available, and are used for longer periods of time. By any analysis, the costs of this crisis are enormous, and most are yet to come. This is in addition to the pain and suffering of persons living with HIV and AIDS, and the loss and grief experienced by loved ones.
dren. Although epidemiologists agree that this epidemic is unlikely to ignite within the broader community to the same extent it has among injection drug users, it will nonetheless touch many lives, infecting and affecting many people who have never used drugs.
New drug-using trends can affect HIV rates significantly.
While recognizing the seriousness of our circumstances, it must be acknowledged that there is hope. There are effective strategies that have been documented and can be implemented, and there are new paths to explore. Drug users can and do learn to use safer methods of injecting which can protect them, their partners, and their children from HIV. Some stop using drugs altogether. The right interventions, offered at the right time, do work. It is time to move beyond debating ideological differences and take full advantage of the knowledge and experience already available. It is time to act.
Attention has typically been focused on the heroinusing population, but new trends indicate an increasing shift toward cocaine use in many cities across the country. In Vancouver, 80% of needle exchange clients inject cocaine (Strathdee et al, in Press, 1997). In Montreal, the figure is 70% (Hankins, 1997) and in Halifax 52% (Grandy, 1995). This raises the spectre of a broader range of networks for HIV transmission, given that there is not perfect overlap between heroin and cocaine-using populations. Combined with the higher injection rate (up to 20 times per day), health and safety concerns are significantly increased. Why Is This Issue So Important? It has been estimated that between 42,500 and 45,000 people have been infected with HIV in Canada. It is impossible to know exactly how many have become infected through the use of injection drugs, but the information provided above clearly indicates not only are the absolute numbers of concern, but most importantly, they are on the rise. In the U.S., for instance, a recent study estimated that nearly 50% of new HIV infections each year now occur among IDUs (Holmberg, 1996). While the direct and indirect costs associated with these HIV infections are still being calculated, early indications suggest they will no doubt justify a dramatic increase in investment to keep this epidemic under control. It is not only the absolute numbers one must take into account, but the alarming and consistent rates of increase, as well as the toll in dollars and human suffering. People who inject drugs do not usually continue to do so all their lives. When they successfully stop injecting, society wants them to have years of productive life ahead of them. For this to happen, we must keep them healthy, HIV free, and alive. Injection drug users do not live in a vacuum. They are members of our community and, both during and after the periods of their lives which involve the injection of drugs, they form intimate partnerships and have chil-
The Action Plan Scope The Action Plan: 路
identifies the most pressing issues, offers strategies with which to address these concerns, and suggests who are in the best positions to implement the recommendations. It recognizes that different issues are of greater or lesser importance to different individuals and organizations, and presents the current recommendations as first steps in addressing priority concerns. strongly supports the use of a harm reduction approach, in conjunction with other, complementary approaches recognizes the urgent need to make strong recommendations, but not to be prescriptive. Each level of government, each community, each individual must apply the recommendations as is appropriate, developing unique, but complementary responses to a common problem, takes a simple, straight-forward approach to increase the likelihood of action, but does not avoid complex issues, in particular, those dealing with drug policy and enforce
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