Dimagi was one company fortunate enough to recognize this potential early on.

Founded in 2002 as a health-software company comprised of a group of clinicians and programmers from MIT’s Media Lab, Dimagi has looked to use mobile phone technology as a tool for fixing some of the most pressing health needs of the developing world – from mobile health education, to health records keeping, to aiding the diagnosis of disease. The company has set up systems from Bangladesh to South Africa, while their current focus project, CommCare, a cell phone- based system for community health care workers, is being developed in Tanzania.

According to Jonathan Jackson, co-founder and CEO of Dimagi, CommCare is the product of collaboration among many partner groups and is built on an open source data collection platform. While Dimagi is responsible for the software programming side of the project, another company, D-Tree International, is leading the implementation on the ground.

“[The CommCare program] runs directly on your handset and it helps groups like community health workers. It will allow them to do scheduling, task management, and decision support,” Jackson said.

CommCare aims to link individuals, community health workers, and larger health organizations through a network of on-the-ground record-keeping.

The software also provides detailed symptom questionnaires, which can be followed by less-skilled health care workers in routine house-to-house check-ups. This would allow health organizations to extend their reach as health care services could be extended to a greater number of communities.

“Usually, they are going household to household and recording symptoms of people on their phone – and that’s driving them through this tree of questions in our program [on their handset]. Depending on how people answer, it directs the health care workers to refer them to the right medicines or other services.”

For Jackson, the provision of such services through mobile technology is especially important in settings where greater technological infrastructure is lacking.

“There aren’t necessarily standardized health records [in many developing countries], which is a big problem. So we’re focused on minimal data fields [and] the household, whereas you’d usually be talking about data gathered at the clinic,” he said.

“We are a ways off from an accessible clinical records sharing system going across many of these countries because of the basic lack of Internet connections. I think the small-scale, phone-based, community programs are going to work because they are such simple systems and can therefore actually be implemented.”

Dimagi and its partners are currently working on expanding the field of users on the CommCare platform. According to Jackson, the use of a uniform product across sectors would facilitate communication and health information sharing between different levels of health officials and organizations, contributing to better community health data gathering overall.

“Right now we’re just in the early stages of design for the headquarter software, and that will be used by a number of different people, like the supervisors of community medical centres, but also centres of operations, like the NGOs who are employing these workers, so that they can check trends, not just individual cases. They can then chart the overall health of the system, which is a huge missing gap today,” Jackson said.

Still, Jackson believes that technology alone is not sufficient to make a deep-seated impact on health care delivery in the developing world. Instead, the main contribution of technologies such as CommCare is their ability to facilitate better monitoring of and communication between health service providers on the whole. In this way, such systems can allow for greater innovation in the direct patient care already being provided by community health programs.

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The event, held partly in celebration of Valentine’s Day, will test the feasibility of offering rapid HIV testing on a permanent basis at McGill Health Services.

“From speaking to students, what has come out as the biggest barrier of accessing HIV testing is the wait times at McGill Health Services,” said Jamie Lundine, director of the McGill Global AIDS Coalition.

Rapid HIV tests – involving little more than a prick of the finger – would provide immediate results, since analysis is performed on-site. According to Dr. Pierre-Paul Tellier, director of McGill Student Health Services, the minimum two-week waiting times associated with the HIV test currently offered at the McGill clinic may be a deterrent for many students to get tested at all – on-the-spot results may provide the extra incentive to go in and get tested.

“There’s no anxiety about waiting…and there’s also no anxiety, or even inconvenience, over coming back for results,” Tellier said.

The “Love Yourself!” campaign will be the first time rapid HIV testing will be made available at McGill. They have not previously been offered, in part because of financial constraints.

“[The Quebec government doesn’t] cover anything that is done in a ‘private lab,’ which is what we’re equal to. Whether it’s HIV testing or a urine test, it’s the same,” Tellier said. “Up until now we’ve absorbed the cost for all tests, but this one is a little more costly, so we don’t particularly want to put it in our budget right now.”

Friday’s free pilot program will be used, in part, to gauge the reaction of the student body to rapid HIV testing, as well as their willingness to pay $15 for the test if it were to be introduced permanently in the clinical setting.

Though McGill is not licensed to give anonymous HIV testing, “Love Yourself!” will provide non-nominal testing, which will separate students’ results from their charts.

“In the charts, all we [will] indicate is that a patient was seen, but not what for. There is no recording of the test or the results anywhere,” explained Allison-Joy Flynn, Health Promotion Officer for McGill Health Services.

Tellier did, however, note one drawback to rapid HIV testing: such tests are more susceptible to false positive results – when a test reports HIV-positive but a patient is really HIV-negative – than regular tests. A second, longer, confirmatory test is strongly recommended for all HIV-positive results to determine if the result is a true or false positive.

While regular HIV tests that report a false positive also should be followed by confirmatory tests, most labs will perform the second test immediately after the first so that they are returned to the patient together, meaning that false positives are ruled out before the patient sees any results. The problem with rapid testing is that even though patients would receive counselling, they would be unsure of their status until the second round of test results were received, causing heightened worry for that period.

Nonetheless, Tellier sees rapid testing as a big step for McGill Health in a positive direction.

