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IV. BACKGROUND
Vancouver, British Columbia, Canada, a city renowned for the mountains and beaches that have made it a tourist magnet, is the home to what is arguably the worst AIDS epidemic in the developed world. The Downtown Eastside of Vancouver is among the most impoverished neighborhoods in Canada.3 The ten-square-block neighborhood with an estimated population of 15,870 is home to about 5000 injection drug users.4 A high rate of overdose deaths and other health complications of drug use have been observed in Downtown Eastside for many years. During the last mayoral election campaign in 2002, one candidate frequently cited the figure of 1200 drug users having died of overdose or drug-related death in Vancouver in the previous ten years.5 An explosive HIV/AIDS epidemic in the neighborhood came to national attention in the mid-1990s. In 1997, an epidemiologist at the University of British Columbia estimated that injection drug users were being infected with HIV at the rate of about 20 percent per year,6 high by any standard. HIV prevalence among injection drug users in the Downtown Eastside stands at an estimated 30 to 40 percent,7 comparable to some of the worst epidemics in developing countries. (HIV transmission through use of contaminated injection equipment is generally more efficient than through unprotected sex.) If 30 percent of 5000 drug users in the Downtown Eastside's drug users are HIV-positive, they would account for a very large proportion of the HIV-positive injection drug users in Canada.8 The HIV-related death rate in the Downtown Eastside was estimated in 2001 to be about thirty-eight times that of the province of British Columbia as a whole.9 It is estimated that over 90 percent of the injection drug users in the neighborhood have contracted hepatitis C.10 In the face of an AIDS epidemic increasingly affecting injection drug users, the Canadian government at all levels has invested in both law enforcement and harm reduction-that is, measures such as syringe exchange and substitution (methadone) therapy that aim to minimize the infectious disease and other harms associated with injecting drugs. Many jurisdictions in Canada, including Vancouver, have invested in needle exchange programs that provide sterile syringes to injection drug users and dispose of used syringes safely.11 Methadone maintenance therapy12 is also supported by the Canadian government. Drug users themselves reported to Human Rights Watch that methadone access in Vancouver and British Columbia is very good.13 In April 2002, a report commissioned by Health Canada, the federal health ministry, called on the government to allow the establishment of safe injection sites-facilities where users can inject drugs in a calm, clean and medically supervised setting, usually with access to other medical services.14 The government since proposed that three such sites be established around Canada as a pilot project.15 In November 2000, the Vancouver city government released a paper proposing a "four-pillar" approach to drug problems in the city, where the pillars were prevention of drug use, harm reduction, treatment including detoxification programs, and law enforcement to combat drug trafficking.16 In November 2002, Vancouver elected a mayor and a number of city council members who were affiliated with the so-called Coalition of Progressive Electors (COPE) whose platform included support for protecting the rights of drug users and ensuring safe access to sterile syringes and other harm reduction measures, including a safe injection site.17 The newly elected mayor, Larry Campbell, promised before the election that if elected he would ensure that a safe site would be up and running by January 2003.18 In general, the harm reduction and treatment parts of the four-pillar approach have received relatively little government support compared to law enforcement measures. The city government announced that it has a $50 million (U.S.$34.5 million) plan for the three pillars-treatment, prevention and harm reduction-other than law enforcement, but it lacks the funds to implement the plan.19 This resource allocation in Vancouver reflects a national pattern. A 2001 report of the federal auditor general indicated that over 90 percent of federal monies devoted to combating illicit drugs was devoted to law enforcement activities.20 Indeed, the city of Vancouver's response to injection drug use since the announcement of "four pillars" has included numerous police crackdowns, some of which have impeded access of drug users to needle exchange services. In June 2002, the sidewalk needle exchange service operated by the Vancouver Area Network of Drug Users (VANDU) under the auspices of the Vancouver Coastal Health Authority, a government body, was shut down by a police raid.21 Needle exchange providers said this was a turning point and signaled a "harder line" by the police in its "war on drugs."22 The police had alleged that illegal activity was being conducted near the table, but the chief of police later apologized, and the sidewalk service was reopened.23 