1 Barriers to access to sterile syringes in Canada: legal, policy and human rights issues XVI International AIDS conference Tuesday, 15 August 2006 Alana Klein Senior Policy Analyst

2 About the Canadian HIV/AIDS Legal Network The Canadian HIV/AIDS Legal Network ( promotes the human rights of people living with and vulnerable to HIV/AIDS, in Canada and internationally, through research, legal and policy analysis, education, and community mobilization. The Legal Network is Canada’s leading advocacy organization working on the legal and human rights issues raised HIV/AIDS.

3 HIV, HCV and injection drug use in Canada 14% of new HIV infections in Canada in 2005 attributed to sharing injection equipment. More than half of new HIV infections among Aboriginal Canadians attributed to sharing injection equipment Canadians living with HCV; More than half of new infections result from sharing injection equipment. —Public Health agency of Canada 2005, 2006 HIV and HCV rates among people who use drugs  HIV rates range from 11.8% to 20.3% in major cities  HCV rates range from 35% to 65% in major cities, even up to 88% in some studies —Fischer et al 2005; Strathdee 1997

4 Effectiveness of sterile syringe programs (SSP) “[S]tudies reviewed... present a compelling case that [SSPs] substantially and cost effectively reduce the spread of HIV among [people who use drugs] and do so without evidence of exacerbating injecting drug use at either the individual or societal level.” “[Authorities] should adopt measures urgently to increase the availability and utilization of sterile injecting equipment and expand implementation to scale as soon as possible.” —World Health Organization 2004

5 Full coverage remains a distant goal E.g., in Ontario, only 5% of need being met. —Millson et al. 2005

6 The human rights context International Covenant on Economic, Social and Cultural Rights Article 12 Right to the “highest attainable standard of health.” Obligation upon states to “take steps to achieve the full realization of the right,” including those necessary for “the prevention, treatment and control of epidemic, endemic, occupational and other diseases.” Article 2.2 States must guarantee that each covenant right “will be exercised without discrimination of any kind as to race, colour, sex….or other status.” People who use drugs have an equal right to effective ways to protect themselves from HIV.

7 Methods Literature review Document review Consultation with provincial and territorial health officials, program staff Self-completed questionnaires Questionnaire-based interviews

8 The barriers Program and policy related barriers Social barriers Law-related barriers

9 Limited operating hours of SSP Nearly 2/3 of Vancouver-based subjects with difficult access to syringes cite sterile syringe program operating hours as an access barrier. —Wood et al The majority of SSP in Canada operate mostly during weekday business hours.

10 Location/Coverage of SSP In Vancouver, more than 1/3 of participants with difficult access to syringes pointed to distance from facilities. —Wood et al. 2002

11 Lack of awareness of SSP No empirical data from Canada 46% of participants who did not use SSP in Sydney, Australia reported that they were not aware of the programs. —Treloar & Cao (2005)

12 Stigma and privacy concerns No empirical data in Canada In Sydney, Australia, 2/3 of participants who never or infrequently used SSP cited stigma as a barrier to access. —Treloar & Cao 2003

13 Mode of service delivery Community based organizations:  multiple-use or stand-alone  fixed site, mobile, home delivery Health clinics Pharmacies Vending machines Secondary exchange

14 Criminal law: the law on the books Section s of the Criminal Code of Canada prohibits promotion or sale of instruments for illicit drug use, with an exception for an “article... for use in... the...prevention of disease.” Controlled Drugs and Substance Act s. 2(1) A controlled substance includes “any thing that contains or has on it a controlled substance and that is used or intended or designed for use in introducing the substance into a human body.”

15 Canadian Association of Chiefs of Police, Resolution # “Harm reduction policies mislead people into thinking they can use drugs ‘safely’ and ‘responsibly’, as opposed to encouraging them not to use drugs at all;” “It is unethical to provide drug addicts with assistance in conducting behaviour that is harmful to themselves, and potentially to others (e.g. needle exchange programs, crack pipe kits etc.)” Implementing harm reduction policies sends a message to drug addicts that society has given up on them, choosing to maintain their addiction in order to ‘reduce the harm’, as opposed to pursuing treatment and rehabilitation options” Resolution ultimately called on the Federal Minister of Health to ensure that harm reduction strategies are based on evidence and that they be equally supported with treatment, prevention, education and services.

16 Criminal law: enforcement Crackdowns Police presence No-go zones

17 Zoning regulations E.g., Surrey HIV/AIDS Centre Society v. City of Surrey and Murray Dinwoodie (Supreme Court of British Columbia, 15 February 2006) Zoning by-law amended June 2005 to require Community Impact Study for business licenses for community service use. Court held that Surrey HIV/AIDS Centre Society could operate with a medical license; community impact study therefore not required.

18 Community resistance Consequences: Intensified police activity Being forced to move locations Restrictions on mobile unit operation —Strike et al., 2004

19 Going forward Accountability and goal-setting Experimentation and sharing best practices Reform of drug laws Education: of police, of community members

20 Alana Klein Senior Policy Analyst Canadian HIV/AIDS Legal Network 1240 Bay Street, Suite 600 Toronto, Ontario Canada M5R 2A7 Telephone: x 233 Fax: Website: