Disease Control, said that she completely agrees with the Victoria research. Her experience on the street, she said, confirms the Victoria findings about housing as a primary concern.
"When you see someone become homeless, you see their life spinning out of control," Gold said. "We need much more supportive housing in Vancouver, with trained staff to help people navigate their challenges. Housing can bring stability that supports recovery. The 'housing first' approach makes sense to me." ![]()




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alive
2 years ago
look at this objectively, please
Is it just a given that people "do drugs"?
Seems our society focusses on helping addicts instead of preventing a stupid habit from starting in the first place.
It would cost less money and effort to stop distribution than to help overcome the disasters that results afterwards.
Our revolving door policy in the courts are no doubt to blame, There is little crime in places where offenders get punished immediately and harshly.
It is misplaced sensitivity to worry about criminals rights, when their crimes costs so much misery!
mary jane
2 years ago
sharing comments
I have heard from those who listen to drug users drugs take away hunger and cold. If someone uses drugs ti fend off cold and hunger who is responsible for that problem. Campbell the same guy who has cause so many problems in BC
Fish-counter
2 years ago
Low-cost or free housing prevents a lot of things.
People who live in houses or other accomodation are less susceptible to many diseases and misadventures. There are diseases other than AIDS that are equally deserving of assistance. Anyone using injected drugs for recreational purposes has already dropped off the map as far as I am concerned. Let's give help to people who are working to better themselves. Better research than that quoted in this article says that they are more likely to benefit from it.
Squish
2 years ago
Totally agree
I couldn't agree with this research study more. It makes very good sense that a person's hierarchy of needs need to be met and shelter, food and clothing are at the top of the list. There are many reasons why people resort to drug use. They were all innocent babies at one time. What happened to them in life? We need to be more understanding regarding the ills of society.
RickW
2 years ago
alive
Prevention is bad for business, Period. What would the drug companies and medical profession do if everyone was healthy and of sound mind?
Bobby Peru
2 years ago
What a joke!
The Tyee publishes another biased study on behalf of the poverty pimps who perpetuate the homeless and drug problem in Vancouver. So it's all that simple, huh? Just give the homeless homes and they'll stop using drugs? Has anyone thought about the cost of building and maintaining homes in Downtown Vancouver and Vancouver in general? It's an insult to hard working, honest, non-druggie Vancouverites who pay taxes to support this system,
Many of the homeless need institutional care at some level. If you define housing them as placing them in confined hospitalization then we're taking a step in the right direction. Giving them the kind of homes non-druggies live in only creates a ghetto- we'll have druggies doing more drugs in the comfort of a home. And that home will turn into a slum: toilet overflowing, waste all over the place and downgrading and endangering of the surrounding neighbourhood. Shelter is important, but the way it is now done means it is only a temporary solution. The ultimate solution is hospitalization and removal from situations that enable more drug use. Addicts need to be shipped away to rehab camps.
The price of becoming a drug addict and a beggar of the government should be treatment, not love and encouragement to perpetuate this lifestyle. I know the poverty pimpers, which include the current mayor, would love to inflict the homeless on the rest of us in an effort to shame us about our lifestyles. But, we have nothing to be ashamed about.
morechatter
2 years ago
What Comes First?
The Street or the Drugs? And the answer is the "Street" as many find themselves there because of domestic violence,disabled, low income, family violence, child sexual abuse, child abuse, minimum wage earners, war vets, seniors, youth to name a few who find themselves on the streets as they slip through the gapping holes in the system. Its what happens when you put people, young and old alike in an environment that isn't healthy and there is little hope as unable to afford the rents.
morechatter
2 years ago
Liberal's Olympics Inflicts Homelessness
Now thats more the truth Bobby Peru as it isn't the Mayor who created the problem he is just trying to ease the problem. As land developers go for the big bucks and rents continue to climb while seniors find themselves out in the cold along with the young who can't make a living on min wage.
