MISSING
ANGELA
An HIV epidemic swept through Vancouver’s Downtown Eastside in the late 1990’s, carrying off the poor, the drug addicted, the mentally ill, and other vulnerable souls
Article by
Guy Saddy
With photography by
click on image to increase size
“I’m police Chief Bruce Chamber’s daughter,”
she’d lie to the assembled reporters, some of whom dutifully took notes.
“You can interview me later.” This was her day, and in her mind, she was
both host and focus. Up close, you’d notice the flashing, wild eyes, the
slight downward curve of her open mouth. But it was the soft pink dress, like a
bridesmaid’s gown, that made her unforgettable. The bruises seemed even uglier
against the contrasting swish of the pretty pink hem.
By 4 o’clock she wanted to leave. She had been here
for six hours, a long time in one place without drugs. For most of the day,
she’d been genially harassing Liz Evans for money. Evans, who manages the
Portland Hotel, where angle lived, kept finding little pieces of paper in her
pockets: invoices from Angela for imaginary services. They started at $50, then
dropped as the day wore on until her final demand came in at a very reasonable
per diem rate of $5.
“Okay,
Angie,” Evans said laughing and handing her a five-dollar bill. “Thanks. You
earned it.” Angela pocketed the money, leaned in, and kissed Evans on the
check, then took off in the direction of Powell Street, wobbling on those
unsteady high heels into the most dangerous neighbourhood in Canada. It was the
last time anyone saw her.
click on image to increase size
Cheap hotels, drugs, and a concentration of social services draws a wide variety of disaffected people to the Downtown Eastside.
People to the Downtown Eastside
It
wasn’t always like this. HIV infection, while previously not unheard of among
Vancouver’s drug community, had for years remained steady at extremely low
levels, a fact largely attributed to the establishment in 1998 of a highly
regarded needle exchange program (see sidebar, page 48). Everything, it seemed,
was working the way it should: from the late 1980s, when the first studies were
done, to the early 1990s, the HIV “seroprevalence” for IDUs fluctuated
between 2 and 3 percent. Vancouver was a model: a city that had stemmed the tide
of HIV in an extremely vulnerable population.
In 1994, however, things began to change. Street nurses
started to report more positive tests among Downtown Eastside addicts. At nearby
St. Paul’s Hospital, Julio Montaner, an HIV/AIDS specialist, saw a shift in
his patient profile from mainly gay men to IDUs, who quite suddenly accounted
for 45 percent of his new patients.
More than a shift, really: a sea change. The percentage
of addicts testing positive for HIV had climbed from 2 percent to 7 percent in
18 months. In 1995, 38 percent of newly diagnosed HIV patients claimed IDU as
their primary risk factor, up from 9 percent in 1995.
Click on photo to enlarge
“We
seemed to be doing the right things,” reflects Steffanie Strathdee, who,
before moving on to Baltimore’s John Hopkins School of Public Health in 1998,
was director of the epidemiology program for the B.C. Centre for Excellence in
HIV/AIDs, the province’s foremost HIV research center. “What is unusual
about Vancouver is that things stayed stable and low for a long time and looked
under control---and then we had an explosion.”
In
1990, Angela Jardine, said by her mother to have the intellectual abilities of
an 11 year old moved to the Downtown Eastside and landed right in the middle of that
explosion. The elder of two daughters, she was born in Sudbury, Ontario, in
1971, and at the age of 9 moved with her family to Sparwood, British Columbia,
where the coal industry beckoned with the promise of jobs and a better life.
Long before the move, however, there had been signs that Angela was different.
She was slow to walk and talk. In kindergarten, she was prone to off-the-wall,
emotional outbursts, leading to her first psychological assessment at the age of
5. While no definitive diagnosis was ever forthcoming, over the years the usual
catch phrases, clinical and otherwise, were tossed around: hyperactive, sever
behavioral problems, cognitively impaired, and extensive supervision
required.
She
liked school but didn’t fit in. The other kids made fun of the way she talked
and tormented her about her noticeably imperfect coordination. “Angela was
like some sort of beacon that kept blinking ‘I’m different,’” her
mother, Deborah Jardine, remembers. “It was like an aura that was around her.
People who came close to her, right away it made them angry, and they didn’t
want anything to do with her, which was unfortunate.”
Unable
to control her any longer, Jardine allowed Angela, then 16, to be moved into
“respite care” in nearby Castelgar. Then, in 1990, Angela left rural British
Columbia forever and moved to Vancouver’s Downtown Eastside. Her timing
couldn’t have been worse.
At the WISH drop-in centre, above, street sex workers can find a brief respite from the hardships outside. The Portland lobby serves as an impromptu clinic where residents can receive cocktails of HIV-fighting drugs.
