Preventing the spread of HIV: The critical role of addiction treatment services

Dr. Lois Jackson of Dalhousie University (NPI) and Cindy MacIsaac of Direction 180 (PKU) recently received some great news from CIHR. Their team’s project, Preventing the spread of HIV: The critical role of addiction treatment services, has been funded under the HIV/AIDS CBR Operating Grant program.

This research will help us to better understand the barriers and facilitators of access to and retention in various publicly funded addiction treatment programs across Atlantic Canada for people who use drugs (PWUD). It will also examine the implications of accessing and/or not accessing these critical services in terms of HIV and hepatitis C-related risks. Very importantly, the proposed approach will provide for an open and meaningful discussion with PWUD and other key stakeholders about the barriers, and potential actions for reducing them and improving access.

Addressing issues of access to and retention in publicly-funded addiction treatment program is critical to Canada’s response to HIV, not only in terms of prevention, but also in engagement and care. Studies conducted within Atlantic Canada have documented a number of systemic barriers to treatment access and retention, including various policies and practices which serve to deter, hinder or facilitate access to and success of treatment. Research is clearly needed to highlight these key barriers and facilitators and to develop strategies and actions for addressing the barriers in moving forward effectively.

For more information about this initiative, please see Stay tuned for more details.


Project Update: Additional Harm Reduction Services in Two Sites in Nova Scotia


In the spring of 2017, Dr. Lois Jackson, Diane Bailey, Christine Porter, Dr. Margaret Dechman, and the other members of the CBR team* received some support from REACH 2.0 to conduct a one-year study titled, “Additional harm reduction services in two sites in Nova Scotia: An exploration of advantages, community interest and methods of delivery.” The results will help inform decisions about additional harm reduction services in Nova Scotia, and will likely form the foundation for future research. This blog provides a brief update on the developments of this project.

A poster outlining the objectives and methods was presented at the 1st CRISM Maritimes Symposium/Exchange session held in Halifax December 5, 2017.  CRISM – Canadian Research Initiative in Substance Misuse – is a national multi-year initiative launched by the CIHR Institute of Neurosciences, Mental Health and Addiction. The theme of the CRISM symposium was Collaborative Research & Implementation Science in Addiction Intervention.

The purpose of this collaborative, community-based study is to explore what people who use drugs (PWUD) and key local stakeholders think about additional harm reduction services in their communities of Halifax and Sydney, Nova Scotia.  More specifically, the objectives are to understand what PWUD and key local stakeholders perceive as: the advantage(s) of each of the additional harm reduction services; the implementation climate (e.g. support for implementing the additional harm reduction services); and how to adapt additional harm reduction services to meet local needs (e.g. how should the services best be delivered – fixed site, mobile site, etc ?).

Additional harm reduction services for the purpose of this project refer to:

  • A no cost naloxone program for PWUD;
  • A peer-staffed community detox or withdrawal management program;
  • A supervised consumption room;
  • A peer-run navigation service (to assist in accessing supportive housing, navigating social services, etc.); and
  • A no cost needle syringe distribution and disposal (NSDD) program within existing local services (e.g., hospital emergency department).

For the Sydney site, additional harm reduction services also includes a non-governmental, community-based, low-threshold opioid substitution program, which is currently not available in Sydney (but available in Halifax).

Approval was received from the Research Ethics Boards at both Dalhousie University and Cape Breton University. The project is being conducted in two main phases, the first involving the administration of questionnaires for PWUD through Mainline Needle Exchange in Halifax (100 participants) and Sharp Advice Needle Exchange in Sydney (50 participants) sites. The second phase will be launched in early 2018, and will involve a small number of interviews with various local key stakeholders. Data collection with PWUD is almost complete across both sites, and the data analysis for the questionnaire portion will begin soon. For more information about this project, please contact Dr. Lois Jackson, School of Health and Human Performance, Dalhousie University at


  • L. Jackson1; D. Bailey2; C. Porter3, M. Dechman4, J. Gahagan1, J. Karabanow5, S. MacKenzie6, P. Melanson7, M. Proctor-Simms8, N. Tousenard9