A November 2002 report by Pivot Legal Society, a Vancouver-based NGO, published the affidavits of drug users in the city who had experienced what Pivot concluded to be torture and beatings, unreasonable use of force, arbitrary and unlawful arrest, unlawful searches, and harassment at the hands of the city police.24 A number of Pivot's witnesses reported severe beating by police officers after they were already in custody and in handcuffs, and several suffered broken bones and teeth. Of the thirty-six persons who recounted to Pivot unreasonable force by the police, only eight ever finally had charges brought against them.25 The Pivot report was preceded by two survey-based studies documenting extensive police misconduct on the Downtown Eastside, not only against drug users but against sex trade workers as well.26 From November 2002 to January 2003, the Vancouver police again increased their presence around the site of the VANDU sidewalk needle exchange with a round-the-clock or "24/7" presence.27 The police referred to this operation as the "Seinfeld approach" in which they did nothing but make sure they were visible.28 This operation had the effect of moving the densest population of injection drug users and sidewalk dwellers from the corner of Main Street and Hastings Avenue, the location of the Carnegie Community Center, to a location about a block away. It also caused a reduction in the number of needles exchanged through the VANDU service.29 In January 2003, six Vancouver police officers were suspended from duty when they were accused of taking three suspected drug dealers to a parking lot near the city's Stanley Park and beating them severely.30 A case against the police was brought to the Vancouver provincial court; the next hearing is scheduled for May 7.31 The Stanley Park incident occurred a few weeks before the visit of the International Olympic Committee to Vancouver.32 Vancouver is a candidate city for the 2010 Olympic winter games; the city is dotted with banners saying, "We support the bid" and "Candidate city 2010." VANDU also agreed in March to move its sidewalk needle exchange service from the area outside the Carnegie Center to a nearby indoor location,33 a move that coincided with the visit of the International Olympic Committee delegation. Reportedly spurred in part by the prospect of the opening of a safe injection site, the Vancouver Police Department brought to the city council on March 27 a request for support for a "special enforcement team" for drug-related crimes to consist of sixty officers.34 The strategy of this special unit, according to the Police Department request, was to maintain a very visible physical presence in the Downtown Eastside; the request cited the example of New York City in this regard. The proposal to the city council said the greater police presence would be "important to ensuring this measure [the safe injection site] has every chance to make a difference and succeed." Since the launch of the crackdown, Mayor Larry Campbell has reiterated his support for a pilot safe injection site for drug users in the city.35 City officials said their application for a safe site was delayed as they waited for guidelines from the federal health ministry to apply for funds to support the site, and the application was submitted to Ottawa on March 7, 2003.36 The city council refused the police request for extra officers for the purpose of this crackdown.37 The Police Department, however, went ahead and reallocated forty officers from other parts of the city to the Downtown Eastside, joining the twenty already assigned there, beginning on April 7, 2003.38 The resulting labor-intensive action in the neighborhood was commonly referred to as Operation Torpedo. 3 The Downtown Eastside is reported to have the lowest per-capita income of any postal code-determined zone in Canada. Government of Canada, Statistics Canada, Population Census of Canada, 1996. 4 See British Columbia Centre for Excellence in HIV/AIDS and St. Paul's Hospital, Community Health and Safety Evaluation (CHASE) Project, Semi-annual Report, February 2003, p. 6.; and Pivot Legal Society, "To Serve and Protect," November 2002, http://www.pivotlegal.org/beta/aff/pivot_toserveandprotect.pdf (retrieved April 17, 2003). 5 Clifford Krauss, "A would-be mayor's mission: `Safe injection sites'," New York Times, November 15, 2002, at A1. 6 See, e.g., David Crary, "AIDS Epidemic Rages in Vancouver," Associated Press, October 16, 1997. 7 See Joel Baglole, "Vancouver Drug Facilities Draw Ire of U.S. Officials," Wall Street Journal, April 1, 2003, citing an estimate of 40 percent HIV prevalence among drug users in the Vancouver area. See also B. Fischer, J. Rehm and T. Blitz-Miller, "Injection drug use and preventive measures: A comparison of Canadian and Western European jurisdictions over time," Canadian Medical Association Journal, vol. 162, number 12, pp. 1709-1713, which suggested that the HIV prevalence in the Downtown Eastside in 2000 was 23 to 30 percent. 8 Government of Canada, Health Canada, Centre for Infectious Disease Prevention and Control, "HIV/AIDS Epi Update," April 2002. 9 CHASE Project, Semi-annual Report, p. 4. 10 Ibid., p. 5. Hepatitis C is a blood-borne and sexually transmitted viral infection causing liver inflammation. Most patients respond to treatment with costly pharmaceutical drugs. Hepatitis C is the leading cause of liver transplantation in the United States. See U.S. National Institutes of Health, Medical Encyclopedia at