“Rapid testing would be another option to give people, and if more people end up coming, it gives us more of an opportunity for education,” Tellier said. “On campus, the primary focus of HIV testing is really educating people [about HIV as well as other sexually transmitted infections], because the actual HIV prevalence we’ve detected on campus is extremely low.”

However, Tellier said that he has no specific expectations concerning turnout on Friday. He noted that the pilot project will hinge on the feedback of those who do come out and get tested, rather than on sheer numbers of participants.

“It’s more about the way things go on that day – how the nurses feel about administering it and how the students feel about it. Was it a key factor in their decision-making? That’s the kind of factors we’re looking at,” Tellier said.

“We just hope that the students can give us some usable feedback on Friday that can help us make our decision [in regards to rapid HIV testing].”

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Though most of us are probably unfamiliar with web sites such as Rushmore Drive – a black-centric search engine started in April of 2008 – such identity-specific searching is slowly carving its own niche in the wide world of the world wide web, and looking to challenge Google’s hegemony.

According to Kevin McFall, representative for Rushmore Drive and Vice President of products for its parent company, Black Web Enterprises, Rushmore Drive provides search results that are more relevant to the black community by blending mainstream searching with a heavier weighting on historically black-selected URLs. The web site also includes a black-centric job-search engine, as well as a social networking application.

Dr. Vivek Venkatesh, assistant professor of educational technology at Concordia University, whose work focuses on the shift from algorithm-based searches to more humanized forms of information gathering on the web, sees the development of identity-specific web searching as a natural course for Internet searching to take.

“I think it’s a natural progression or an evolutionary progression of how people are reacting to the growth of the Internet,” Venkatesh said.

According to Venkatesh, the impetus for more personalized search engines – whether geared toward a specific racial, ethnic, or personal-interest group – comes from a need to aggregate the information most pertinent to a group with particular searching preferences in the ever-growing field of information that is the Internet.

“Regardless of why people are searching…I think that [they] are looking to find more efficient results as quickly as possible,” Venkatesh noted.

One criticism levied against race- or identity-specific search engines is that they have the potential to be divisive, undermining the idea of the Internet as a difference-eliminating, unifying force – one that allows users to remain anonymous from their racial, ethnic, or group affiliations.

McFall rebutted this divisive take on identity-specific search engines.He noted that the Internet may be unifying in its basic nature, but that it is also quite fragmented – it does not necessarily fulfill the promise of immediate access to information for all groups. Rushmore Drive fills the needs of a niche audience who may be looking for different results than the average search engine, like Google, might provide.

“What [Rushmore Drive] does, is that it helps people who are specifically looking for a black perspective understand what the black experience is about,” McFall said. “You don’t have to be black to use Rushmore Drive; you can be any nationality [and use it] if you want to gain that additional perspective.”

While Rushmore Drive allows a specific cultural community to sift through the burgeoning landscape of the Internet more efficiently, McFall contended that it does not bias its results in a way which excludes other important information. Instead, Rushmore Drive looks to unify a black perspective with a mainstream one.

“It provides a bit of a laser focus. We provide a very vertical experience for people trying to access information, [just like any interest or identity-based search option]. The example I like to use is that if you’re a fan of baseball, you’re probably going to go to mlb.com to get your information about baseball,” McFall said, implying that if you’re looking for a black perspective, you’ll go to Rushmore Drive.

Though Rushmore Drive seems to be the most prominent example, many other niche-market search engines are available to address the needs of diverse groups – whether they are defined by race, nationality, interest, or any other unifying traits.

Ask.com, partner company to Rushmore Drive, has recently launched Nascar.com, a new – you guessed it – Nascar-based search engine geared toward those interested specifically in all things Nascar. Closer to home, there’s Canuckster.com, a Canadian-centric search site.

For Vinkatesh, the key issue of more personalized searching is self-identification. The goal is to make finding information relevant to each individual’s identity as efficient as possible.

“I identify a lot more with my hobbies; they define me more than my race [does]. So, hobby-specific searches are more necessary for me. But this isn’t the case for everyone,” Vinkatesh said. “[Where you search] really depends on the individual – how they self-identify and what they need from their searches.”

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It may come as a surprise to many, but the role of the U.S. in funding the global HIV/AIDS battle has been hailed as one of the few shining lights of the Bush years, by no less than the New York Times, among others. With the authorization of the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, the U.S. committed an unprecedented US $15-billion over five years to fight the HIV/AIDS pandemic internationally. It has been hailed as the largest health initiative directed at a single disease to be initiated by one country – ever.

The successes of PEPFAR are many; the program more than doubled the number of people receiving anti-retroviral treatment (ART) in the most hard-hit countries from 2004 to 2008. Yet, it has also faced its fair share of problems and criticisms.

PEPFAR has most prominently been accused of being largely morally motivated. Of the US $15-billion allotted in 2003, 20 per cent was outlined to be spent on prevention efforts, one-third of which was earmarked to go toward non-scientifically based “abstinence only” education programs. These sorts of programs have been largely dismissed as unconstructive both in the U.S. and abroad, as they provide a narrow educational lens and leave participants more vulnerable when they do choose to engage in sexual relations at a later time. PEPFAR’s ideological policing of funding has also required agencies to sign an anti-prostitution pledge – requiring an explicit opposition to sex work – before being eligible for funding, leaving one of the most stigmatized and at-risk groups out of a constructive dialogue of prevention and care. PEPFAR has also turned a blind eye to another marginalized community – intravenous drug-users – by not supporting clean-needle-exchange programs.

