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Street roots 9 March 4, 2011 drug use. I mean, what else do you want? At the same time we have shown that the site is associated with decreased loitering and decreased disturbance in the environment where the site is located. I mean, ethically, morally, scientifically, economically, I cannot conceive an argument why the site should be closed, so let’s hope ' that smart people, well-informed people, arrive at the right decision. S.C.: I n 2007, the United Nations reported that the Downtown Eastside had a Hepatitis C rate o f ju s t below 70 per cent a n d an H IV rate o f approximately 3 0 per cent. W hat needs to be done to get a hold on these numbers? is actually related to the prevention of the progeny of HIV infection that that person would have derived. S.Ç.: Despite issues with the federal government, Canada is seen as very progressive around the world. Some American states don’t, even allow needle exchanges. What do you hope the Vienna Declaration ca n d o globally? J.M.; All my life I’ve been reluctant to „ praise myself for being better than the worst R ie rèality is that the United States has an abominable track record when it comes to dealing with substance use problems. They haven law and order J.M.: The epidemic in the Downtown approach, which unfortunately-is a very easy Eastside has already matured. The thing to seU to the uninformed public, and likelihood that we’re going to-prevent a lot all it has done is enrich the operators, of more HIV in that first cohort of people, that correctional facilities. You can scarè people opportunity is gone. Now, given the very quickly foto believing that if I put dynamics of drug use, there are always new everyone in jail it solves all your problems. entries into the drug use environment. The The federal government in Canada is now important thing to realize is that if we proposing to expand the number of jails for address the issue of hann reduction and unreported crime, which I find absolutely anti-retroviral therapy to all those that are incredible.The statistics show that crime is eligible for it within that community, and for going down, but they say unreported crime that matter within the whole province, then is going up. Obviously théy are stating the We would have the best possible opportunity facts as they see it because they have a to reduce the likelihood of HIV conviction that is basically ideologically transmission. motivated. In order to do that, we need a I think our expectation with the Vienna ' comprehensive outreach strategy. We call it Declaration is that it’s going to generate a “Seek, Test, Treat and Retain” (STTR), dialogue, à debate around what is a proper which means: if you are not accessing the policy for progressive societies today in services, we need to access you. The dealing with harm reduction. The fact that problem is that there is a large proportion Vancouver, Victoria and Toronto have now of people on the fringes who are involved in aligned themselves formally behind the - risky activities that could lead to HIV, but Vienna Declaration (means), sooner or later,, they don’t somehow identify theriisélves as it will create the kind of momentum for being in a high-risk situation, who are the these discussions to be brought up to the ones that are the hardest ones to reach. attention pf the federal governmerit. The Now, there may be elements of evidence is here, the cities that are dealing socioeconomics or mental health or with the problems are asking for this . homelessness, or there may be various because this would be a better use of our resources. We don’t need more jails; we other complicating factors, but what we ■fìé&l rftófg'gilpèrvised injection sreesrlf we* -- need is Sn aggressive strategy to get do that, we will need even fewer jails.’ those individuals if we are going to control the epidemic. S.C:; U N A ID S recently reported that there 'Riere is always a tension in our society were 2.6 million H IV infections around the regarding the competition for these very world in 2009, which were 20 percent fewer scarce dollars. So whenever we propose, than the late 1990s. While it ’s great progress, , ‘Well, let’s have a mass testing campaign,’ the report also said the issue is still ‘“halting” people start arguing, ‘Who do we take money from?’ At the end of the day it comes and fragile1. Do you think people havegotten too complacent on this issue? down to an issue of cost-effectiveness and what we have argued is that investing on J.M.: I think we have to look at the UN testing and treating people with HIV is AIDS figures and conclude that some highly cost effective to the point that you progress has been riiade. The figures .show are generating a return on the investment that we can deliver on our promise to stop that is riot just related to the health the epidemic if we have the resources. outcomes of the perSon that is infected, but "W ith a ll the Implications that it has lor human security and for the stabilization of the globe which is something that, 3 0 years from now, we're going to regret that we didn't stop this when we could have. And our data shows, if we do the right thing, we can do it." There was a hope that by 2005 they would put 3 million people on treatment and that eventually there would be universal access to treatment, care and prevention by 2010. This was a commitment by the G8. The truth is that by 2005, it riever happened. It took until 2007 to get 3 million people in treatment. As a result of that we’ve been behind all along. I find it objectionable, if not highly irresponsible and hypocritical, that die G8 met in Canada (last) year and basically decided to change the agenda to maternal and child health issues, and forgot about the AIDS pledge. There is no apology or even commentary as to how we’re going to catch up on this. They pretend that they’re going to deliver on maternal and child health when, in Africa, 30 percent of the women are infected with HIV. We seem to look at the problem of HIV as if it were remote, and we don’t care about it To be perfectly honest with you, if the HIV crisis was not affecting racial minorities, people with drug-use problems, or homosexual men, our leaders would feel a lot more sympathy anti empathy for this problem. They have applied their judgement: these lives are expendable. Well, they’re not expendable. If we don’t solve the AIDS crisis, our children, and the children of our children are going to be burdened with an AIDS mortgage that’s only going to get worse. With-all the implications that it has for human.-security and for the stabilization of the globe which is something that, 30 years fro m now , w e ’r e going to r e g r e t t h a t w e - didn’t stop this when we could have. And our data shows, if we do the right thing, we can do it. - S.C.; According to the U N AIDS, while more people are getting access to treatment, the num ber o f people around the world with H IV has increased to 3 3 3 million, which is the highest its ever been. J.M.: The number of people we’re treating is growing but not as fast as the epidemic is growing. The problem is if we don’t get ahead of the number the curves will continue to grow separately so that the number of people in need will continue to outpace our ability to deliver. We can see the future and toe future says if we have a society where 30 percent (of the people) are infected with HIV, that country is not stabled In South Africa, toe GDP is suffering because of AIDS - toe economy is being compromised; How can you protect the integrity of a society when you reach a critical mass of people infected with HIV? People are dropping like flies, and that’s what people need to understand; S.C.; Your critics, .including form er M inister o f Health Tony Clement, have claimed that you have drifted away from being a scientist into being an activist. W hat is your response to those kinds o f accusations? J.M.: The reason why “Dr. Montaner”, as (Tony Clement) said it, “has drifted into an advocacy role,” is because I have the profound conviction that when you do clinical and public health research and your data is clear, transparent and definitive, you have an obligation to inform the public and . decision makers regarding the next steps that need to be taken, particularly to address the epideriuc situation of HIV and drugaddiction. The more those policy makers refuse to accept the facts, the greater my responsibility to educate toe public and the decision makers. S o , my crusade, to . disseminate this knowledge, is a fu n d a m e n ta l n e x t s te p in th is k in d of work;„ , My answer to thefederal government is that they can say whatever they want but my credentials speak for themselves. The problem we have is that their credentials - are also transparent and they’re perfectly clear: they are not about evidence, they’re not about public health, they’re simply about continuing to rule this country based, on an ideology that unfortunately is not congruent with the needs of toe patients that we’re trying to serve. Originally published by Megaphone, Vancouver, B.C. © www.streetnewsservice. org A n attendant cares fo r a patient infected with H IV / A ID S in a ward in Uganda’s Infectious Disease Institute in the capital Kampala. REUTERS/JAMES A K E N A (U G A N D A )