1 School of Health and Human Performance, Dalhousie University, 2 Mainline Needle Exchange, Halifax, NS, 3 Sharp Advice Needle Exchange, Cape Breton, 4 University of Cape Breton, 5 School of Social Work, Dalhousie University, 6 Nova Scotia Health Authority, 7 Mobile Outreach Street Health, 8 NS Advisory Commission on AIDS, 9 Halifax Area Network of Drug Using People (HANDUP)


Free Naloxone Now Available in Nova Scotia Pharmacies


Naloxone, a life-saving antidote to an opioid overdose, is now much more available and accessible throughout Nova Scotia thanks to the government’s Take Home Naloxone Program, announced earlier in 2017 as part of its Opioid Use and Misuse Framework.

At the end of September 2017, Take Home Naloxone kits became available free of charge at more than 240 participating community pharmacies across Nova Scotia.  These kits are available anonymously without a prescription or health card to anyone who is at risk of an opioid overdose or is likely to witness and respond to an overdose (e.g. family/friends and frontline service providers).  Individuals wanting a naloxone kit must first complete basic opioid overdose/naloxone administration training at the pharmacy which takes approximately 20 minutes. To learn more about Nova Scotia’s Take Home Naloxone Program, including a map of participating pharmacies, visit  For media coverage surrounding this program, click here.


HANDUP Mobilizes for International Overdose Awareness Day


Held globally on August 31st each year since 2001, International Overdose Awareness Day (IOAD) is aimed at raising awareness of overdose and reducing the stigma of drug-related deaths. It also acknowledges the grief experienced by families and friends who have lost a loved-one as a result of a drug overdose.

The marking of International Overdose Awareness Day (IOAD) was extra special this year in Halifax, as a crowd of supporters with silver ribbons joined members of Direction 180, Mainline Needle Exchange, and the Halifax Area Network of Drug Using People (HANDUP) in a peaceful march to City Hall.

This was Halifax’s fourth IOAD event, and the largest to date. It was also the very first to include members of HANDUP— launched in early 2017 as the only group of people who use drugs in Atlantic Canada— and an official proclamation by Mayor Mike Savage, on behalf of the members of Halifax Regional Council,  recognizing August 31st, 2017 as “Overdose Awareness Day”.

HANDUP works to improve the lives of people who use drugs through user-based peer support and evidence-based education. Its purpose is to empower, educate and inform current and former drug users to give them an opportunity to have a voice and to impact the decisions that are made for them and about them.

The crowd gathered in front of the Mi’kmaw Native Friendship Centre, in the heart of Halifax’s North End. Marching toward City Hall in peaceful protest, participants carried signs to raise awareness and to symbolize impatience in waiting for changes to Canada’s drug policies.  Following a series of media interviews in front of City Hall, there were three moments of silence. The first was dedicated to those who have died unnecessarily from a drug overdose; the second was for their family and loved ones; and the third was to appeal for evidence-based interventions, services and supports to mitigate the risks for people who use drugs.

Natasha Tousenard, the Coordinator of HANDUP was clearly pleased with the event. “Thanks to everyone who came out to support International Overdose Awareness Day!” she stated. “HANDUP firmly believes that, to end this epidemic, we need broader support for people who use drugs and a wide range of services, including overdose prevention sites, community detox and injectable diacetyl morphine and/or hydromorphone. Today signifies our community’s willingness to have this conversation!”


HANDUP Video Sends Powerful Message


Launched in early 2017 with funding from M.A.C AIDS, HANDUP works to improve the lives of people who use drugs (PWUD) through user-based peer support and evidence-based education. As the first-ever group of PWUD in Atlantic Canada, its purpose is to empower, educate and inform current and former drug users to give them an opportunity to have a voice and to impact the decisions that are made for them and about them.

Natasha Tousenard has been coordinating HANDUP since its inception in January 2017 and her dedication, knowledge and lived-experience has been inspiring.  While the group is still in its early phases, the impact on individual members has been profound and palpable, as has the impact on the broader community.

