Traphouse hero: Man uses clean needles as weapon in war against HIV
Former addict Terry Grady leading group of volunteers running overnight needle exchange on foot
A figure wearing shorts, Crocs and a military backpack strides confidently through the glow of neon lights. A pug trots at his heels.
Terry Grady — ex-military member, recovering addict and former monastery resident — is headed into a high-crime, high-poverty neighbourhood on Saskatoon's west side.
Grady is following his regular route past working girls and into "traphouses," which are often controlled by gangs.
Now that he's managed to free himself from the grips of addiction — a change that happened after he was almost murdered — Grady wants to help those who haven't.
Even if they were, the local needle exchange service stops running between 11:30 p.m. and 7 a.m. Drug addicts often don't sleep, let alone live, on nine-to-five schedules.
"There's nothing available on the weekends or after a certain time of night and my phone is always on," said Grady.
"We go to drug houses, we walk down 20th Street, there's a lot of working girls down there late at night.
"We give them condoms and syringes so they can be a little more safe."
New group collects estimated 2,000 needles weekly
Grady is the founder of a new group called Saskatoon Cares, modelled after similar needle exchange outreach services in other cities.
He estimates the group of up to six people collects about 2,000 dirty needles every week, and gives out 1,000 clean ones.
The membership consists of former and current drug users and non-addicts who want to help stop the spread of HIV and AIDS in Saskatchewan.
The province has the highest rates of HIV in Canada. In 2015, the HIV diagnosis rate was 2.4 times higher than the national rate.
That's oxygen to them … You've seen a fish out of water, how it gasps? That's how they feel inside. They're gasping for it.- Former drug user Marlon Gidluck
A preliminary report released last year showed the number of HIV cases in Saskatchewan rose 10 per cent in 2016, compared with the 10-year average from 2006-2015.
There were fewer new cases in Regina and Saskatoon in 2016 than the average for the 10 years prior, but other parts of the province saw increases of up to 800 per cent.
In 2015, injection drug use was the primary risk factor in 61 per cent of new cases and more than 75 per cent of the people diagnosed identified as being Aboriginal.
A night on the street
On a warm night in early May — the first after a long, Prairie winter — Grady is in his apartment making kits to hand out on that night's delivery.
Each kit contains a needle, a rubber tie, swabs, condoms, straws for lines, "fixing water" and a heating item called a cooker.
He stuffs a box of granola bars and some juice boxes into his bulging camouflage backpack, then starts walking to the first house. He takes his dog, Mac.
He knocks on the door to the first house and offers the clean needles, which are provided for free by the Saskatchewan Health Authority.
This time, the people inside say they don't need anything.
He continues onto nearby 20th Street, toward an area where he says he often sees working girls.
Grady said it took a long time to build rapport in the houses he visits. Some are affiliated with local gangs and it took time for them to trust that he was not associated with authorities.
As a teenager in 1992 he found himself living on the streets, and remained there until 2001.
"I was 13 and living on the streets of Hamilton. I was raped. I was lured into a place on my second night on the streets and I was raped, and after that I found my way to Toronto and I was a male prostitute, and I had a big crack addiction," he said.
"It was a vicious circle so my innocence was taken away from me, so I needed to use drugs to … I thought it was my fault."
Grady found work in Alberta but kept losing jobs because of his addiction. Since then, he said he has found recovery and relapsed more than once. He believes his addiction is beatable.
He said the turning point for him was being beaten to the point that he almost died.
"I've remade myself professionally a few times in my life, and addictions keep taking me down.
"It's not a moral deficiency, it's a disease, and we start off with you know, experimenting when we're kids, peer pressure or whatever and partying, and then you cross this invisible line, right, where you can't stop."
Grady said he has been clean now for almost a year. He said his biggest concern about the work he is doing through Saskatoon Cares is being "triggered."
"I don't like to hang around too much," he said.
Calls for services to match other cities
In Saskatoon there are three needle exchange services: the health authority has a fixed site and a mobile service that runs until 11:30 p.m., AIDS Saskatoon has one that closes at 4 p.m., and there's a daytime and weekend clinic at the Saskatoon Tribal Council.
Marlon Gidluck, a former addict, said a service that fills the gap in the evening hours is "sorely needed."
"The [mobile service] is great but a lot of the time it's like 'Oh we won't be on the west-side until 9:30,' " said Gidluck.
"You're not gonna tell someone who's dope sick and ready to go with everything but the clean equipment that: 'Oh, just wait three and half hours man.'
Gidluck said some existing programs also sometimes have policies that could prevent someone from wanting to turn for help, such as the requirement that they return old needles to retrieve new ones.
He said he thinks a street outreach program will help prevent situations where a person is tempted to use dirty needles because of a lack of access to clean ones.
"I think [Grady]'s a hero. I would love to be involved in something like that but it should be the government," said Gidluck.
