Harm Reduction in Victoria: Reflections on an Ongoing Battle.
(Please note that this post was updated on Friday, June 8 to reflect more current information regarding the zoning of harm reduction in Victoria. See Section II. -FC.)
By Fathima Cader, Pivot Legal Intern.
Last week was Community Solidarity for Harm Reduction Week in Victoria, comprising a series of events put together by a coalition of local organisations to mark the fourth anniversary of the closure of Victoria's only fixed-site needle exchange program. Pivot, in the forms of myself, Scott Bernstein, who heads our Health and Drug Policy campaign, and Darcie Bennett, our Campaign Director, were honoured to be there to share our experiences here in Vancouver and to learn about the situation in Victoria. I’m happy to report back that my time hanging out with harm reduction activists in Victoria was inspiring and informative – and here’s why.
I. The History of Harm Reduction in Victoria.
In 1987, AIDS Vancouver Island (AVI) began operating fixed-site needle exchange services in Victoria. AVI, with funding from the Vancouver Island Health Authority (VIHA), opened its needle exchange on Cormorant Street in downtown Victoria in 1999. At that time, they served about 200 clients. By 2007, that number had ballooned to 1,500 people. However, without a parallel increase in funding or resources, staff were left to struggle to meet the demand, with clients having to wait on the street to get into the tiny storefront.
Had this been some other kind of establishment – one that administered, say, coffee, not healthcare – there likely would have been a second Starbucks at that corner in no time. Instead, a select handful of Victoria residents and business mounted protests against the needle exchange, culminating in the program’s eviction on May 31, 2008.
The chilling effect of that eviction has been disastrously long-term. Landlords in area, four years on, remain unwilling to host the program for fear of re-inviting NIMBY (Not In My Backyard) protests. And so, AVI has had to move their needle exchange services to a mobile delivery model, with staff providing daily service on foot and on bicycles and from a van. (For more information, see Harm Reduction Victoria’s (HRV) summary of the needle exchange’s history and this short documentary on Rig Dig, a needle retrieval program in Victoria.)
While certainly better than nothing, the mobile model is not enough. Indeed, research by the Centre for Addictions Research of BC at the University of Victoria has shown that rates of needle sharing in Victoria increased following the fixed site’s closure – despite ongoing efforts by medical workers to distribute needles through mobile methods. Moreover, fixed-site needle exchange programs are more effective than mobile models in providing high quality medical care and in referring people to treatment, detox and housing services. (For more information, see AVI’s compilation of local research on harm reduction.)
II. Where Angels Fear to Tread?: Harm Reduction in the “No Go Zone.”
During my three brief days in Victoria, one issue that came up especially often was how little space the mobile dispensing services have within which to operate.
The least restrictive measure is that of “No Service Areas,” which are areas directly adjacent to the front entrances of establishments, like businesses and schools. AVI’s Code of Conduct (as of May 2008) stipulates that “AVI outreach teams will not provide service within a No Service Zone. The teams may stop in a No Service Zone if signaled by a client. The client will be informed that services cannot be provided within the No Service Zone. The client may then choose to meet the team at an appropriate area for service outside of the No Service Zone” (page 1).
The much more egregious restriction is that of “No Go Zone,” an area spanning several large blocks in Victoria’s downtown core. This area is highly frequented by drug users. As per its “VIHA Health Facts” (as of November 2008), VIHA has prohibited AVI from providing any kind harm reduction service within this area. Somewhat confusingly, the Health Facts’ summary of AVI’s Code of Conduct is misleading, especially in the way it conflates the No Service and No Go Zones. It is also worth noting that the No Go Zone, at least in terms of how its borders are policed, in facts span a larger area than suggested by VIHA here. That said, the VIHA document is certainly correct noting that the restrictions were “developed in May 2008 by AVI with input from VIHA, the City of Victoria and the Victoria Police Department.” That police can function as stakeholders in the formation and regulation of health policy is deeply troubling.
Regardless of their affiliation, clients and workers told me about how they are heavily surveilled by police in the region. Workers noted that asking people to follow them just a few blocks down to access clean supplies is ineffective, as many people simply could not relocate. The Victoria Police Department has even intimidated a pharmacy in the Zone that distributes clean needles (see HRV’s response). It’s also worth noting that AVI’s Code of Conduct requires that if clients engage in “inappropriate behavior” near the mobile vehicle, “staff will call the police, if necessary, and move the vehicle to another area” (page 1).
The police’s involvement in the “development” of the No Go Zone and their intimidation of people in and around the Zone is a distressing example of police misuse of power in affairs that should strictly be the domain of medical staff. (For more information on the policing of street-involved people in Victoria, see the Vancouver Island Public Interest Research Group’s (VIPIRG) January 2012 report “Out of Sight: Policing Poverty in Victoria, Coast and Straits Salish Territories.”)