AT
THIS OFFICE IN ST. PAUL’S HOSPITAL, the largest HIV treatment facility in
Canada, Martin Schechter leans forward in his chair, eyes locked on his computer
screen. He does this a lot. For Schechter, the computer is his weapon in the
fight against the Vancouver outbreak. Largely through mathematical modeling, he
is changing the way people think about how this epidemic progressed.
Previously it was thought that if 10 percent of an IDU
community became HIV positive, that would set the stage for an explosive
outbreak that would see seroprevalence rise to 40 to 50 percent within one to
four years. “People would talk as though an area could go along with a
relatively stable prevalence---3, 4, or 5 percent---but once it crept up to 10
percent, things would really explode,” says Schechter. “Over that last
couple of years, I’ve come to think that’s probably wrong.”
Instead, Schechter argues, the key to understanding the
explosion is primary infection---the immediate period after a person, “seroconverts,”
or initially comes into contact with HIV. “In the early 1980s, people were
thought to be very infectious in the later stages of the disease,” says
Schechter. “But nobody really talked about what happened immediately after you
were first exposed to HIV, the reason being, it’s really only a short period
of time. Why would you worry about a period of two or three months compared to
years, right?”
So when a new 1996 B.C. Centre for Excellence in
HIV/AIDS study that reported rocketing transmission rates also stated that
“frequent NEP attendees” were, in fact, more likely to have been infected,
it caused a huge stir---mainly in the United States, where the very concept of
needle exchange is a hot political potato. Could Vancouver’s NEP actually be
contributing to the outbreak?
The data showed that regular NEP users were engaging in
higher-risk activities, and the paper mused that NEP sites may be spawning
“new social networks” where new attendees met sharing partners. “A lot of
the ideological opponents [of NEPs] took the Vancouver data and seized on it,”
says Martin Schechter, one of the study’s authors. “We became the poster
children for the anti-needle-exchange crowd.”
But a subsequent 1999 study of almost 700 IDUs showed
that during 15 months, only 0.7 percent reported meeting new people through the
NEP, while only one person met a “sharing partner” there. And the study
confirmed what NEP opponents had chosen to ignore in the earlier report: the
reason frequent NEP users were more likely to be HIV positive was that the NEP
regularly attracted the highest-risk IDUs. As for whether the NEP has had a
beneficial effect, “I would hate to think of the level of HIV infection
without it,” says John Turvey. “You know, I think it would be staggering.”
--G.S
“Assuming
they were sharing with a continuous number of partners through their lifetime,
in that three-month period after initial infection, they could infect as many
other people as they would during 300 months of latent infection. Three hundred
months is twenty-five years,” says Schechter, “So when you think of it like
that, this short period takes on a whole new meaning.”
click on photo to enlarge
Downstairs,
in the Portland Hotel’s office, Theresa, a 44-year-old HIV-positive resident,
sits slumped in a chair while a visiting nurse cuts away the bandages that cover
her ankles.
“It’s
not from fixin’,” she assures us, as the bandages covering one leg fall
away. In front of her is her antiretroviral AIDS medication, 22 pills that she
takes daily.
Beyond
the office door is the hotel lobby, dominated by a pop machine, a television
set, and a few ratty, cast-off couches---a singularly grey place that serves as
the only common area for the hotel’s 70 hard-to-house residents, many of whom
have been diagnosed with multiple problems: chronic mental health conditions
combined with an addiction, for example. Publicly funded by provincial and civic
coffers, the Portland provides housing for those who, like Angela and Theresa,
can’t find anywhere else to live.
Theresa
slowly peels away the bandages. “I’m feeling sick. I think it’s from the
medication.” She has endocarditis and methicillin-resistant Staphylococcus
aureus, one of the superbug bacteria, a surprisingly common affliction in
the Downtown Eastside. Theresa was diagnosed with HIV about four years ago, just
as the epidemic started to pick up steam, and health problems have dogged her
since. “I’m not used to bein’sick,” she says, dropping her gaze. “And
I lost my figure too.” She’s on a methadone maintenance program administered
through the Portland.
click on photo to enlarge
At the Portland, hope comes in the
form of a creative-writing workshop, offering a change from the day to day
demands of Carrall Street, just outside.
“Angela?
We knew each other, yeah,” says Theresa, peeling off the last of the bandages
to reveal a yellowing would. “But we weren’t friends, you know? Angela had a
hard time keeping friends.”
