More than a quarter of female sex trade workers in city infected with virus By Pamela Fayerman, Vancouver Sun March 5, 2009

 Twenty-six per cent of Vancouver’s female sex trade workers are infected  with HIV,  as are 17 per cent of the city’s injection-drug users, a new B.C.  study shows. 

 The study, by researchers at the B.C. Centre for Excellence in HIV/AIDS and  published in the Harm Reduction Journal, is the first in Canada to estimate  the per-capita prevalence ranges for high risk groups, using  United Nations/World Health Organization software, 2006 Statistics Canada data and  other sources such as population surveys.  Gay men, the local population of which is said to be 20,000, including male  sex trade workers, have an estimated HIV prevalence rate of 15 per cent.  The overall prevalence of HIV in Vancouver is about 1.21 per cent, six times  higher than the national rate.  “Drugs and sex are the preferred routes for transmission. Female sex trade  workers get paid more money for having unprotected sex with johns,”  explained co-author Dr. Julio Montaner, who is president of the  International AIDS Society and head of the division of HIV/AIDS at the  University of B.C.  There are up to 520 female sex trade workers in Vancouver. Montaner, asked  if the high HIV prevalence among prostitutes should trigger a warning to  visitors during the 2010 Olympics, said:  “I don’t want to jump on the Olympics bandwagon with this. There should be  public advisories everywhere about this, not just because of the Olympics.  People who avail themselves to this industry should know you better watch  out. At home, tourists and transients may behave like star citizens and  then, when people go to places like Vancouver, Vegas or Thailand, they party it up.” 

 Dr. Patricia Daly, chief medical health officer for Vancouver Coastal  Health, said she had not yet read the report, so she couldn’t say whether a  targeted public health campaign for those who pay or trade for sex is  required.  “Our message has always been that you should assume sex trade workers are  HIV positive,” Daly said. “It is a high-risk activity for all kinds of  infections and therefore you need to practise safe sex. During the Olympics,  we are going to be distributing 100,000 condoms to athletes and hotels along  with educational information. Whether it will specifically mention the sex  trade I cannot say at this point.”

  The high prevalence of HIV among female sex-trade workers is an emerging  trend, given that in the 1980s, most infections were among gay men and in  the second wave of the epidemic, injection drug users were hit hard.  “We always knew we had a significant problem, because of factors like our  benign climate causing people to drift here, being a port city, and having  so much poverty and so many homeless people on the Downtown Eastside,”  Montaner said, adding that it is difficult to know if men who buy sex from > infected prostitutes are also getting infected.  “We don’t have any way of accessing the johns to ask them those questions,”  he said. “And if we see them in our clinics, it’s not like they volunteer if  they got it that way. They would be more likely to report that they got it  through having casual sex, or with multiple partners.”  Montaner said HIV experts have made a pitch to the provincial government to  “seek out and treat” HIV-infected individuals who are not on medications. 

 It’s estimated there are about 13,000 B.C. residents infected with HIV —  11,000 males and 2,000 females  but fewer than a third of them are taking  such medications.  Montaner believes the number on medications should be more like 7,500. He  said that would reduce the number of new infections each year from 400 to  300.  “The premier, the health minister and other government officials have been  very supportive about this kind of progressive approach. But now with the  economic downturn, we are in a waiting mode. We need an outreach program  that brings treatment to the people, to make it more accessible,” he said,  referring to his vision of clinics in high-risk neighbourhoods where such  medications would be distributed.  Currently, the drugs are not taken by HIV-infected patients until their  immune systems have deteriorated to a certain level. The  delay-until-you-can-no-longer-delay approach is intended to save money and  stall the potentially unpleasant side effects of medications. But it also  means that untreated HIV patients can transmit infections.  Under another proposed strategy by Montaner’s group, the “highly active  antiretroviral therapy” (HAART) medications would be taken by infected  patients far earlier in their disease process, so they wouldn’t get the  opportunity to transmit the disease.  HAART is said to be nearly 100-per-cent effective at preventing HIV by  suppressing viral loads to undetectable levels and preventing people from developing full-blown AIDS by boosting the immune system. 

 Sun Health Issues Reporter pfayerman@vancouversun.com

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