III. May 28-31, 2012: Community Solidarity for Harm Reduction Week in Victoria.
Victoria’s Community Solidarity for Harm Reduction Week was well underway when I arrived in Victoria on the afternoon of Wednesday, May 30. I’d left Vancouver early that morning, got on a bus that got on a ferry, and headed over to St John the Divine for the Peer Convergence, an all-day conference organised by drug users through Street College, a partnership project between AVI and SOLID. One of the event’s long-term goals is to turn the Convergence into a national conference for drug users. The organisers had invited 50 peers (former or current drug users) and strategic allies to learn from the perspectives of drug users on how to support and implement harm reduction programs. Pivot was one of those allies, and I was honoured and excited to be attending the Convergence in that role.
I attended the workshop on harm reduction, facilitated by Heather Hobbs and Jude Smith. Participants defined harm reduction as a philosophy and practice that spans a wide spectrum of services (such as prevention, equipment distribution and retrieval, supervised consumption, treatment, and detoxification), provided through variety of delivery options, all with the goal of supporting people in making decisions for themselves. Participants also stressed how important it is that mainstream society recognise that people who use drugs have the interest and capacity to take leadership in the harm reduction movement, and that fostering community- and peer-based and driven movements is an especially important way to counter the stigmatisation of drug users. While analyses that centre “public harm” take a prescriptive approach, one that mandates the surveillance of drug users, a peer-based approach is grounded in the practicalexperiences of people who have “been there, done that.” Tangible details that may be lost on service providers (for example, that it does not hurt to insert clean needles, but does to insert dirty ones) are often of great importance to clients. Participants also stressed that harm reduction is about more than the provision of drugs; to be effective, it must engage with the numerous factors that impinge on people’s abilities to make informed decisions about their lives, which contradicts popular “bad choice” rhetoric. They also talked about how the concentration of drug user community in Vancouver's Downtown East Side would have naturally encouraged harm reduction activism in that neighbourhood, but drug users in Victoria are much more dispersed throughout the city, making organising concerted actions more difficult.
On Thursday, Scott arrived. We made a brief stop at the AVI offices, and then we headed over to “Why InSite won: A forum on the community struggle for Vancouver's supervised injection site.” The forum was presented by AVI, the Beddow Centre, HRV, Pivot, SOLID, VIPIRG, and Victoria AIDS Resource & Community Service Society (VARCS). James Boxhall, AVI’s executive director, described the forum’s importance this way: “As long as we have a deficit of services for one group in our community, there is a deficit in the health of the community as a whole.”
Besides Scott, the speakers included Liz Evans, executive director of the Portland Hotel Society, which operates Insite in Vancouver; Dean Wilson, a community activist who was one of the litigants in the Insite case; and Kenneth Tupper, Director of Problematic Substance Use Prevention, BC Ministry of Health. The presenters spoke to a packed room about the social, legal, and policy considerations of harm reduction. Of particular note was Kenneth’s summary of the sections in the Ministry’s 2005 report “Harm Reduction: A British Columbia Community Guide,” which provides a “plan of action” for how municipalities can “provide leadership to support, or at least not impede, local responses to harm reduction” (page 13).
On Friday, Darcie arrived, and our trio was complete, in time for Scott and Darcie’s facilitation of a YIMBY (Yes, In My Backyard) workshop in the Victoria Public Library. As Darcie had previously pointed out, “issues of neighbourhood opposition can become a real barrier even in cases where political funding and approval are there.” (For a history of NIMBYism in Victoria, check out this University of Victoria student newspaper article.)
Participants were not only very enthusiastic about learning to implement YIMBY projects, they were also very informed about relevant best practices. Conversations about the efficacy of “Good Neighbour Agreements,” which Pivot has used in its Vancouver-based housing campaigns, were especially live, as similar agreements have in fact already been used to repress, rather than foster, harm reduction services in Victoria. As at the Convergence, participants stressed the importance of ensuring people who use drugs are involved in the development, delivery and evaluation of harm reduction programs.
IV. Looking Forward.
And so, as I took the ferry back home on Friday evening, my mind was whirring with thoughts about the imperative nature of health policy; about the appropriate role of allies and non-profits in these street-based struggles for life-saving medical practice; and about how it is that police can so openly dictate the provision of health care – it cannot be in the public’s interest that people with guns get to decide if people with illnesses get to access medical aid; it certainly isn’t in the police’s mandate.
But, coming back to Vancouver after those three brief days in Victoria, I was also awash with gratitude that I’d had the chance to meet such an inspiring and dogged community of medical workers and community organisers – and with excitement for all the incredible community organising that is sure to follow.
From Vancouver to Victoria, with love!