Other criticisms levied against PEPFAR include its initial refusal to use generic drugs, instead requiring FDA-regulated, name-brands despite the high costs associated with them. However, this clause has been reformed to an extent since 2005, making generic ARTs at least partially available.

Due to the ideological short-sightedness implicit in PEPFAR’s requirements for gaining program funding, many organizations and governments have chosen to turn their backs to this considerable tool in the fight against HIV/AIDS. For instance, the BBC media outreach program in Tanzania and the Brazilian government, both at odds with the anti-prostitution pledge, have refused PEPFAR sponsored funds.

While the Bush administration showed positive initiative in its bipartisan and globally oriented proposal of PEPFAR, the mire of moral baggage that comes along with funding only weighs down the full potential such an initiative could offer. PEPFAR funding can no longer be tied to ideology and unproven science. While steps have been taken to remove some specifications from the 2008 PEPFAR reauthorization – such as the exact percentages of money allotted for prevention and abstinence programs – the general atmosphere of moral stringency associated with the Bush administration’s agenda remains.

With administration change, however, comes a new opportunity to set PEPFAR funding free from previous moral constraints. Obama’s pledge to “ensure that best practices – not ideology – [sic] drive funding for HIV/AIDS programs,” is certainly a firm step in that direction. But now, upon officially entering office, Obama must work toward the structural changes that can provide a more comprehensive and wide-reaching access to anti-HIV/AIDS funding from the U.S. for all of those countries in need.

Now is the time to act on AIDS worldwide; now that gains are already being made, we cannot sit idly by and feel as if our part of the work is finished. Instead, Bush’s initiative must be set for a more expansive course. In hard economic times, it may be easy to say that a reformation of PEPFAR may not be at the top of the agenda, but millions of lives literally depend upon such reforms. Global as well as domestic expansion of anti-HIV/AIDS funding and reforms of existing legislation should be a top priority for the new administration.

For a full outline of the Obama administration’s HIV/AIDS initiative pledges, visit change.gov/agenda/the_obama_biden_plan_to_combat_global_hiv_aids/. Nadja Popovich is The Daily’s Mind&Body editor. Send your used condoms to mindnbody@mcgilldaily.com.

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Now don’t get me wrong, this news wouldn’t have made me put down the cup. But as I read on, the article revealed that coffee can simultaneously help to protect against breast cancer. I breathed a small sigh of relief at the fact that this provided me with a more concrete, though frankly unnecessary, reason to continue the habit.

But wanting to know more about the seemingly magical breast-cancer-risk-reducing powers of coffee, I looked up the two Swedish-based studies – published in the British Journal of Cancer earlier this fall – which the article was based upon.

After deciphering these heavily scientific papers on the relationship between coffee, breast size, and cancer – and talking to Helena Jernström, one of the researchers behind them – a different version of the story came out.

According to Jernström, it’s not so much that “three cups of coffee a day can make breasts shrink.” Rather, an increased intake of caffeinated coffee in young women who are not on birth control, but are carriers of the alternative gene variation of CYP1A2 for an enzyme that metabolizes both caffeine and estrogen, have exhibited smaller breast size. But this makes for a less snappy headline.

Jernström said that the only real conclusion to be drawn from the studies is that caffeinated coffee may protect women with the specific enzyme variant against breast cancer, but she stressed that the link still needs more research to be substantiated.

And as for your B-cup dwindling to an A during exam season?

“Women with the [specific gene] variant who drank three or more cups of coffee per day had smaller breasts than other women…. [But] we don’t yet know whether coffee actually shrinks the breasts or if these women had smaller breasts anyway,” Jernström said. “It is too early to draw any conclusions.”

So thank you, Internet news, for providing me with that brief moment of doubt over whether I should get up for a refill. But going by Jernström’s reasoning, we may not have to choose between our breasts and our espresso; in fact, if your gene variants align just so, that third cup may help your breasts stay healthy and cancer-free.

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While all of us are familiar with the preachings on sustainability and the greening of our urban environment for the earth’s sake, our future children’s sake, and quite possibly our own psychological sake, the study, published in The Lancet, has indicated that exposure to green spaces is also directly linked to our very immediate bodily health. Subjects in England, across income ranges displayed longer life spans on average; with increased exposure to greenery, they were also less likely to die of circulatory disease specifically, although the study found no correlation between cancer and proximity to green spaces.

The idea that “green is good” has been around for a while now, but according to Richard Mitchell, a co-author of the study, there is little research on the concrete impacts of greening.

“We lack a lot of evidence on exactly how green space is beneficial to health,” Mitchell said. “There have been studies about the relationships between green space and population health, but we think this is the first [study] to look at its impact on inequalities in health.”

Across the pond, Montreal has not yet shifted the focus of its greening approaches to concentrate more directly on health and income inequalities, but the city nonetheless has an extensive plan for urban green spaces, often collaborating with neighbourhood-based organizations in their greening initiatives. In turn, these non-governmental groups, such as La Société de Verdissement (Soverdi) and the Urban Ecology Centre, attempt to solve problems such as the urban heat island effect – where cities are warmer than their rural surroundings – and work with communities to build greener, healthier environments.

