The Dominion - HIV

Raising Justice, Reducing Harm

taramichelle — Wed, 15 Aug 2012 09:40:07 +0000

Ottawa Prisoners' Justice Day raises awareness on the impact of prisons on drug use

OTTAWA—The issue of harm reduction in prisons dominated the presentations at the Prisoners’ Justice Day event held in Ottawa, at the Jack Purcell Community Centre on August 10. The event included a table fair, a prisoners’ book drive and presentations from organizers and former inmates.

“Prisoners’ Justice Day is a day of solidarity, to honour and remember all prisoners who have died unnatural deaths while incarcerated, and to cast light on the on-going human rights issues present in prisons,” said Jennifer Rae, a member of Campaign for Safer Consumption Sites in Ottawa (CSCS), in a speech. “This year, [the] day will also focus on the need for harm reduction policies in Canadian prisons to reduce the spread of infectious diseases and save lives.”

CSCS, an organization that promotes dignity and respect for all drug users, was one of the many community groups organizing this event. According to her speech, estimates of HIV and Hepatitis C prevalence in Canadian prisons are respectively 10 times and 20 times the estimated prevalence in the rest of Canada, and are especially high among drug users. Additionally, suicide rates in prisons are seven times higher than the general Canadian population, and between 2005 and 2010 there were over 33,000 formal complaints from prisoners, mostly regarding lack of health care in federal prisons.

Caleb Chepesiuk is the Harm Reduction Program Coordinator at AIDS Committee of Ottawa, another group organizing the event. The group provides support and promotes the wellbeing of people affected by HIV/AIDS. Chepesiuk said that the prison policies do not provide a space for safe drug use, encouraging the spread of infections such as HIV and Hepatitis C.

“The policies create more harm for people who use drugs than the drugs themselves,” he said. “There has been a call for a needle distribution system in prisons for years now…and this is being actively ignored by our politicians and bureaucrats.”

Chepesiuk added that even people who are on trial or spending shorter periods of time in prisons are also at a risk of facing many problems.

“Whether it is a couple of weeks or a couple of months, [those policies] disrupt any efforts of getting employment, or housing, all those different pieces that really help build a healthy community,” he said.

On August 10, inmates in Canada and in prisons around the world went on a hunger strike in memory of Eddy Nolan who bled to death in Millhaven Penitentiary in Ontario on August 10, 1974. That incident along with a four day riot that resulted in the death of two inmates at the Kingston Penitentiary in 1971 led to major improvements in the Canadian prison system.

Inmates also released a statement on Prisoners’ Justice Day, written by Alex Hundert, and Mandy Hiscocks, both community organizers who are currently imprisoned on charges related to activist organizing around the G20 Summit, in Toronto in 2010. The statement was written with input from more than a dozen inmates inside the Central North Correctional Complex in Penetanguishene Ontario.

Similar events were held in other Canadian cities such as Toronto, Halifax and Vancouver, Montreal and Sudbury.

Crystel Hajjar is an Ottawa-based writer, organizer and climate justice activist.

Ottawa Prisoners' Justice Day

Indoor Work Spaces Prove Safer for Sex Workers

Tim McSorley — Tue, 15 May 2012 23:28:17 +0000

Study shows drop in abuse, HIV rates when sex work brought indoors

VANCOUVER—A recently released study by the BC Centre For Excellence in HIV and the University of British Columbia proves what community advocates have been saying for years: safer indoor spaces for sex work save lives.

The study interviewed 39 women living in supported housing projects on Vancouver’s Downtown Eastside. Run by RainCity Housing and Atira, these projects are self-identified women-only (in terms of staff and residents) and include safety measures such as cameras in the buildings, sign-in sheets for guests and harm reduction supplies. Sex workers who live in these buildings are allowed guests, which means that they can bring in their clients.

The women who live in these buildings were largely homeless before moving in, or living in buildings that did not allow guests. This lead to interactions with clients where the workers had very little power or control. “It’s common sense if you think about it,” says long time sex work advocate Trina Ricketts. “Imagine yourself preparing to work outside in the cold, negotiating services and fees in strangers’ cars. Then imagine yourself preparing to work out of your apartment building, which happens to be staffed with caring, vigilant support staff committed to helping you stay safe no matter what.”

The findings are that these projects help empower women to better negotiate safer sex with clients, which is a factor in preventing HIV transmission. “We have previously shown that displacement and lack of safer indoor options for street-based sex workers are directly associated with elevated rates of violence and HIV risk,” says Dr. Kate Shannon, the senior author of the study. Of course, having easy access to healthcare workers with harm reduction supplies also helps.

