AIDS experts reveal plan to treat BC's vulnerable
Strategy would help province, professionals attract addicts, the mentally ill and others who aren't taking life-saving drugs
Globe and Mail Jane Armstrong, 30 Oct 2008
Vancouver—BC government is considering aggressive new methods of luring the province's most hard to reach HIV patients into treatment, including paying the poor and enticing drug addicts with incentives linked to recovery programs.The strategy is aimed at corralling highly vulnerable people with HIV, including addicts, homeless, the mentally ill and some who are aboriginal. Many aren't taking life-saving, anti-retroviral drugs, which have proved to slow AIDS symptoms and cut the risk of spreading the disease.
AIDS professionals in BC—with the backing of the provincial government want to target these groups with the hope of persuading them to get treatment. Methods would include dispatching public-health teams to Insite—Vancouver's supervised injection site, to homeless shelters and to remote native communities, said Julio Montaner, who heads BC Centre for Excellence in HIV/AIDS in Vancouver.
In an interview, the crusading physician also said that if the government one day gives the go-ahead for a program to treat drug addicts with heroin or prescription painkillers, AIDS treatment should be linked to it.
Researchers in Vancouver and Montreal recently completed a year-long study in which participants were given heroin, methadone or hydromorhone, a prescription painkiller to treat their drug addictions. They said participants responded well to the program, and argued that this kind of treatment should be available in Canada.
Dr. Montaner said he could envision a program in which HIV-positive patients who are also addicts would receive daily anti-retroviral drugs at the same clinic where they receive drug addiction therapy. The HIV treatment would have to be tailor made for each individual.
"Say you are coming for your heroin visit everyday. So we provide you an HIV treatment just before you get your shot everyday. The incentive could be food. The incentive could be a roof. The incentive could be a place for them to make phone calls." "Say you were fixed on heroin, I just link the HIV treatment with your methadone program," said Dr. Montaner, who is also president of the International AIDS Society. "If the methadone program doesn't work, I just link the treatment with your heroin program, and if heroin doesn't work, with your hydromorphone program. It's a matter of finding what will work."
Traditionally, health care professionals have had a tough time persuading vulnerable populations to seek care because most have no incentive to go to a doctor, Dr. Montaner said. Rather, they are focused on solving their immediate problems, such as finding shelter or getting a drug fix.
"I would like to have an opportunity to tie my services to something they really want," Dr. Montaner said. "People have an instinct for self-preservation. If we listen to them and we ask them, "What will it take for you to do this (take HIV treatment) they will tell you."
He added: "If we can get these people hooked on us instead of hooked on their dealers, we can work with them and try to make HIV treatment a priority."
BC Premier Gordon Campbell and Health Minister George Abbott have pledged support for the aggressive tack. In an interview, Mr. Abbott would not comment on the logistics of the plan but said it's needed to help reduce the spread of AIDS.
"If we ignore these problems, they are not going to go away," Mr. Abbott said. "They are simply going to compound and find themselves more and more into the mainstream populations. So it's very important to address the needs of the vulnerable."
"What I've seen and heard from Julio is both persuasive and exciting."
Dr. Montaner said the aggressive HIV treatment strategy is cheaper in the long run and the right thing to do. The cost of treatment for one AIDS patient over his or her lifetime ranges from $250,000 to $500,000, he said. Each year, there are about 400 new cases of HIV in BC. Dr. Monaner said studies show the infection rate can be cut in half if most infected people are getting treatment.
The case for extending treatment is more urgent than ever because powerful new anti-AIDS drugs not only lengthen and improve the quality of patients' lives, they also reduce the spread of the disease.