Among medium-sized cities, Montreal is faring well in green initiatives.

Owen Rose, president of the Urban Ecology Centre, noted that from an ecological perspective, Montreal benefits from its large, densely-populated urban core, which facilitates access to transit and services, and contributes to the city’s vibrant urban culture. But, according to Rose, Montreal, like most North American cities, also has a tree deficit.

“In the long run this means that… we’ll see fewer trees than we have already,” he said.

Pierre Belec, special advisor to the General Manager for the city of Montreal and liaison for Soverdi, meanwhile, noted that the tree-planting project is only one aspect of the city’s complex sustainability and greening plan. However, he identified it as a keystone initiative.

“The tree planting projects in the boroughs are big projects because often old [trees] need to be cut down and new ones replanted en masse,” Belec said. “There is a renewal of the urban forest which is being planned right now.”

Yet Rose contends that even though the city plants new trees every year, there is still a net deforestation problem. This, in turn, is exacerbated in the more dense, urban, downtown neighbourhoods.

“There is limited per capita access to green space in the old pre-World-War-II neighbourhoods, for instance Rosemont, or the South centre, St. Henri, Point St. Charles, [and even] the Plateau,” Rose said. “All of these central neighbourhoods have a low level of park access per capita because they were densely populated and densely grown. The challenge is how to give them greater access to more green spaces.”

The city has no specific guidelines for selecting which neighbourhoods will undergo greening projects, and leaves such issues to the boroughs. Thus, economic considerations – such as a prioritization of marginalized areas in greening projects, per The Lancet study’s findings, for example – are not accounted for.

According to Belec, the impetus for greening projects is instead left largely to individual communities themselves.

“We work mostly on a first-com- first-serve basis because of the necessary involvement of people,” he said. “There is not such a planning process.”

Belec added that neighbourhood greening projects have been initiated through various routes – both top-down and bottom-up. He cited the examples of Verdun and Rosemeont, two areas in which the elected officials were involved in the process, often going door-to-door to mobilize people interested in pursuing a greening objective. On the other hand, districts like the Plateau have seen citizens take a much more hands-on approach.

“[In the Plateau] people have been greening their back alleys for 20 years now, so you don’t need to go out and convince them, they’ll come to you; and this means that we don’t need to do a lot of planning on which neighbourhoods to target,” Belec said.

However, Rose explained that certain neighbourhoods are, by nature, able to support more greenery based on their relative location and wealth.

“Westmont and Outremont [for example] are old neighbourhoods, but they are very green,” he said. “The problem with the old, downtown, pre-World-War-II neighbourhoods is that they can’t compare in greenery, [and] they also tend to be poorer neighbourhoods as well. The periphery, outside the central area, just by virtue of being much less dense, has more greenery.”

Though the Urban Ecology Centre itself does not have a policy to target less advantaged neighbourhoods, Rose noted that this is not a matter of ideology, but rather a matter of geography – the Centre is located in the Milton-Parc neighbourhood. Still, the Urban Ecology Centre concerns itself with a range of urban environmental issues, which have impacts city-wide – from sustainable neighbourhood planning, to urban transport and water management. Rose reported that a large new project on green neighbourhoods, geared toward healthy active transport, is currently at the top of the Centre’s agenda.

“It’s about encouraging people to walk, bike, and use public transit, as well as focusing on neighbourhoods that are poorer, to improve healthy living conditions,” Rose said, adding that people need to be able to walk and exercise in safer environments in order to be healthier.

“We need safe sidewalks and bike-paths,” Rose said. “[The problem is that] in Montreal, our poorer central neighbourhoods have less per capita green space and higher traffic densities, so it’s not as encouraging for people to walk and exercise.”

This, he said, may be a factor contributing to the health discrepancies among income groups, adding that poorer areas tend to be deprived of the green spaces which are so integral to health – both physically and psychologically.

The city, meanwhile, has its own plans for boosting accessibility.

Noting the importance of bike paths in linking the city’s neighbourhoods, as well as facilitating access to green spaces and parks for many residents, Patricia Lowe, communications officer for the city of Montreal, has reported that plans to open a “beltway” or “green loop” around the mountain are in the works. The project is scheduled to be completed next year.

“That will [allow] access – [for both] biking and walking – to the mountain from different areas of the city that were previously cut off. The Plateau and Côte-des-Neiges will have easier access, and downtown eastern Montreal too,” Lowe said, adding that this would greatly ameliorate issues of differential access to green spaces.

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The study, published in the Canadian Medical Association Journal (CMAJ), looks at the prevalence of traumatic brain injury and current health situations of the homeless. Approximately 900 homeless men and women who frequent Toronto homeless shelters were asked to self-report cases of brain injury that “left the person dazed, confused, disoriented, or unconscious.” It is currently the largest study of its kind worldwide.

The study results show a 58 per cent incidence rate of brain injury in homeless men, and 48 per cent in homeless women – a prevalence rate 5 times higher than the US average. According to coauthor Dr. Stephen Hwang of the Centre for Research on Inner City Health at St. Michael’s Hospital in Toronto, the fact that a majority of respondents sustained traumatic brain injury before they became homeless suggests a causational link.