Workers also reported that being housed inside made them feel safer from police harassment and violence. While many of the workers interviewed for the study were quite weary of police, they found that they felt safer when placed in one of the housing projects.

As one sex worker explains: “On the corner, doing it in the car, I used to be scared all the time, paranoid about cops, scared of getting charged. It is a lot easier now. It is different.”

Less fearful relationships with police as well as access to trained healthcare staff and harm reduction supplies are meeting survival sex workers where they are at. “We have created policies and practices that support women’s choice and ensure their health and safety are protected,” says Amelia Ridgway, Manager of RainCity Housing. “Women have the right to govern their own bodies. We believe that housing is a human right and this is about providing women with the most basic human rights around protection from violence within a harm reduction framework."

This study reinforces the need and effectiveness of safe, indoor sex work spaces which is very encouraging for the sex work community. “Safer sex work spaces support better health and safety, period,” said Dr. Patricia Daly, Chief Medical Health Officer, Vancouver Coastal Health.

Kathleen Cherrington who has organized events such as the International Day To End Violence Against Sex Workers says that perhaps more intentional work spaces may be a next logical step. Not everyone wants to bring their work home with them. “Some sex workers have children and need a place to work that isn't from home. So we also need brothels that are for those wanting a place to work that is away from home,” says Cherrington.

The West Coast Cooperative Of Sex Industry Professionals has formulated a business plan which includes a collectively run sex work space where workers can take their dates. This would be a multiple room establishment where folks could pay per use. Their vision is described as similar to a bath house, with showers, towels and safer sex supplies avaialble to both workers and patrons. The hope would be that as patronship increased, costs could be kept low. Unfortunately, this plan was formulated quite some time ago and has not come to fruition due to both a lack of funding (capital) and legality issues.

This study comes on the heels of a legal development that the sex working community sees as encouraging. The Supreme Court of Canada has ruled that prohibiting bawdy houses is unconstitutional, as it increases the dangers faced by those who are forced to work on the streets. While the Conservative government is currently in the process of challenging this decision, it may very well find its way into the practices of law enforcement in Vancouver.

In the meantime, Ricketts feels that more housing, like the facilities in the study, are sorely needed in Vancouver and that no survival sex workers should go without a home. “In my opinion, being homeless is violence,” she says. “So providing housing is paramount to reducing violence against women.”

Eli Mills is a contributor to the Vancouver Media Co-op.

This article was originally published by the Vancouver Media Co-op.

Trina Ricketts

The Other Drug Trade

hillarybain — Fri, 25 Feb 2011 06:03:44 +0000

New bill could make cheap HIV meds easier to access

HALIFAX—On March 9, Members of Parliament will have a very simple choice to make, according to Richard Elliott, executive director of the Canadian HIV/AIDS Legal Network. They can vote for Bill C-393, and make it easier for people in the developing world to access affordable HIV medication.

“When you could do something with the most minimal of efforts to prevent these [HIV related] deaths from happening, to not [do so] is profoundly immoral,” says Elliott.

Despite Elliott’s confidence in the importance of the Bill, its passing on March 9 in the House of Commons is far from certain.

Bill C-393 seeks to amend a piece of legislation enacted in 2005, known as Canada’s Access to Medicine Regime (CAMR). CAMR was created to help Canadian generic companies produce and export generic medicines at reasonable prices to the countries that need them most.

In 2009, almost 15 million people in low- to middle-income countries were living with HIV, and only five million of them received treatment, according to the World Health Organization (WHO).

Despite these numbers, CAMR has been used only once. Advocates for Bill C-393 argue that CAMR is too complicated and must be fixed to make it easier to export affordable medication.

Apotex, a Canadian generic drug company, successfully shipped anti-HIV drug Apo-TriAvir to Rwanda in 2008 and 2009 under CAMR. The shipments contained enough medication to treat 21,000 people living with HIV for one year.

Turns out, this feat was a one-hit wonder.

“We're not likely to repeat the process under [CAMR],” said Bruce Clark, Apotex’s Senior Vice-President, Medical and Regulatory affairs. Clark says CAMR is not easy to use. “It’s a practical reality that no second country has made a request under the regime because it’s so complicated.”

Many steps are required before a shipment of drugs can be made. It took four years for Apotex to complete the process and get their shipment authorized by the Canadian government.

