Valerie Nicholson

Battle to beat AIDS offers lessons in fighting opioid crisis

On Vancouver's Downtown Eastside, experts in HIV/AIDS and drug overdose prevention are working together.

When asked what title she’d prefer for this story, Valerie Nicholson laughed and said, “Grandmother, first and foremost.”

It makes everything she explained later all that more powerful.

Nicholson, now a peer researcher with B.C. Centre for Excellence in HIV/AIDS, was homeless and addicted on the streets of Vancouver a decade ago.

Opioid addiction is the current health crisis in B.C. and the rest of Canada, but Nicholson was one of the thousands of Vancouver’s forgotten that were part of another prominent health crisis: the HIV epidemic.

“Addiction can happen to any one of us — it happened to me,” she said. “We can have a tragedy in our life and we go to the easiest coping skill.”

At its worst, HIV/AIDS killed more than 250 people in B.C. in 1994. Illicit drug overdoses, meanwhile, killed a record 914 people in B.C. last year.

So it’s likely no surprise that experts in both medical fields are collaborating. In fact, that is the plan at the Hope to Health Research Clinic.

The new facility, which is set to open in February, will continue the centre for excellence’s world-renowned research on HIV/AIDS and viral hepatitis, as well as substance use and addiction, on Powell Street in the heart of the Downtown Eastside.

Health Minister Terry Lake announced this week the expansion will include a new clinic called Connections, a low-barrier treatment facility set to open in the spring that will offer opioid substitution therapies like Suboxone and Naloxone, which is used to treat opiate overdose.

Dr. Julio Montaner, the man behind the lifesaving anti-retroviral therapy called HAART, will be leading Hope for Health, and Dr. Evan Wood, interim director of the BC Centre on Substance Use, will run Connections.

The clinic is prepared to serve an estimated 200 people per day, and offer personal health care plans for those seeking treatment, while also giving referrals to treatment beds and counselling — services not currently offered at the facility.

Feelings of shame and isolation

HIV-positive and a recovered crystal meth user, Nicholson dealt with the same barriers during the throes of her illness that she imagines opioid addicts face today: a lack of empathy and sympathy — sometimes even from health officials.

“I hear of doctors double-gloving still today,” when treating HIV-positive patients, she said.

Supervised drug injection sites have been a flashpoint for opponents who believe they enable drug users, create concentrated drug-tolerant ghettos and ultimately waste taxpayer money without delivering a lasting solution.

PHOTO: A tow-truck seen in Chilliwack, with a sign that reads “Give Em All Fentanyl.” (Submitted)

One comment sticks with Nicholson from back when she was in the waiting room of a dental office.

She had filled out a form and ticked the box that indicated her HIV status.

As the assistants called others around her, her name was never called and she instead received loud whispers in her direction.

“Everyone else was getting called and I hear them whispering, ‘You know she has HIV. If we ignore her, will she go away?’”

“That put down was enough to keep me down.”

A similar plan of attack

Opioid addition and HIV/AIDS don’t have a lot in common. One is a social disease, while the other is a virus that begins as infection.

But Montaner, who for most of his career has stood at the forefront of HIV treatment innovation, says the two can be tackled the same way: ensuring access to various treatment options.

Many of his clients resisted when he his groundbreaking anti-retroviral therapy, and he said it was important to also be able to offer them nutrition supplements, medical marijuana or drugs that would prevent infection.

To combat the opioid crisis, first responders and social workers in B.C. continue to treat overdoses with naloxone, and access to that medication is expanding.

The next step, he said, is a variety of choices that don’t drive people back to street illegal drugs. Those include methadone, suboxone, and diacetylmorphine, also known as medical-grade heroin.

“While injection drug use or substance use can get you sick and kill you, the illegal drug supply can kill you much faster,” Montaner said. “We can’t change that, but we can change the short-term.”

Montaner is well-known in the HIV/AIDS medical community for his unrelenting passion. And he says it stems from a simple notion: that the ideal is to die of old age.

He says treatment for those addicted to fentanyl and oxycodone, the notion should be no different.

“I will not give up, and that’s what we need to export to the addiction field. We need a holistic system that embraces people the way they are, supports them in their journey so that that then they can make whatever decision for them without pushing them to the illegal drug supply that is going to kill them.”


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