Jon Tattrie

Shining a light in the darkest corners

Most doctors have no trouble finding patients: they just go to the waiting room. But for doctors who have chosen to work with troubled, vulnerable people, even reaching their patients can be extremely difficult.

Dr. Julio Montaner, director of the B.C. Centre for Excellence, is one of the world's leading HIV-AIDS experts. Part of his work includes combating the disease in Vancouver's impoverished Downtown Eastside.

He says people on the streets have seemingly bigger problems than treating HIV.

Finding food, shelter, staying safe, dealing with mental-health problems and getting the next hit all take precedence over an invisible infection that hurts little in the early stages.

"They need places they can get services that are the number one priority for them, so that eventually … you can start addressing other issues. I always say, 'HIV is my priority, but it is not your priority,'" Montaner explains.

"The number one priority is to help these people live a better life. The second priority is to stop the stigma and discrimination that makes it so difficult to work with these individuals."

Part of that is decriminalizing drug use, he argues. "We can't continue to try to help these people because they have a drug problem and on the other hand, chase them around because they have five grams of marijuana in their pocket. We're working at odds with each other; we need to get our priorities straight."

Supervised injection sites and the medicinal use of heroin can help, too, he says.

"If we can give people the opportunity to engage in HIV treatment, these become life saving for them," he says. The treatment also vastly lowers the presence of the disease in the body, meaning it is much less likely they will transmit the disease. "Unless we do that, we are not going to be able to control the epidemic."

But many street people don't get treatment, meaning they get sick and die after being infected for many high-risk years. Montaner calls it a "reservoir of highly infectious cases that is not controlled."

"People are telling us that treatment for HIV is expensive; we're saying not to bring treatment to these people … is not only unethical, but it's actually stupid. It's more expensive not to do it."