Upstairs,
Angela’s belongings fill six small boxes. One of them contains a drawstring
purse, a few shirts. In another, a pair of sensible white shoes, the kind nurses
wear. Next to these are two carved doves, one of which is missing a wing. A
workbook falls open to a completed page: “The REATH is an organ,” it reads,
and next to it, in Angela’s childlike hand, the carefully filled-in blanks:
HEART.
There’s
also a collection of photographs, and Mark Townsend, who with Liz Evans
co-manages the Portland, starts laying them down, one by one, as though dealing
from a deck of cards. Angela with her sister Amber at Christmas. Angela was 16.
“It’s
quite amazing,” says Townsend, lingering over the last shot. “Her face has
hardly changed.”
He’s
right. Even then, however, it’s clear there was something wrong with the
little girl in the photo. She seems jumpy and wired, barely in control. Next,
Townsend turns over a plasticized ID from a neighbourhood cheque-cashing store.
On it is a birth date: June 23, 1971. Angela was 27 when she disappeared on
November 20, 1998. Even Townsend is surprised. She looked much older.
The
Downtown Eastside has been victimized by the rest of the city’s overall
success. Since Expo 86, when local real estate prices began to soar,
Vancouver’s stock of cheap hotels and rooming houses outside the Eastside has
been steadily eroding, with many being converted to mid-priced backpacker
lodgings or “boutique” hotels. In 1994, the federal government slashed
social-housing spending, prompting a migration of new residents---many of them
drug users and deinstitutionalized mentally ill---into the Downtown Eastside
searching for what services and affordable accommodation remained. At the same
time, the area itself was becoming smaller as developers eyed the elegant
turn-of-the-century architecture on the edges of nearby Gastown. The result was
an area unlike any other in Canada or, indeed, in the U.S. Pacific Northwest: a
dense concentration of poverty-stricken users compressed into an
ever-constricting space.
Within
that environment was a smaller ecosystem dominated by single room occupancy
(SRO) hotels.
click on photo to enlarge
A
typical SRO hotel room is nine square metres of living space, generally without
bathroom facilities, refrigerator, or stove. If they are classed as housekeeping
rooms, linens are changed, usually weekly, while those classified as sleeping
rooms are little more than places to fit a bed and usually, although not always,
a sink.
Some
SRO hotels are like the Portland, clean and well run, but others are hellish, as
Laviolette readily admits. “The North Star just got shut down,” he says.
“Out of 30 rooms, there were maybe 6 legitimate monthly renters. The rest were
dailies and hourlies. And in that case, the rooms were being used for fixing.
The Roosevelt was run by a bunch of dealers, and some of the rooms were being
used for tricks and rented hourly. No doors on some rooms, no maintenance. There
was sewer water from a leaky toilet running down the stairs.”
A
1995 study headed by Steffanie Strathdee found that living in unstable
housing---on the streets or in a shelter, having no fixed address or in an SRO
hotel---doubles the risk of contracting HIV. Within many SROs, there is a
“climate for needle sharing” where many newly infected addicts, their viral
loads soaring, casually engage in needle sharing. These informal sharing
networks constitute another critical piece of Vancouver’s HIV puzzle.
Again,
Martin Schechter does the math. On his computer, he shows two groups, each
consisting of five people. “If you just measured things like links and
partnerships, both groups would look roughly equal,” he says. “But this
one,” pointing to the second group, “is far more dangerous.”
The
first group is a “monogamous model”---five people in a row. For the
infection to pass from the initial infectee through the entire chain, four
separate infections would have to take place. The second group is a wheel of
four people with a fifth person at its center. “Suppose he gets infected,”
says Schechter, pointing to one of the peripheral people and tracing a path
through the center to one of the other spokes. “He’s only two relationships
away from everybody else in the cluster. So it just spreads, like a fireball.”
When
the fireball explodes, it burns from the middle. Those who engage in the
highest-risk behaviors---indiscriminate needle sharing, working the sex trade,
frequent injectors---are the first to be infected. Angela, a drug-addicted
prostitute whose life was chaotic at best, was living at ground zero.
click on photo to enlarge
Recently one of the 23 missing was
found, but 22 women are still unaccounted for since 1995. People wonder: Are we
doing enough?
ANGELA’S ARRIVAL IN VANCOUVER coincided roughly with
the first wave of cheap injection cocaine, perhaps the most critical event in
the natural history of the Vancouver epidemic. Since becoming both inexpensive
and plentiful in the early 1990’s cocaine is now cited as the drug of choice
by 64 percent of Vancouver’s IDUs. Studies indicate that addicts who
frequently inject cocaine tend to take more irrational chances---sharing needles
or preparation solutions, for instance, or letting someone else inject
them---thereby significantly increasing their risk of HIV infection.