The awareness/educational opportunity to the broader public is particularly evident in the recent release of their brief but powerful video. “This video took a lot of courage for our members to make and share with the public,” says Natasha. “The hope is to educate a larger audience on the effect of drug harm. Addiction and overdose does not discriminate.”

Produced by students as part of the Service Learning Program at Dalhousie University’s Undergraduate Medical Education Program, this video begins by stating that “An estimated 12,000 Nova Scotians are dependent on opioids. The health of people who use drugs is often impacted by: Inadequate social support networks; lack of access to appropriate health services; stigma and discrimination; mental illness; and poverty. We spoke with seven individuals affected by this growing health concern.”  Holly, Cyril, Norm, Natasha, Julien, Gillian, and Paulette are interviewed individually, and addressed questions in four main areas: Their history of drug use; the impact on their health; their experience of stigma and discrimination; and the effectiveness of Halifax’s community-based harm reduction programs.

As stated on Facebook by Julien, one of HANDUP’s members, “August 31 is now internationally known as overdose awareness day. Proclamation was given by our major and city. Another success for our team… And our short film has 50,000 views already. Well done team! Really didn’t think that this group would be going this far when I joined it honestly, and am proud and elated that we have gotten so far and only going further. Thank you Natasha, thank you Direction 180, and thanks to everyone in front and behind the scenes making all of this possible.”

The video is copyrighted but, since mid-August, can be accessed on the HANDUP Facebook page at Congratulations to HANDUP for standing up to increasing awareness!





MEPA“Meaningful Engagement and GIPA/MIPA:  The CBR agenda must: be driven by the community, democratize knowledge (all partners having an equal voice), and build on strengths and resources within the community. Community and people with lived experience are actively and meaningfully engaged at all stages of the research process, which actively aligns and is integrated with the HIV sector’s Greater/Meaningful Engagement of People Living with HIV/AIDS (GIPA/MIPA) principles and has been thoroughly ingrained in the practices of the CBR Collaborative.”

I was involved in HIV-related work in the late 1980s through to the mid-2000s, when my path redirected to focus more broadly on health equity and social justice. I returned to the field less than two years ago. Besides changes in the prevention, testing and treatment landscape, I was excited to see progress toward the principle of Meaningful Engagement and GIPA/MIPA.  While much more work remains to be done, an attitudinal shift away from tokenism was palpable, as I witnessed research teams genuinely striving to embrace and practice this foundational CBR principle.  For the sake of brevity, and in alignment with the terminology preferred at the workshop to which I refer below, I use the term GIPA/MEPA to convey both the Greater Involvement and Meaningful Engagement of People living with HIV in all aspects of the research process.

Engaging Peer Research Associates (PRAs) is integral to the GIPA/MEPA principles. Last November, I had the opportunity of being one of the 41 individuals from across Canada to attend a one-day workshop hosted by OHTN titled Supporting Peer Research Associates Effectively. While designed for all research stakeholders, the workshop was intended to be of greatest benefit to the 31 peer researchers and emerging academic researchers who participated.  I fit into neither category. As a member of the REACH staff, my role was to take notes and write the workshop proceedings report, but the experience extended much beyond.

The following reflections on GIPA/MEPA are drawn largely from a few of my learnings at this inspiring event where welcoming words to participants included:

“Our greatest vision is to have GIPA/MEPA realized. This is easier said than done. However, the principles of engagement, equity and social justice we say we apply to people living with HIV are realizable. We all have small and large behaviours, attitudes and tasks that help GIPA/MEPA come true every day. In this workshop, we will help you hone and organize your thinking about GIPA/MEPA from the perspective of research. In all kinds of research, especially in community based research, people living with HIV are of paramount importance. The way we treat them, treat each other, the opportunities we build for them, the ways we communicate, they all matter.”  — Francisco Ibáñez-Carrasco, Director of Education and Training at OHTN

Francisco’s message resonated with me throughout the day and beyond, and memories flooded back to the various projects (not all) in which I was involved where GIPA/MEPA meant asking very few people with lived experience to sit on an advisory or steering committee comprised largely of academics, government representatives and staff from ASOs/CBOs who may or may not have been living with HIV.  For many of those with lived experience, this must have been very intimidating, rather than empowering. What in the world were we thinking? As I heard throughout the workshop, it is important to involve peers as advisors at the earliest stages of a research project, even before writing a grant. What we think is a great idea may not be at all to community members.  People with lived experience are invaluable to and enrich all stages of the research – from development of the research idea and project planning through to participant recruitment, data collection, data analysis and knowledge exchange/ sharing.