11 In September 2002, Human Rights Watch and the Canadian HIV/AIDS Legal Network gave an award to the Vancouver Area Network of Drug Users (VANDU), a drug users organization founded in 1998, for its work on harm reduction and respect for the rights of drug users, including its provision of an extensive needle exchange service in the Downtown Eastside. 12 Substitution or maintenance therapies such as methadone programs provide narcotics drug users with access to legal drugs that can substitute for drugs that are illegal or are obtained through illegal means. As the Drug Policy Alliance notes, these programs seek to assist drug users in switching from illicit drugs of unknown quality, purity and potency to legal drugs obtained from health services or other legal channels, thus reducing the risk of overdose and other medical complications, as well as the need to commit crimes to obtain drugs. Because methadone is dispensed orally, not injected, it also carries no risk of transmission of blood-borne diseases. For heroin addiction, methadone is a "substitution" drug of proven effectiveness. See Drug Policy Alliance, "Reducing Harm: Treatment and Beyond" [online],
13 Human Rights Watch interview with Charles Joseph Parker, president, British Columbia Association of People on Methadone, Vancouver, April 12, 2003. 14 Canadian HIV/AIDS Legal Network, "Establishing Safe Injection Facilities in Canada: Legal and Ethical Issues" (report prepared for Health Canada), April 2002. Available online at www.aidslaw.ca. 15 See, for example, "CTV News Staff, "Committee calls on Ottawa for safe-drug sites," CTV News, December 9, 2002, http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/1039456835192_34866035/ (retrieved April 18, 2003). 16 City of Vancouver, "A Framework for Action: A Four-Pillar Approach to Drug Problems in Vancouver," November 21, 2000. 17 See elements of the COPE platform online at
18 See, e.g., Frances Bula, "Injection Sites by Jan. 1: Campbell," Vancouver Sun, November 5, 2002. 19 Frances Bula and Petti Fong, "Police drug plan was six months in the making: Embarrassment over city's image drove force to act," Vancouver Sun, April 11, 2003. 20 Government of Canada, Office of the Auditor General, 2001 Report, especially Chapter 11, "Illicit Drugs: The Federal Government's Role," Ottawa: 2001. 21 Frances Bula, "Vancouver police thwart attempt to help addicts: Closing a sidewalk needle exchange shakes coalition of civic agencies," Vancouver Sun, June 6, 2002. 22 Ibid. 23 See David Carrigg, "Gimme shelter," Vancouver Courier, September 25. 2002. 24 Pivot Legal Society, "To Serve and Protect," November 2002. 25 Ibid. These included three charges for theft under $5000, and one charge for each of the following: outstanding warrant for theft under $5000, outstanding warrant for assault, driving while impaired, failure to appear as a witness in a spousal dispute, and creating a disturbance. 26 Prostitution Alternatives Counseling Education Society (PACE), "Violence Against Women in Vancouver's Street Level Sex Trade and the Police Response," 2001; data from Vancouver Injection Drug User Study (VIDUS), 2001. 27 See, for example, minutes of the meeting of the Vancouver Police Board on November 20, 2002
28 Beddall, ibid. 29 Human Rights Watch interview with Jim Jones of VANDU, Downtown Eastside, April 13, 2003. According to Jones, the 24/7 presence included positioning police cars, motorcycles and officers so that it was at times difficult for drug users to reach the needle exchange table without a close encounter with police or a police vehicle. VANDU's records indicated that the nightly average number of needles exchanged at the table before the 24/7 operation was 1200 to 1400; the figure fell to about 700 during the operation. 30 Rod Mickleburgh, "Vancouver police accused of brutality," Globe and Mail (Toronto), January 15, 2003. 31 Petti Fong, "Delay granted in case of six police officers accused in beatings," Vancouver Sun, April 12, 2003. 32 Associated Press, "Olympic officials visit Vancouver sites," March 1, 2003. 33 Human Rights Watch interview with Jim Jones, April 13, 2003. 34 Chief Constable, Vancouver Police Department, Administrative report of the Standing Committee on City Services and Budgets [memorandum], March 27, 2003 (CC File No. 3701/1601). 35 Frances Bula and Brian Morton, "Mayor kickstarts four-pillar drug plan," Vancouver Sun, April 16, 2003. 36 Ibid. 37 Frank Luba and Ian Austin, "City council torpedoes crime-crackdown funds," The Province, April 12, 2003. 38 Peg Fong and Frances Bula, "90 arrested in drug sweep: The first five days of a major campaign has produced hundreds of trafficking charges," Vancouver Sun, April 12, 2003.
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