Pamela Fayerman

One-quarter of Vancouver's female sex trade workers infected with HIV

VANCOUVER — Twenty-six per cent of Vancouver's female sex trade workers are infected with HIV, as are 17 per cent of the city's injection-drug users, a new B.C. study shows.

The study, by researchers at the B.C. Centre for Excellence in HIV/AIDS and published in the Harm Reduction Journal, is the first in Canada to estimate the per-capita prevalence ranges for high risk groups, using United Nations/World Health Organization software, 2006 Statistics Canada data and other sources such as population surveys.

Gay men, the local population of which is said to be 20,000, including male sex trade workers, have an estimated HIV prevalence rate of 15 per cent.

The overall prevalence of HIV in Vancouver is about 1.21 per cent, six times higher than the national rate.

"Drugs and sex are the preferred routes for transmission. Female sex trade workers get paid more money for having unprotected sex with johns," explained co-author Dr. Julio Montaner, who is president of the International AIDS Society and head of the division of HIV/AIDS at the University of B.C.

There are up to 520 female sex trade workers in Vancouver. Montaner, asked if the high HIV prevalence among prostitutes should trigger a warning to visitors during the 2010 Olympics, said:

"I don't want to jump on the Olympics bandwagon with this. There should be public advisories everywhere about this, not just because of the Olympics. People who avail themselves to this industry should know you better watch out.

"At home, tourists and transients may behave like star citizens and then, when people go to places like Vancouver, Vegas or Thailand, they party it up," he said.

Dr. Patricia Daly, chief medical health officer for Vancouver Coastal Health, said she had not yet read the report, so she couldn't say whether a targeted public health campaign for those who pay or trade for sex is required.

"Our message has always been that you should assume sex trade workers are HIV positive," Daly said.

"It is a high-risk activity for all kinds of infections and therefore you need to practise safe sex.

"During the Olympics, we are going to be distributing 100,000 condoms to athletes and hotels along with educational information. Whether it will specifically mention the sex trade I cannot say at this point," she said.

The high prevalence of HIV among female sex-trade workers is an emerging trend, given that in the 1980s, most infections were among gay men and in the second wave of the epidemic, injection drug users were hit hard.

"We always knew we had a significant problem, because of factors like our benign climate causing people to drift here, being a port city, and having so much poverty and so many homeless people on the Downtown Eastside," Montaner said, adding that it is difficult to know if men who buy sex from infected prostitutes are also getting infected.

"We don't have any way of accessing the johns to ask them those questions," he said. "And if we see them in our clinics, it's not like they volunteer if they got it that way. They would be more likely to report that they got it through having casual sex, or with multiple partners."

Montaner said HIV experts have made a pitch to the provincial government to "seek out and treat" HIV-infected individuals who are not on medications. It's estimated there are about 13,000 B.C. residents infected with HIV — 11,000 males and 2,000 females — but fewer than a third of them are taking such medications.

Montaner believes the number on medications should be more like 7,500. He said that would reduce the number of new infections each year from 400 to 300.

"The premier, the health minister and other government officials have been very supportive about this kind of progressive approach.

"But now with the economic downturn, we are in a waiting mode. We need an outreach program that brings treatment to the people, to make it more accessible," he said, referring to his vision of clinics in high-risk neighborhoods where such medications would be distributed.

Currently, the drugs are not taken by HIV-infected patients until their immune systems have deteriorated to a certain level. The delay-until-you-can-no-longer-delay approach is intended to save money and stall the potentially unpleasant side effects of medications. But it also means that untreated HIV patients can transmit infections.

Under another proposed strategy by Montaner's group, the "highly active antiretroviral therapy" (HAART) medications would be taken by infected patients far earlier in their disease process, so they wouldn't get the opportunity to transmit the disease.

HAART is said to be nearly 100-per-cent effective at preventing HIV by suppressing viral loads to undetectable levels and preventing people from developing full-blown AIDS by boosting the immune system. A report from the B.C. Centre for Disease Control shows that in 2007, there were only 61 full-blown AIDS cases in B.C, the lowest number since 1994, largely because of the availability of such lifesaving medications.

– Sun Health Issues Reporter
pfayerman@vancouversun.com

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