“I think that this article doesn’t make the link definitively, but it is hypothesis generating. It raises a possibility which has not been discussed by researchers before,” Hwang said.

He added that further research is needed to provide strong causational evidence for the connection between traumatic brain injury and homelessness.

The CMAJ study concludes that doctors and clinical professionals need to pay closer attention to signs of traumatic brain injury in the homeless. It also emphasizes the need to routinely ask homeless patients if they have suffered from such disturbances, since those suffering from traumatic brain injury may require different therapies than would otherwise be prescribed.

According to Hwang, there are two other major conclusions to be drawn from the study.

“The second point is that these individuals may require constant support to avoid homelessness because of their cognitive impairment [due to traumatic brain injury]. The third point is the speculative one that this may be a causal factor and that we need to do further research to explore that,” Hwang said.

Matthew Pearce, director general of the Old Brewery Mission, the largest men’s shelter in Quebec and largest women’s shelter in Canada pointed out that there is nothing new about the connection between mental illness and homelessness.

While the majority of their clients do not suffer from serious mental problems, Pearce said that the Old Brewery Mission’s figures indicate that about 35 per cent exhibit some form of mental illness. Pearce noted that the Old Brewery Mission’s shelter services take into account the mental state of those in need. Their off-the-streets program, l’Étape, provides 24-hour counselling support to aid the transition to a more stable and secure living arrangement.

Though traumatic brain injury is a separate issue which has received less attention in the analyses of homeless people’s mental health status, Pearce argued that a range of factors contribute to the mental health and stability of homeless people.

“[The homeless] are complex as a group. They are homeless, but they are people. There is more than one cause of homelessness, and more than one cause of mental illness; and there is more than one set of circumstances that causes the two to come together. Head injury is just one of them,” Pearce said.

Denis Nault, one frequenter of the Old brewery Mission, now homeless for three years, gave a similar assessment. While he reported not to have suffered from any mental health problems himself, he noted that for many, life on the street tends to foster a cyclical process of mental breakdown, no matter which causational factor – brain injury, substance abuse, or genetics – may be to blame.

“We’re all depressed. Everyone has psychiatric or substance abuse [problems]. Me too, I drink. What else can I do?” Nault asked. “[For some] it’s worse, but everyone has something. The game is surviving all day, every day outside.”

While the CMAJ study poses some loose links between traumatic brain injury and other mental problems, including substance abuse, the authors maintain that more studies need to be pursued before any concrete conclusions can be reached.

Aaccording to coauthor Dr. Angela Conatonio, Senior Research Scientist at Toronto rehab, the CMAJ study is significant despite being preliminary.

Colantonio pointed to the often overlooked fact that traumatic brain injury is the leading cause of death in people under 45 in Canada, and added that, despite its incidence, traumatic brain injury does not garner enough attention.

“[What] we are saying is that [the homeless] should be screened,” she said. “It should be a factor one should look for.”

Colantonio added that screening for previous traumatic brain injury may be beneficial – such a finding might account for otherwise unexplained behavioural issues. Identifying the root cause of such issues could allow for better treatment. Expanding on Hwang’s second conclusion, Colantonio suggested a range of other options that may be worth pursuing for homeless people suffering from traumatic brain injuries.

“Cognitive rehab [may be beneficial to those who have suffered traumatic brain injuries] for example, or they might benefit from some assisted technology, such as help with their memory,” she said.

“No two brain injuries are alike. Depending on where the injury is, it needs to be individualized,” Colantonio said. “Down the road we need to look at intervention studies, [we need to] look at the supportive approach, [and we need to] look at treating the person as well as the environment. Even educating the [homeless] about their brain injury would be a step in the right direction. Even if they have a history of cognitive sequelae but no symptoms, they need to be educated about it.”

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Bolduc’s predecessor Philippe Couillard, who stepped down from his post in late June, had been considering setting up a safe injection site project in Quebec, but Bolduc’s office announced a turnaround in their stance towards SISs.

Quebec’s Ministry of Health and Social Services under Bolduc held that there was not enough direct evidence in support of safe injection sites for the project to go on. The announcement came less than a week after Canadian Health Minister Tony Clement delivered a speech at the Canadian Medical Association’s Annual Conference (CMAAC) attacking the merits of safe injection sites, and citing “profoundly disturbing” ethical concerns.

Most recently, a number of community health organizations, including the Coalition des organismes communautaires québécois de lutte contre le SIDA (COCQ-Sida), an umbrella organization consisting of over a dozen local activist groups, have come out in direct opposition to the new decision to scrap the SIS project.

Where to draw the line?

Currently, North America’s only safe injection site, Insite, is located in Vancouver, British Columbia, but even this site’s continued existence came into Health Minister Clement’s line of fire.

Clement’s office provided a transcript of the CMAAC speech, which particularly expressed great moral concern over government’s role in establishing safe injection sites. He stated that this type of service really provides “palliative care” rather than a road to “full recovery.”

While he did not call for a full-out closure of Insite, he outlined funding cuts for the safe injection services at the facility in favor of detox and classical rehab expansion.

“I believe we have to draw the line somewhere with regard to these kinds of measures,” stated Clement, calling it a “slippery slope.”