The conversation also underscored that PRAs today are commonly involved in participant recruitment and data collection. However, many are interested in getting more engaged in other aspects, including data analysis and knowledge exchange/sharing (KTE).  When not involved, they feel disempowered.  The perspective of peers greatly strengthens data analysis and KTE, yet many researchers are unsure how to involve PRAs in these roles. There are many ways in which to facilitate this engagement but this requires flexibility, support, and thinking “outside of the box”. It is time to create the necessary conditions for PRAs to thrive.

While we have come a long way in the past decades, I recognize that the vision expressed by Francisco has yet to be realized. As highlighted throughout the workshop, working with people with lived experience as PRAs benefits the research teams, the process and the research evidence. In a research role, peers bring trust, credibility and insight from the community otherwise unattainable.  Engaging people with lived experience as researchers also comes with the great responsibility of supporting PRAs in specific ways, including in administrative, financial, emotional and educational areas. The meaningful engagement of PRAs requires providing appropriate support, and there is no “one size fits all” approach to doing so. To learn more, stay tuned for a link to the workshop proceedings report.

Read our CBR principles here.


2017 Researcher of the Month Program: Rising Star Research Awards

rising stars

Do You Know a Rising Star in Health and Life Science Research?

The new 2017  program is aimed at promoting careers in health research and life sciences and at recognizing excellence in research conducted by university students at the Master’s, Ph.D.(c), and post-doctoral levels, and by recently recruited research professionals (research assistant or associate for less than 5 years) in all areas and disciplines that  all under health research.

Once a month, from January 2017 to October 2017, in the lead-up to the 5th Gala of Excellence in health research in Nov. 2017, the NBHRF will present $250 to the monthly winners in each of the award categories (Master’s, Doctoral, Post-doctoral & Research Professional).

In order to be nominated, a student, post-doctoral fellow and/or a research professional must send an email to, that includes a completed CCV and a .pdf of the best e-pub or article that has been accepted (in press with proof of acceptance) or that has been published in a peer-reviewed scientific journal IN WHICH THEY ARE THE LEAD OR 2nd AUTHOR.  Articles will be accepted retroactively to January 1, 2016. The submitted nomination remains eligible for the entire duration of the competition, regardless of month submitted.  During the competition year, nominees can submit more than once with a new publication.

Monthly winners will be selected by the President, CEO and Scientific Director of NBHRF and announced on the final day of the month.   A newspaper ad will showcase the Laureates  the following Saturday (unless it is within 4 days of the end of the previous month, in those cases the article will appear on the subsequent Saturday).

All monthly winners will be equally showcased at the 5th Gala of Excellence in November 2017.


The Tidal Wave of Our Overdose Crisis


Close to 100 representatives of community agencies, government, health professionals, police, and people with lived experience gathered for a very successful day-long workshop earlier this month to learn and talk about opportunities to work together in the face of the overdose crisis.

“The Tidal wave of our Overdose Crisis” was held June 8th at the Mi’kmaw Native Friendship Centre in North End Halifax. It was hosted by Direction 180 and Mainline Needle Exchange, two community agencies at the forefront of harm reduction efforts in Halifax and beyond. Members of the Atlantic Interdisciplinary Research Network on Social and Behavioural Issues in Hepatitis C and HIV (AIRN) were pleased to be involved on the planning team and at the event.

Four guest speakers from British Columbia—Donald MacPherson (Canadian Drug Policy Coalition), Ann Livingston (Vancouver’s Downtown Eastside Overdose Prevention Society), Jordan Westfall (Canadian Association of People who Use Drugs), and Lynne Belle-Isle (Canadian AIDS Society)— shared their expertise and wisdom working at the epicentre of Canada’s overdose crisis. Main themes included the need for drug policy reform, the role of compassion, action and civil disobedience, and the necessity of meaningfully involving people who use drugs (PWUD). Unless the voices of those with lived experience are heard and respected, the crisis will continue.