Are BC residents really proud of having the worst possible conditions in Canada for its low income residents and small children who are often better off dead. Or how about war vets who can't find a safe place to lay their heads or the disabled or the sick and infirm? Oh and addiction often starts at the Doctors office and works itself to the street as government creates an environment condusive to addiction as it leaves citizens without hope as $20 food crisis grant for the month can either buy you a Macdonald's burger for the month or a hit of crack. I wonder what government was thinking?
Bobby Peru
2 years ago
Economic reality
You raise very real problems, 'morechatter', but the economic realities are simply cold, hard logic. Downtown Vancouver property or Vancouver property in general is simply too expensive to be used for social housing. If average, non-druggies, working people can't afford to live downtown, why should druggies and the homeless be granted housing as if it is a God given right?
It's all a matter of opportunity cost. Suppose the govt doesn't release land to developers and reserves it for social housing. The cost is not only forgone income, but the creation of a slum in the middle of what has already become expensive neighbourhoods. Unfortunately, the reality is that poor people should live further away from Vancouver and live in cheaper areas.
And, many of the homeless, as I've said, are druggies who need hospitalization and treatment. The poverty pimpers like to cover up this reality, trying to fool us into believing that the homeless are just sober people a few paychecks behind rent.
morechatter
2 years ago
Living Downtown?
Why are the homeless downtown? Do you think it might be the resources available to them are located right in the midst of all the filth and dirt as the homeless are placed into the slums. Its dosen't help when places like St James have workers selling crack either in the slums as workers cash in on the plight of the homeless. A coicidence government gives the exact amount for a hit of crack and calls it food money for the month? And who are the homeless? Bobbies says its not people who can't afford the rent who are homeless despite having no where to go or the money to rent a place? Where do people go who can't afford the rent after losing their jobs or being cut off ei or assistance or help to Bobbie's house?
Oh and Bobbie being sober or being straight dosen't mean your going to be homeless now does it? The premier has a nice home despite being a drunk and so do many others who dabble and dipp into coke and crack as its those with money who do drugs and have real nice homes and lots of cash. The homeless could never afford to do the drugs these guys do and thats a fact as those nice homes in Victoria are often engaged in keeping the crack habit going only I like staying alive so we will live that to the police, ha ha because police are to busy giving out tickets to the homeless to bother with the real corruption.
morechatter
2 years ago
And Bobbie
There is no a couple a paycheques behind in your rent its 5 days and your out after the first, its the BC residential tenancy act which is only to happy to help out with the increased homeless.
housingfirst
2 years ago
and bobby #2
bobby peru,
i haven't lived in vancouver for quite some time, but seattle shares some similar issues and your spouting off about the terrors of what would happen if we *gasp* provided housing for the druggies is perhaps a bit misguided. there's starting to be some evidence that shows otherwise.
http://www.seattlepi.com/local/404451_alcoholic01ww.html
subtle-t
2 years ago
We coud try...
Well, Bobby peru, thankfully you are not a policy maker, and your version of "cold, hard logic" is definitely cold, but your armchair rants aren't necessarily logical.
I'm a non-druggie who works full-time and pays taxes, but I certainly do support affordable housing initiatives, various types, including low-barrier for those struggling with addiction.
Judging all addicts as druggie freeloaders, as you seem to be doing is pure ignorance. Have you walked a mile in the shoes of one who struggles like a homeless addict, like someone with mental health issues, like someone who used to be a taxpaying working person who befell any number of lifechanging crises that could end one on the street? Didn't think so...
The healthcare costs associated with the HIV/AIDS, hepatitis, 'street-feet', and other painful, debilitating and dangerous diseases is astronimical.
All I'm saying is we could at least try a housing first approach. Treat people with respect, even if we don't agree with or understand how they got into thier predicament. Give people something to be proud of, something to protect, and many of them will. Some won't, but many will. We could at least try.
Bobby Peru
2 years ago
Housing it real
Like I said, I'm not against housing, it's the type of housing. The type I mean is hospitalization, institutionalization- meaningful steps towards rehab. Merely giving them housing and letting druggies wander about, scoring their next high among the rest of us is unacceptable. And the protests from Vancouverites who have had temporary, open shelter established among them have made that abundantly clear.