“Already there are people saying injection sites are not enough, that government should give out heroin for free,” he stated.

While most Canadians are not calling for government drug handouts, the idea of “inhalation rooms for people who smoke their drugs” is a less far-fetched concern in Clement’s slippery slope argument. Even so, drug inhalation cannot be directly compared to injection. Clement seems to miss that it is the nature of injecting drugs which is problematic – unlike inhalation, injection carries with it more ominous risks, such as facilitating the spread of infections and disease.

The issue is further complicated by the absence of comprehensive statistics on the impacts of safe

injection sites on target populations. For instance, few concrete numbers exists on the role of safe injection sites in reducing new HIV/AIDS and hepatitis C infections, as well as other injection-related diseases.

Clement cited an Expert Advisory Committee commissioned by his office as having found no sure evidence of supervised injection – such as that offered at Insite – making “any difference at all in the transmission of blood-borne infections, including HIV/AIDS.”

Despite the lack of statistics on infection transmission, there is evidence that safe injection sites can be beneficial to users. A study published on behalf of the Society for the Study of Addiction found that “the SIF’s [safe injection facility’s] opening was associated independently with a 30 per cent increase in detoxification service use, and this behavior was associated with increased rates of long-term addiction treatment initiation and reduced injecting at the SIF.”

Health Canada’s web site offered a similar assessment, stating that although the evidence is inconclusive on the impact that safe injection services have on rates of blood-borne

disease or injection-related infections, the sites “positively impact many at-risk behaviors,” such as decreasing needle sharing and increasing the regular use of condoms.

Contradictory ethics

While Clement’s concern stems, in part, from the questionable ethics of allowing illicit drug use under government watch, he also sees SISs as an inappropriate form of patient care. In his speech, he characterized safe injection facilities as offering “palliative care,” not “full recovery,” asserting that rather than addressing the problem of addiction directly, they only “slow the death spiral of a deadly drug habit.”

Others, however, would rather call safe injection a philosophy of harm reduction.

Quebec director of public health Alain Poirier shares the latter opinion. He has been a steadfast voice of support for the plan for Quebec safe injection sites, even as the Health Ministry’s stance has shifted with the change in administration.

“We have evidence that they could be part of a solution – even if not the solution – to the consequences of drug use,” said Poirier.

He views these sites in a more positive light than Bolduc or Clement. “They have given good results where they have already been implemented,” Poirier said. “I’ve been to Geneva. I went to visit the sites they have. There is a big difference from what we have here.”

Starting with the Netherlands in the 1970s, many countries around the world, including Germany, Switzerland, several northern European nations, and Australia have implemented safe injection programs as a tool in their fight against drug abuse. Poirier sees Quebec as being able to gradually integrate a similar system.

“In Quebec we have 820 sites where you can exchange old syringes for new ones – sterile materials. There are exchanges in most pharmacies, hospitals, and some community organizations. This is the next step,” he said.

What Poirier noted as the problem is a lack of consensus. “It is feasible [to have safe injection sites around Montreal and Quebec] but we first need consensus…. We need a group of citizens [to back the sites].”

Still, he concedes that people don’t know what to think about these types of facilities, and have nowhere to turn for answers. “Do these sites increase the number of drug users? The number of people on the streets? The answer is no, but people wonder,” Poirier said.

Meanwhile, local community groups are openly calling for a re-evaluation of the stance against safe injection sites by the Ministry of Health and Social Services .

Members of COCQ-Sida are among those coming out against the decision. One such group, Anonyme, is a Montreal-based organization aimed at helping young people with drug addictions, health problems, and other issues leading to social exclusion.

Julien Montreuil, Anonyme’s Coordinateur à l’Intervention, asserted that safe injection sites can be an integral part of the fight against drug addiction, and the range of negative consequences that can accompany intravenous drug use. To him, Clement and Bolduc’s stances against the expansion of these facilities are counter-productive to the war on drug abuse.

“When we give people who inject drugs clean materials to use, we give them advice about their proper use, general health, and other issues. But I feel like I then have to say ‘now go to a very dirty place and shoot yourself up.’ However, with safe injection, we could continue to help these people and offer other services. The sites would be a good door to come to for people in need, for people who wouldn’t otherwise go to clinics,” he said.

Montreuil also expressed concern over the moral considerations touted by Clement. “Tony Clement said that the ethics of doctors are at question [with regards to] safe injection sites. But what is more ethical – letting the people shoot up in back streets?” asked Montreuil.

Instead, Anonyme sees safe injection facilities playing a positive role in the battle against drug abuse, especially as a transitional step towards full recovery.

Montreuil is another believer in the harm reduction approach. Much like Poirier – who has called SIS’s a “complementary service,” not one necessarily in opposition to that of classical detox and traditional rehabilitation – Montreuil sees safe injection sites as a good intermediate level of care, specifically for those who are not ready to go into detox or who have tried it and failed.

“A lot of people aren’t able to quit right now, but the motivation from inside is better than from out,” said Montreuil. “If the government sends you to detox, it’s not the same as if the person is ready to work on it themselves, to quit the lifestyle of drug abuse. It’s society’s responsibility to help these people even when they can’t quit. We need to help them be as safe as possible in this situation so that they can eventually make the choice to go to detox of their own will.” He holds that safe injection sites can play an integral role in this.

