Vancouver, Canada is home to one of the worst epidemics of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in the developed world. Injection drug users are the most affected persons; as many as 40 percent of them in Vancouver's impoverished Downtown Eastside are living with HIV/AIDS. On April 7, 2003, the Vancouver Police Department launched a major crackdown in the Downtown Eastside of which the stated purpose was to clear the streets of drug dealers. Health and social service providers, some government officials, and many injection drug users fear that one of the main consequences of this aggressive crackdown will be to fuel a new wave of transmission of HIV and other blood-borne and sexually transmitted diseases as well as to increase the risk of complications from overdose, including death.
Operation Torpedo, as the crackdown is commonly known, continues as of this writing. It apparently succeeded in clearing the streets of some of the drug dealers sought by the police, but at a high cost. In a brief stay in the Downtown Eastside toward the end of the first week of the crackdown, Human Rights Watch documented numerous cases of unnecessary use of force and illegal search and seizure by the police directed against persons, mostly injection drug users, who were not charged with dealing drugs. These actions, which violate Canadian and international human rights guarantees, contributed to driving drug users underground and away from life-saving HIV prevention and other health services. Out of fear of police harassment, drug users have curtailed their use of needle exchange programs, a vital service for HIV and hepatitis C prevention. Street-based health services, crucial to injection drug users and the homeless, have been greatly impeded, causing some health workers to fear a major new wave of disease transmission.
City officials in Vancouver, most notably Vancouver's recently elected mayor, Larry Campbell, claim to be committed to a "four-pillar" approach to narcotics drug use, including treatment (for drug addiction), prevention, harm reduction, and law enforcement. The city council has thus far refused the police department's request for extra funds to finance the crackdown; however, since Campbell's term began in January 2003, the crackdown has represented Vancouver's only conspicuous anti-drug initiative. A long promised safe injection site-a location where injection drug users could inject drugs under medical supervision and without police harassment and be referred to other services-remains unrealized. An effective street-based needle exchange program operates on a shoestring. The city government said the treatment and harm reduction "pillars" will be built up as part of a $50 million (U.S.$34.5 million) plan, but the plan remains unfunded. The four pillars, as one activist said, appear to be "a tree trunk and three toothpicks."
Vancouver is one of two cities being considered by the International Olympic Committee to host the winter Olympics in 2010; the host city will be chosen in July 2003. As the time of that decision approaches and the temptation to "clean up" the city grows stronger, the risk of human rights violations that fuel HIV/AIDS and hepatitis C as well as severe illness and death from overdose among the city's most marginalized persons will also grow unless the city's strategy changes. Experiences from around the world have shown that HIV transmission increases with the incidence of abuse and stigmatization faced by those most at risk of the disease. Failing to learn this lesson, for Vancouver and the injection drug users who make the city their home, would exact a high and avoidable human cost.
 According to the Vancouver Police Department, the term "Operation Torpedo" refers to an undercover investigation carried out immediately prior to the campaign documented in this report. Much of the local press in Vancouver continued to use the term "Operation Torpedo" after the campaign began.
 Harm reduction refers to actions designed to diminish the individual and social harms associated with drug use, including the risk of HIV infection, without requiring the cessation of drug use. In practice, harm reduction programs include needle exchange, replacement therapy using substances such as methadone, health and drug education, HIV and sexually transmitted disease screening, psychological counseling, and medical referrals. For more information on harm reduction, see the web site of the International Harm Reduction Development program of the Open Society Institute, www.soros.org/harm-reduction.