Injection drug use and HIV infection among the seriously mentally ill: a report from Vancouver

A recently reported outbreak of HIV among injection drug users in Vancouver determined that, in early 1997, 23% of this population was HIV-positive, and that HIV-negative injection drug users were becoming positive at the rate of 18.6% per year, the highest rate reported in North America. One significant factor behind the outbreak is the high prevalence of injection cocaine use among drug addicts in Vancouver. Cocaine, because it has a short "high," creates a need for more frequent injections and therefore increases the likelihood of needle sharing and HIV transmission. The mentally ill in Vancouver are particularly at risk for HIV infection because of their vulnerability to substance misuse and because large numbers of them reside in the main drug-using neighborhood. The provincial and federal governments have made $4,700,000 available to respond to this public health emergency, to be spent on the expansion of community services, including a number of needle-exchange sites. Accessing these and other health care services continues to be a challenge for injection drug users who also suffer from serious mental illnesses; for these persons an assertive case management model may be the most effective way of maintaining continuity of care.