Current HIV/AIDS Reports

, Volume 9, Issue 4, pp 394–400

Deadly Public Policy: What the Future Could Hold for the HIV Epidemic among Injection Drug Users in Vancouver


  • Michael V. O’Shaughnessy
    • BC Centre for Excellence in HIV/AIDS
    • BC Centre for Excellence in HIV/AIDS
    • Faculty of Health SciencesSimon Fraser University
  • Steffanie A. Strathdee
    • Division of Global Public Health, The Department of MedicineThe University of California San Diego School of Medicine
  • Julio S. G. Montaner
    • BC Centre for Excellence in HIV/AIDS
    • Division of AIDS. Department of Medicine Faculty of MedicineUniversity of British Columbia
Behavioral Aspects of HIV Management (RJ DiClemente and JL Brown, Section Editors)

DOI: 10.1007/s11904-012-0130-z

Cite this article as:
O’Shaughnessy, M.V., Hogg, R.S., Strathdee, S.A. et al. Curr HIV/AIDS Rep (2012) 9: 394. doi:10.1007/s11904-012-0130-z


The scope and scale of the HIV outbreak that occurred among injection drug users in Vancouver in the late 1990s was unprecedented and resulted in some 2,000 new HIV infections, with incidence rates reaching 18 per 100 person-years. This outbreak, localized mainly in one neighbourhood, cost the Canadian health care system more than 1 billion dollars to diagnose, care and treat. A number of factors combined to stabilize HIV incidence: 1) HIV prevalence became saturated among those at highest risk; 2) several public health policies focused on drug users were implemented, including increased and additional decentralized needle exchange programs, expanded methadone maintenance services, better addiction treatment services, improved housing, and mental health programs; and 3) increased access and expansion of Highly Active Antiretroviral Therapy. To ensure that a similar outbreak never occurs again in Vancouver and other cities, future health policy must consider the political, psychosocial and socioeconomic factors that contributed to this outbreak. These policies must address the unintended adverse consequences of past policies and their repercussions for marginalized individuals living in this community and beyond.


Injection drug usersHealth policyHIV infectionPublic policyVancouverCanadian health care systemBehavioral aspects of HIV management

Copyright information

© Springer Science+Business Media, LLC 2012