"The fact that this guy had to go to these great lengths and heroics is kinda sad."
Jason Mercredi, the executive director at AIDS Saskatoon, said services are limited because there is insufficient funding for needle exchanges.
AIDS Saskatoon isn't funded to run the needle exchange at its drop-in centre on 33rd Street but it pays its staff to dispense donated supplies.
Mercredi said the problem with Saskatoon's existing services is not only that their hours are limited, but that they are not reaching some of the city's most vulnerable population.
"They're there for, they could be there for months, and they're very reluctant to engage because they are in such a vulnerable state that they're quite nervous about engaging with any institution including a low-barrier service like ours."
Mercredi believes drug addiction is the one area where programming is not adjusted to meet the needs outlined by people with lived experience.
It is not realistic, he said, to expect that drug users in places like traphouses can plan ahead to stock up on needles before the services stop running.
"These folks are living in abject poverty, they don't have money to eat, they barely can pay rent if they have a place to live and their addiction is fuelled by trauma," said Mercredi.
"A lot of the folks we work with have been sexually abused from a very young age, a lot of them have been physically abused from a very young age in foster care, residential schools, so the idea that they're just going to be able to get better and operate within a system is not viable right now."
Although Saskatoon Cares is still small and operating without funding, Mercredi believes it's the type of group that can help fill that gap.
Montreal group with overnight service expresses concern
Cactus Montreal, a community organization that works to prevent blood-borne and sexually-transmitted infections, distributes 60 per cent of safe supplies for drug users in that city.
Sandhia Vadlamudy, the executive director at Cactus Montreal, said she's concerned about needle exchange services in Saskatchewan.
"I'm worried. In fact, I'm asking public health authorities to invest more in prevention and harm reduction because it's an approach that works with people like people who inject drugs," she said.
It also provides a fixed site from 2 p.m. to 4 a.m. during the week and from 2 p.m. to 10 a.m. on the weekend.
Grady said the fact there is no overnight needle exchange in Saskatoon despite the province's troubling HIV numbers is evidence that Saskatchewan has a "backward" attitude toward addictions treatment.
He believes the province has been too slow to adopt a "harm reduction" approach to treatment, which aims to minimize the negative health effects of using drugs in situations where a person is too addicted to avoid them.
Grady also can't understand why the province does not start giving out pipes as well as needles to help reduce the spread of blood-borne infection.
No plans to change mobile service hours
Dr. Johnmark Opondo, a medical health officer with the Saskatchewan Health Authority, defended the health region's HIV prevention work.
He said the programs are up-to-date, adding that the province has made significant progress.
Dr. Opondo said the province recently became the second in Canada to cover all HIV and Hepatitis C medications.
He said the existing needle programs also help introduce users to counselling and other support services if they are ready for treatment. There are no plans to change the existing hours, and service can provide enough needles to last a person overnight, Dr. Opondo said.
He described injection drug use as being just the "tip of the iceberg," suggesting root causes such as trauma are a major factor.
"If you really drill down as to why HIV and hep C is a persistent problem in Saskatchewan it's more rooted in some of our historical experiences in Saskatchewan as a people," said Dr. Opondo.
"The distribution of disease is really important to understand because that begins to indicate why we have the problem we have in Saskatchewan and why our HIV epidemic in Saskatchewan is different in Ontario."
Pipe could be option to reduce HIV transmission
Dr. Opondo said crack pipes are not being distributed like needles because powdered cocaine is more common in Saskatoon than crack cocaine, which is smoked through a pipe.
But Mercredi said pipes are also used to smoke crystal meth, a drug whose usage has spiked dramatically in Saskatoon in recent years.
"A lot of of the people that we work with that have quit shooting crystal meth, they went from injecting crystal meth, to smoking crystal meth and then to stopping crystal meth, and so it's a nice stepping stone for people who do want to quit," he said.
He said the federal government needs to step up and offer more, not only for urban centres like Saskatoon but for regions where HIV rates are the highest.
"I think everybody is doing the best job that we can. Now, are we effective? I think the rates show that we're not being effective," he said.
"So you can place the cause wherever, but either way we need to step up and we need to improve service delivery."
He said opening a safe-injection site is one way to improve the situation in Saskatoon. Dr. Opondo said discussions about that are underway, but he could not say if there is any commitment to make that happen.
Saskatoon Cares wants to grow
Grady is working to turn his group into an organized not-for-profit with funding. He said operating without any funding means it's harder to find people to walk the streets with him at night.
Back on the street in May, Grady goes into one house he knows to be affiliated with gangs in the city.
When he emerges, he is cautious not to reveal too many details about what he sees inside the houses, to preserve the privacy of the people inside, and because he said he wants to reduce stigma.
But Grady tries to summarize what he saw the best way he can.
"It looks like a warzone," he said.
At the last house he visits that night in April, the people inside say yes — they do need clean needles. Grady leaves with a canister of 500 dirty ones.