The number of HIV-positive patients using emergency services at St. Paul's Hospital in downtown Vancouver could be reduced with better care and housing for drug addicts, according to a report to be released today.

"If you are able to deal with their active injection drug use then you free up a lot of resources for other things so that emergency care can be used in other ways," said study co-author Dr. Robert Hogg, director of the B.C. Centre for Excellence in HIV/AIDS' drug treatment program.

The study looked at 493 HIVinfected people taking highly active antiretroviral therapy, or HAART, who also answered an extensive questionnaire. It found 153 people -- or 31 per cent of that group-- used St. Paul's emergency, mainly for skin infections typical of injection drug users, followed by injuries and poisoning.

Of those emergency room patients, the report also found:

• 90 per cent were unemployed.
• 87 per cent were on income assistance.
• 79 per cent had hepatitis C, indicating a history of drug use, although only 26 per cent reported current drug use.
• 55 per cent had unstable housing.
• 44 per cent were aboriginal.

Patients who had their condition under control with the HAART drug cocktail were less likely to end up in emergency than those who were not taking the medication properly, had unstable housing and continued unsafe use of injection drugs, said Hogg.

"If we can expand HAART therapy in the Downtown Eastside as part of the pilot program this would be useful in reducing the viral load and actually reducing the number of people coming forward," said Hogg.

The government of B.C. announced earlier this year that it will spend $48 million on a four-year pilot project to expand the HAART program to hard-to-reach patients such as sex trade workers and injection drug users in Vancouver and Prince George, in north-central B.C. The program uses a "seek and treat" strategy in which health workers go out to find people who are infected but unlikely to seek treatment.

About 5,000 HIV-positive B.C. residents are receiving HAART medication free of charge and 2,800 of those are in Vancouver.

The St. Paul's data was collected from January 2007 to January 2010.

About five per cent of patients treated in St. Paul's emergency department in the 2009-10 budget year had no fixed address, according to Providence Health Care, which runs the hospital. The emergency department budget including labour during that period was more than $12 million.

The research was to be made public today in Vienna at the 2010 International AIDS conference, chaired by Vancouver's Dr. Julio Montaner, head of the B.C. Centre for Excellence in HIV/AIDS.

The official declaration of this year's conference states that the war on drugs is helping to spread HIV/AIDS -- outside of sub-Saharan Africa -- by discouraging people from seeking medical help.

Reprinted under license from the Vancouver Sun.

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