So far, community groups have spoken out against the decision to halt plans for the safe injection sites at a press conference denouncing the Quebec Health Ministry’s stance. But Montreuil promised that “we will continue to fight this.”

“The government doesn’t need any more delays,” he said. “Mr. Bolduc just needs the population to stand up and say ‘hey, this is a good thing.’”

The post The great safe-inject debate appeared first on The McGill Daily.

While Anderson’s boot camp was a state-run facility, privately-owned versions abound. “Tough-love” rehabilitation camps for teens are prevalent throughout the United States, with a disturbing lack of formal regulation.

“No one knows how many of these programs there are out there. They aren’t very regulated,” says Maia Szalavitz, author of several articles and books on abuse in tough- love programs and senior fellow for Stats.org, a media watchdog web site. “Many programs work outside the States too: in Mexico, Samoa, Jamaica, all over really. And they have these incredibly ironic names. like ‘Tranquility Bay.’”

Though not always manifesting themselves as a “boot camp,” all of these so-called tough-love programs seem to be based on the same approach: with enough confrontation, kids may undergo a sort of “reality check” that will allow them to put their past behaviour behind them when reintegrated into society. But according to many recent studies, including a National Institute of Heath State-of-the-Science conference statement on Violence and Related Health-Risking Social Behaviour, this is simply not the case.

“No matter what these places may call themselves – boot camp, ‘tough-love’ drug rehab, or emotional-growth boarding schools, or wilderness programs – the basic concept is always the same: break the kids down in order to fix them,” says Szalavitz.

Though much more prevalent south of the border, it would be naïve to think that Canada was devoid of boot camp rehab centres.

“I was shocked this place existed in Canada!” attests Rebecca Smith, a former “client” of a Canadian tough-love drug rehabilitation facility. “My Canada, which I know has a great human rights record. I could not fathom that this place was allowed to exist. While there, more than once I said, ‘You can’t do this! I have rights!’… and they said, ‘Druggies don’t have rights.’”

The breakdown

Szalavitz has traced the proliferation of most modern teen rehabilitation programs from Synanon, the first “tough-love” rehabilitation prototype, in Santa Monica, California. Initially a drug rehabilitation centre in the late fifties, Syanon gained cult status by the seventies, before it closed its doors in the 1990s. Its legacy still casts a large shadow on the drug rehabilitation field.

Founded in 1958, it was the first program of its kind, and it promised “lifetime rehabilitation.” The basic therapeutic idea behind Synanon was a “game” in which youths were encouraged to use humiliation and insults to break each other down. The organization, by then named the Church of Synanon, was raking in millions each year. It gained public infamy after a report was issued by a Grand Jury accusing the facility of child abuse – stunningly, no steps were taken to shut down the organization at the time. Synanon closed in 1991, however, facing financial problems and a multitude of allegations.

Since the closure of Syanon, a host of other tough-love teen rehab programs have come and gone. Even with crusaders like Szalavitz making their cases against these programs, the moment one centre closes, another one opens.

The latest in a line of controversies came from a rehabilitation chain named Kids Inc., a successor to Synanon’s breakdown model. Though no Canadian Kids programs were ever officially opened, so many Canadian youths were sent to Kids of Bergen County in northern New Jersey that a Kids of the Canadian West program, based in Alberta, was in the works in the early 1990s. But following several allegations of abuse against various Kids facilities, centres all over the United States were shut down.

Plans for such a Canadian Kids facility were scrapped. Instead, the man set to head the Kids camp in Alberta, Dr. Dean Vause, went on to found his own facility: the Alberta Adolescent Recovery Centre (AARC), in Calgary. While there have never been any formal charges laid, and the AARC firmly denies any allegations, a preliminary report done in 2003 by the nonprofit International Survivors Action Committee (ISAC) concluded that the AARC bore an all-too-striking resemblance to its Kids predecessors.

“With respect to allegations of abuse, I have yet to encounter one,” an AARC representative wrote to The Daily in an email: “If this did occur, however, it would be considered a critical and urgent clinical issue to be addressed by our clinical committee.”

Confined to recovery

One of the biggest problems with many of these programs is that they promise a quick-fix solution to deep-seated psychological problems. Usually these tough-love facilities are not staffed with psychological professionals.

The AARC, for one, touts its “teen-on-teen” care as integral to the rehabilitation process. “Addicts are adept at manipulating and conning others. But they can’t con a con,” reads the AARC web site. In fact, many peer counsellors are graduates of the program itself. “They know all the lines and have heard all the excuses – they’ve used them. Many counsellors have degrees, giving them a powerful blend of real life experience and clinical expertise.”

This model, however, cannot provide kids with adequate psychological help if they really do need it, asserts Szalavitz. Helpatanycost.com, Szalavitz’s accompaniment to her book of the same name, notes that one of the major questions parents should ask when considering sending their wayward children to one of these programs is: “What are the qualifications of the line staff who work directly with the teens?” According to Szalavitz, anything less than a Masters-level psychology degree for all group leaders should be considered a red flag.