Cocaine’s
main impact was both simple and chemical: while a heroin high lasts for hours, a
cocaine high lasts only 20 to 30 minutes. A heroin user might inject once or
twice a day, but a cocaine addict often will shoot up 4 or 5 times daily---or,
when on an exceptional binge, as often as 40 times, according to street-level
studies conducted by the Centre for Excellence. Needless to say, cocaine use
sent the rate of needle sharing through the roof.
To
Martin Schechter, the results were predictable and easily illustrated. Schechter
starts with two conservative assumptions: one, that newly infected addicts had
50 times more virus in their blood than latent users, and two, that the contact
rate between addicts---the number of times they would share their “rigs,” or
syringes---was 2.5 times a month. “You get a kind of smoldering epidemic,”
he says, “with relatively low incidence rates: a slowly rising prevalence,
okay? Now, we said to ourselves, let’s simulate the change when people
switched to cocaine.”
Starting
in 1994, Schechter increases the contact rate from 2.5 to 4.5 times a
month---again, a moderate figure. The result is a massive spike in new
infections, exactly imitating what happened in the Downtown Eastside. “Now,”
says Schechter, “you can see what drives this epidemic.”
In
Angela’s case, cocaine was only one of several culprits. Like the Downtown
Eastside itself, she wasn’t easily solved or understood. Or, for that matter,
helped. “Angie was a very demanding person in a lot of ways,” says John
Turvey, a former addict and now executive director of the Downtown Eastside
Youth Activities Society, which operates the needle exchange. “She was sweet
and could be compassionate when she got outside herself long enough. Very
childlike….I’m absolutely dismayed she went missing. But ask me if I’m
surprised, and I’m not.”
Outside
the Portland, Andrea, a pretty, young, flame-haired girl and a recent arrival at
the hotel, offers a less sympathetic appraisal. “I don’t mean to be mean,”
she says, “but Angela was very mentally ill, and she was ‘dope simple.’
That’s why she would, you know, put herself in stupid situations.”
There
is a pecking order on the streets, and Angela was firmly ensconced at the
bottom, turning tricks behind the Astoria Hotel, perhaps defiantly under the
“No Intercourse” warning painted nearby on an alley wall. Today, there are a
few women working the adjacent avenues. Not many want to talk about Angela---or
talk at all.
“Yeah,
I knew her. She was that retarded girl, right?” says Rebecca, tossing long,
curly, dark hair. “Well, we used to chase her away from here. She was weird,
you know? She’d pull up her top or raise up her skirt and show, you know,
anybody who was driving by. She’d run after cars---I mean, I’m serious,
she’d actually chase them down the street and shout, ‘Five bucks! Five
bucks!’ She was pretty whacked.” Rebecca pauses as passing cars, invariably
driven by respectable-looking middle-aged men, crawl by. “You sure you don’t
have a cigarette?”
click on photo to enlarge
Nothing
much has changed. Needle sharing continues, cocaine is abundant, and living in
an SRO hotel is still often the only viable alternative to being on the street.
And that means for the next influx of “new
susceptibles”---let’s call them people---the conditions are still ripe for
another outbreak. “The street kids of today are going to be the injection drug
users of tomorrow,” warns Steffanie Strathdee. “What frightens me is that a
lot of the conditions that created the epidemic are still there. If we were to
wipe the slate clean and introduce a new population of injection drug users, I
think we’d have another epidemic.”
Back
in the second-floor laundry room of the Portland, Jill Pleskach, a hotel worker,
shows off a small toy she received as a gift: For Jill From Angie, reads the
makeshift card.
“Oh,
yeah, a little thing from Angie,” she says, smiling. “You can say what you
want about Angie. But I liked her. I liked her. She was a pistol, that kid.”
Townsend
misses her too. He misses the woman who had no choice but to live life with the
volume turned up to 10, a self-destructive child lost to the Downtown Eastside
but lose somewhere else a long time before.
He
dreams about her sometimes. Not the violent, terrible dreams some of his
coworkers have. Good dreams. “I’m walking down the street, and I see the
back of her, and I run up---and she’s there,” says Townsend, his voice
trailing off. “She looks just the same. Funny enough, she’s wearing that
pink dress.”
Townsend
looks out the window, his gaze turning westward, beyond the concrete horizon
toward the postcard Vancouver of tourist brochures and travel guidebooks. There,
the cherry trees are in full bloom. The city is awash in pink.
Long-time EQUINOX contributors, Guy
Saddy and Peter Bennett are based in
Vancouver, British Columbia.
E Q U I N O
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VANISHED
VOICES
A beautiful website in memory of Angela and all
the
Vancouver eastside missing women