Abstract
In the area of infectious disease control, Canadian research efforts to address the HIV epidemic in Vancouver’s Downtown East Side neighbourhood have fueled the development of harm reduction and health equity perspectives worldwide. These research efforts have, in turn, reshaped the field of public health approaches to HIV prevention and control. As a result of the intensive and sustained research initiatives led by Canadian scientists Drs. Thomas Kerr and Evan Wood, the ‘HIV problem’ and public health responses to it have been radically reconceptualized–shifting from an exclusive focus on individual choice towards asking fundamental questions about our society and the structural features that put people at risk for contracting HIV. Their research on harm reduction and health equity related to HIV vulnerability and outcomes has informed and shaped: 1) the establishment of North America’s first supervised injection facility, Insite, located in Vancouver’s Downtown East Side neighbourhood; 2) dramatic changes to Vancouver’s needle exchange policies; 3) HIV treatment approaches among injection drug using populations (IDU). By drawing attention to the ways in which Canadian health care policies and programs can be restructured to better support the health of vulnerable populations, the work of Drs. Kerr and Wood represents a uniquely Canadian public health milestone.
Key words: Infectious disease transmission, HIV, drug addiction, harm reduction, injection drug use, supervised injecting facilities
Résumé
Dans le domaine de la lutte contre les maladies infectieuses, les efforts de recherche canadiens pour contrer l’épidémie de VIH dans le quartier Downtown Eastside de Vancouver ont favorisé le développement de perspectives de réduction des méfaits et d’équité en santé partout dans le monde. Ces efforts ont à leur tour transformé les approches de santé publique à l’égard de la prévention et de la lutte contre le VIH. En raison des initiatives de recherche intensives et soutenues dirigées par deux scientifiques canadiens, Thomas Kerr et Evan Wood, le « problème du VIH » et la réponse de la santé publique à ce problème ont été radicalement reconceptualisés. On est passé d’une optique exclusivement axée sur le choix personnel à la formulation de questions fondamentales sur notre société et les aspects structuraux qui exposent les gens à contracter le VIH. Leurs recherches sur la réduction des méfaits et l’équité en santé par rapport à la vulnérabilité au VIH et aux résultats cliniques de l’exposition au virus ont étayé et façonné: 1) l’établissement du premier site d’injection supervisé en Amérique du Nord, Insite, dans le quartier Downtown Eastside; 2) les changements radicaux dans les politiques d’échange de seringues de la ville de Vancouver; et 3) les approches de traitement du VIH dans les populations consommatrices de drogues par injection. En attirant l’attention sur les façons possibles de restructurer les politiques et les programmes de soins de santé au Canada pour mieux protéger la santé des populations vulnérables, les travaux de Kerr et Wood représentent un jalon typiquement canadien de la santé publique.
Mots clés: transmission de maladies infectieuses, VIH, dépendance, réduction des méfaits, toxicomanie intraveineuse, sites d’injection supervisés
Footnotes
The authors developed the case for this nomination based on a large body of scientific evidence generated by Drs. Kerr and Wood and their collaborators at the BC Centre for Excellence in HIV/AIDS as well as research collaborations undertaken elsewhere in Canada and internationally.
Acknowledgements: We thank Kelly Hsu, Deborah Graham, Tricia Collingham and Carmen Rock for their assistance.
References
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