Funded by the Canadian Institutes for Health Research, the United States National Institute on Drug Abuse and the Fonds de la recherche en santé du Québec, this epidemiological study shows that the rate of new HIV infections among IDUs in Montreal has gradually declined since 1992 but that the downward trend has displayed a fourfold increase since 2001. “This finding suggests a favourable impact of  Montreal’s needle distribution program,” notes Bruneau. Drawing on observations of more than 2,000 drug addicts between 1992 and 2008, the study also revealed that needle  sharing, cocaine injection and unstable housing conditions are among the main drivers of the HIV epidemic among IDUs.

MONTREAL LEADING THE WAY

Montreal was among the first North American cities to set up needle exchange programs in the late 1980s. With support from public health authorities, Montreal now has one of the most liberal needle distribution programs in North America. Based on an exchange program, IDUs can obtain an unlimited number of syringes and other injection materials are supplied by community workers and by local community service centres. Also, a network of pharmacies that sell needles at low cost to IDUs was set up.

THE ST.LUC COHORT — AN INDISPENSABLE RESOURCE

The observed decline in infections and its relationship to Montreal’s HIV prevention programs was made possible thanks to the existence of the St.Luc Cohort. This cohort has been recruiting IDUs since 1988, and over time has become one of the only cohorts in the world able to provide information about the natural history, etiology, transmission and pathogenesis of HIV and HCV in this population. The research that it enables benefits not only from a large pool of subjects but also the possibility of following them over long periods of time. The data obtained are crucial to our understanding of the transmission dynamics and the impact of interventions.They also contribute to the application of scientific knowledge to improving the health of the population, as the present recently published study reveals.

A WORD OF WARMING

Notwithstanding the observed progress, Bruneau is quick to point out that the epidemic
has yet to be controlled: “Needle exchange and distribution programs are not enough because
they have to be part of a larger strategy.” A better understanding of the mechanisms of HIV
transmission allow for adjustments to be made to existing measures. The results of Bruneau’s
study argue in favour of a diversity of means for reaching out to and equipping IDUs, including
safe injection sites and innovative drug addiction treatment programs.