Four years is a long time to wait, considering approximately two million people died from AIDS in 2009, according to the WHO.

Despite this, the pharmaceutical industry insists Apotex’s process was “extremely quick” and CAMR is working well.

“There was tremendous co-operation on the industry’s part because we support the intention of CAMR,” said Wendy Zatylny, Vice President of Government Affairs at Rx&D, the association of research-based pharmaceutical companies in Canada.

Rx&D represents the interests of 50 drug companies, including GlaxoSmithKline (GSK), Shire and Boehringer Ingelheim, which were the three patent holders for the drugs that Apotex needed to produce Apo-TriAvir.

Apotex requested voluntary licenses from the three companies in July 2007. Within a month, all three responded and granted permission to manufacture the drugs royalty-free, according to Rx&D’s records.

Many conditions were attached to the voluntary licenses.

“Two of the patentees went so far as to expressly reserve all rights with respect to their trademark rights, effectively threatening suit,” Clark said.

In the end, after fruitless negotiations, the patent holders retracted the voluntary licenses and Apotex applied for a compulsory license in September 2007 under CAMR, he added.

It took 68 days from the time Apotex asked for voluntary licenses to when the government granted the compulsory license. But the entire process took four years because of the details Apotex needed in order to start the process in the first place.

“We were turned back as the request was, in their words, 'premature' as no country had confirmed an order,” Clark said

The developing country has to put forward a request for an exact quantity of drugs to be produced and exported in order for the process to begin. It is difficult for a country to accurately estimate the amount of medicine it needs at any given time. This is particularly true for infectious diseases like HIV, where predicting how many people are infected, and will be infected in the near future, is difficult.

In addition to the barriers to getting permission for exporting generic drugs, CAMR mandates an expiry date of two years on the compulsory license.

Once Apotex had delivered medication to Rwanda, the country wanted to order more. In order to do this, however, both Rwanda and Apotex would have had to go through the entire process again.

So they didn’t.

After this one and only experience working with CAMR, its advocates started discussing how to improve it. The outcome was Bill C-393, which former NDP MP Judy Wasylycia-Leis introduced as a private member’s bill in 2009.

The bill proposes a “one-license solution.” If passed, a generic company would be able to distribute drugs anywhere in the developing world simply by getting a single license from the brand-name companies. This would eliminate the daunting task of having to negotiate a separate license for each country that makes a request.

Furthermore, the bill wants to expand the list of drugs that qualify for compulsory licenses. CAMR only allows the export of certain drugs for certain diseases. Advocates of the bill argue that this list is too restrictive.

“That’s an unnecessary and unjustifiable restriction to the [CAMR] regime,” said Elliott. “It is both unethical and bad public health policy for Canada to tell developing countries that CAMR can only be used to get certain medicines for certain public health problems.”

A parliamentary committee gutted these two provisions from the bill in November 2010. The Conservative MPs in the committee and Liberal Marc Garneau took the position that CAMR works in its current form, a stance shared by Rx&D.

The removal of these provisions from the bill did not come as a shock to Elliott.

“I think there is of course tremendous pressure from Big Pharma,” said Elliott. “They're all over Parliament Hill arguing against the bill.”

During the second vote on the bill in 2009, the liberal MPs who voted against it sat in ridings where many pharmaceutical companies reside. For example, Abbott Laboratories, AstraZeneca and GSK operate within the ridings of Liberal MPs Marc Garneau and Stephane Dion.

In January this year, NDP MP Megan Leslie re-introduced the provisions as amendments to the bill in hopes of salvaging it. These amendments will be voted on in March.

While parliament continues to fight out this battle around reforming CAMR, the developing world faces a cruel reality. There is currently a global deficit of anti-HIV drugs suitable for children and many countries don't have the manufacturing capacity to develop and produce them.

"Unless Apotex or any of the other generic companies see a potential market, they're not going to go ahead on their own to produce the pediatric formulas," said Joel Lexchin, professor at York University. "And there's no market without a reformulation of CAMR."

Apotex has already committed to making and delivering infant and children-suitable HIV drugs if parliament votes to fix CAMR.

“It’s hard to imagine why there’s so much resistance to making this bill more workable and I think we continue to say whose interest[s] we’re protecting in the way the bill currently stands,” Clark from Apotex said. “It’s clearly not those of the developing world and not those [of people] suffering from AIDS.”

Steph Law is a freelance journalist, health rights activist and an epidemiologist. @lawsteph

CAMR 1

CAMR 2