Meanwhile, what Rebecca Smith and many other clients of tough-love programs find most unsettling about these facilities is the basic and uncompromising confinement that is integral to the rehabilitation models. As minors, teens have no control over their placement or stay at rehabilitation programs. As long as they are deemed “in need,” their parents can send them to any private rehabilitation facility, separated from friends, family, and the greater world, for an indefinite period of time.

This unconditional confinement is frustrating for those enrolled in these programs, but it can also be dangerous. Though she has grouped a wide range of programs into the tough-love category, Szalavitz argues that categorizing a program as specifically for “troubled” teens leaves youth stigmatized and vulnerable. When combined with a lack of control over their own circumstances, this labelling can prove deadly.

Szalavitz recounts a story from her book about a teen named Aaron Bacon who died of internal bleeding after a treatable ulcer ate through his stomach lining in 1994, during a “wilderness therapy” excursion.

“The ulcer could have been treated with over-the-counter medication,” she says, “but, instead, it ate through his abdomen over the course of several weeks. The program insisted he was faking.”

“An ‘outward bound’ trip with so-called normal kids can be very good and nurturing,” she continues. “But that’s with normal kids, so, [if you complain of something being wrong] you’ll be believed.”

Troubling labels

Tough-love programs’ remarkably low requirements for admittance is another troubling element, according to Szalavitz.

“I would call [what really drives admittance] a wallet biopsy,” she says. “If the parent can afford it, the child needs the program…[and] if you fill out any of the forms you can make a normal teenager seem troubled. These are not legitimate mental health evaluations.”

One web site, bootcampsforteens.com, offers a “Does My Teen Need Help?” section to guide parents through the process of evaluating their child’s “need” for these camps, concluding with: “When it comes to seeking help for a child in danger it is better to have sought help a little too early than a little too late.”

Not according to Szalavitz, however.

“Some [parents] have been terrorized by the drug war into thinking, ‘Oh my God, my kid is smoking pot, they’ll become a heroin addict.’ This won’t happen; the vast majority of marijuana users never even try heroin. People think, ‘It’s better to be safe than sorry,’ but these programs aren’t safe,” Szalavitz says.

She argues that most teens do not need medical attention for being “troubled,” arguing that developing better communication with teens and family therapy sessions with schooled psychiatrists, social workers, or psychologists as one route, and postsecondary education as another.

“If you actually want to prevent long-term addiction, get your kids through college!… Finding meaning and purpose in their life is the key to overcoming addiction, and you can’t force people to find meaning and purpose.”

Some names have been changed in this article to protect the privacy of those involved

The post “Does my teen need help?” appeared first on The McGill Daily.

According to Jeanie Riddle, creative director of Parisian Laundry, plenty.

Artificiality will always have its place in modern art. In fact, it is the central issue that informs the creative decisions of Parisian Laundry, a striking gallery in St. Henri.

“We live in all things plastic,” she asserts, and we need to embrace it.

Janet Werner’s newest show fits this criteria perfectly: the materiality of the saccharine sweet portraits featured in “Too Much Happiness” force us to face the reality of their artificial construction.

Werner confronts the viewer with the idealized female of the 21st century: the magazine girl. The magazine, as an artistic forum, defines and perpetuates the new “ideal” female: beautiful, inexorably thin, vacant, with not a hair out of place. Yet below this plastic exterior lurk larger implications for contemporary society. Though the idealized female has been a centerpiece of art history for centuries in one form or another, Werner tackles the theme from a distinctly modern perspective.

This is the point for Riddle: what defines art today are new, novel combinations of old themes and practices.

In magazines, woman has transcended her classical place as idealized form on canvas and become a part of everyday life. What more obvious place of her continued existence in modernity than the magazine? Through her contemporary paintings, Werner reclaims the model-as-modern-Venus’s place on canvas once more.

The classical nature of Werner’s medium – large-scale oil portraiture – alludes to what was once considered a category of “high” art in which the female was central. Yet Werner’s paintings never lose their “pop” quality; their essence is sugary kitsch. The subjects could have sprung from the pages of today’s Vogue; even their impassive stares are reminiscent of the blank-faced models gracing the magazine’s glossy pages.

As the works are not reflections of real life, but of the magazine’s construction of reality, Werner’s art takes on the artificiality of the idealized female form in a new way. The self-referential nature of the portraits – their play between painting and magazine as separate artistic media – complicates the distinction between the two. But what seals the deal is the way Werner every so often inserts these model girls into ever more campy natural landscapes. These fake, kitschy scenes are so blatantly disconnected from the girls themselves – though they both reside in the world of the unnatural – that they only serve to further reinforce our unease with the world of the idealized forms that face us.

Yet if the artistic endeavor is to openly evaluate, and perhaps even subvert, the fashion model ideal, it falls short in the end. Though Werner questions the constructed nature of these girls by multiplying the codes of artificiality that mark them, she provides no alternatives. What’s more, by pushing the boundaries of kitsch so strongly in the scenic backgrounds, she seems to step into comical exaggeration rather than critical inquiry.

Still, these women can’t help but persist as an ideal. In the end, the exhibit feels more like a musing on the exaggeration of kitsch through the idealized female form, rather than a true critique of our conceptions of her elevated place in contemporary culture.

“Too Much Happiness” is running at Parisian Laundry (3550 St. Antoine O.) until April 19.

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