Attendees also heard from a panel, including Dr. Lois Jackson, Dr. Matt Bowes, and Paula Hutchinson.  Lois Jackson (Dalhousie University) talked about her community-based study aimed at understanding the perceptions of PWUD and of key stakeholders concerning the implementation of additional harm reduction services, such as no-cost naloxone, peer-led community detox, and supervised consumption rooms (funded by REACH 2.0).  Nova Scotia’s Chief Medical Examiner, Matt Bowes, reported on surveillance and the province’s opioid response plan, and Paula Hutchinson presented on the success of Nova Scotia’s Take Home Naloxone projects.

A highlight of the workshop was the participation of the Halifax Area Network of Drug Using People (HANDUP) who received a standing ovation following the launch of their moving video recounting their lived experiences. Members provided a passionate first voice perspective on what is happening on the street, echoing the mantra of “Nothing about us without us” to organize and demand action. They also played a key role as experts in the afternoon’s small group discussions, where they described their experiences and advised stakeholders what they needed to reduce risks and improve their health and social outcomes.

For more information,

~ Thank you to Michael Liddell, a member of AIRN’s Leadership Committee, for contributing to this post.


Developments in Atlantic Canada’s Opioid Response


As the opioid crisis continues to soar across Canada, there is an urgent need for evidence-based life-saving harm reduction initiatives. To this end, AIRN welcomed the passing into law last week of Bill C-37, simplifying the application process for establishing supervised consumption sites (SCS). While not a panacea, this federal legislation is an important step forward in streamlining the number of conditions required to open a SCS from 26 to 5.  There are no SCS in this region as of yet.

Atlantic Canada’s response to the overdose crisis differs across the four provinces, with varying levels of government commitment and action – see Joint Statement of Action to Address the Opioid Crisis.

A recent meeting of AIRN’s Leadership Committee highlighted the impressive efforts of the government of Newfoundland and Labrador in addressing the opioid crisis. Since December of 2016, for instance, the AIDS Committee of Newfoundland and Labrador (ACNL) has worked closely with the Minister of Health,  the four health authorities, and various community groups to provide training and distribute 1200 naloxone kits through 89 access sites across a vast, largely rural, and remote province. An additional 3000-4000 kits will soon be distributed, along with the launching of a provincial communications strategy which includes radio ads, billboards and posters warning people about fentanyl and how to access naloxone kits.

AIRN is collaborating with ACNL to provide more information and an update on these efforts though the AIRN website and social media channels. There are also plans to host an open AIRN membership teleconference or webinar to discuss developments and actions in the opioid response within the Atlantic region and beyond.


Responding to the Opioid Crisis in Nova Scotia


The Province of Nova Scotia has established a leadership committee and seven working groups to address the opioid crisis. Each will address the following:  surveillance; health promotion; harm reduction; access to naloxone; opioid addiction treatment; enhancing opioid prescribing and pain management; and justice/law enforcement.

AIRN received funding through the Harm Reduction Working Group (HRWG) to prepare a report with recommendations for preferred provincial models for (1) Needle distribution and disposal services and (2) Safe consumption sites to inform the 2018-2019 business case for these two services. This work will involve literature/jurisdictional reviews and environmental scans, including interviews with people who use drugs (PWUD) and other stakeholders in various parts of the province.

The Steering Committee for the preferred provincial model is being established. It includes representation from the Department of Health and Wellness, the Nova Scotia Health Authority, the Nova Scotia Advisory Commission on AIDS (NSACA), various academic researchers, community groups, and very importantly, people with lived experience. The Steering Committee will provide oversight and guidance throughout the project, and will be co-chaired by a community and/or first-voice representative and the NSACA representative on the HRWG. The first meeting will be held at the end of May, and will focus on clarifying expectations, roles, and compensation for committee members with lived experience. Stay tuned for updates!