{"id":25032,"date":"2025-06-19T13:53:27","date_gmt":"2025-06-19T17:53:27","guid":{"rendered":"https:\/\/www.hivlegalnetwork.ca\/site\/?post_type=publication22&p=25032"},"modified":"2025-07-07T10:33:07","modified_gmt":"2025-07-07T14:33:07","slug":"25032","status":"publish","type":"publication22","link":"https:\/\/www.hivlegalnetwork.ca\/site\/25032\/","title":{"rendered":"Open Letter – Prohibition of sterile needle and syringe distribution within HART Hubs"},"content":{"rendered":"

\r\n\tDownload<\/a><\/p>\n

Dear Minister Jones and Dr. Kieran Moore:<\/p>\n

cc:\u00a0 Medical Officers of Health, Ontario
\n\u00a0 \u00a0 \u00a0 Public Health Ontario
\n<\/span>\u00a0 \u00a0 \u00a0 Ontario Public Health Association
\n<\/span>\u00a0 \u00a0 \u00a0 Infection Prevention and Control Canada
\n<\/span>\u00a0 \u00a0 \u00a0 Public Health Agency of Canada
\n<\/span>\u00a0 \u00a0 \u00a0 Association of Local Public Health Agencies<\/span><\/p>\n

RE: Prohibition of sterile needle and syringe distribution within HART Hubs\u00a0 <\/strong><\/p>\n

Since 1989, needle and syringe programs (NSPs) have been a core public health intervention to prevent the spread of infections and preserve the health of people who use drugs in Ontario.[i]<\/a> NSPs provide people who inject drugs with the equipment they need to avoid acquiring and\/or transmitting blood-borne infections such as HIV and hepatitis C (HCV). Research in Canada has consistently shown that NSPs are a cost-effective way to reduce the risk of HIV and HCV transmission, abscesses, and cardiac infections,<\/a> and are a low-threshold way to connect people to healthcare services.[ii]<\/a> The health and public health benefits of distributing sterile injection equipment are well-recognized and established in the peer-reviewed scientific literature. This is why NSPs have been recommended by international health organizations, including the World Health Organization<\/a>, as essential elements of effective HIV and HCV prevention strategies for decades.[iii]<\/a><\/p>\n

Yet, despite four decades of evidence underscoring the individual and public health benefits of NSPs, Ontario has chosen to prohibit all Homelessness and Addiction Recovery Treatment (HART) Hubs<\/a> from\u00a0 distributing sterile needles and syringes.[iv]<\/u> <\/a>This is a dangerous move, especially at a time when HIV infections<\/a> in Canada are on the rise. In 2022, 9.3% of Ontario\u2019s 475 new HIV infections were among people who inject drugs,[v]<\/a> with women accounting for 26.9% of all new HIV diagnoses.[vi]<\/a> While there have been significant advances in treating HIV and HCV, treatment is expensive, and HIV, while a chronic manageable condition for those who have access to care and treatment, cannot be cured. Therefore, prevention remains paramount.<\/p>\n

Your government has made clear that HART Hubs<\/a> are designed to treat clients with complex service needs, providing them with safety and support for substance use.[vii]<\/a> Research<\/a> has shown that NSPs improve access to healthcare services and help to build relationships between healthcare providers and people who inject drugs.[viii]<\/a> In short, the implementation of NSPs lead to overall improvements in health and wellbeing, and increased entry intro substance use treatment programs \u2014 the ostensible goal of HART Hubs. Depriving people who use drugs of the tools that keep them safe and healthy will lead to poorer health outcomes for them, and is completely antithetical to Ontario\u2019s own public health standards.<\/p>\n

In 2018, Ontario\u2019s then-Ministry of Health and Long-Term Care produced its Substance Use Prevention and Harm Reduction Guideline<\/em><\/a> (the \u201cGuideline\u201d), affirming that the \u201cdistribution of needles\/syringes and other drug use supplies has proven to be an effective method in reducing blood-borne infections associated with injection drug use, such as HIV and hepatitis C\u201d by reducing \u201cthe sharing and re-use of needles, syringes, and other supplies\u201d as well as \u201cdiscarded needles and syringes in the community.\u201d[ix]<\/a> At the same time, the Guideline acknowledges that an NSP \u201cprovides a point of access into health and social services for clients who may not otherwise have access to such services, as well as opportunities for education on safer drug use practices.\u201d As such, the Guideline instructs boards of health to \u201cprovide or ensure the availability of sterile needles and syringes, as well as safer drug use supplies currently funded and provided through the Ontario Harm Reduction Distribution Program to individuals who use drugs in the public health unit\u2019s region.\u201d\u00a0 The Guideline remains in place and, in the Ministry of Health\u2019s own Opioid Strategy Performance Indicators, \u201cNumber of needles\/syringes distributed\u201d was added after the Auditor General<\/a> audit of Addictions Treatment Programs in 2019.[x]<\/a><\/p>\n

Similarly, in 2023 Ontario\u2019s Advisory Committee on HIV\/AIDS produced an HIV Action Plan to 2030<\/em><\/a> that confirms that \u201csterile drug using equipment, needle exchange programs, and consumption and treatment services\u201d prevent the spread of HIV and calls for \u201cexpanding access to harm reduction supplies.\u201d[xi]<\/a><\/p>\n

The absolute restriction on needle and syringe distribution within HART Hubs completely contradicts a well-researched body of medical and public health evidence showing that these programs prevent HIV and HCV infections.2<\/sup> We must continue to provide proven tools to prevent infections, reduce healthcare costs, and connect people who use drugs to healthcare services. The attempt to close these vital health programs must be stopped, as closing or limiting their availability increases risks and will harm populations who are already vulnerable due to homelessness and stigma.<\/p>\n

We strongly call on the Province of Ontario to listen to decades of evidence and reverse the disastrous policy decision restricting HART Hubs from sterile needle and syringe distribution. These programs are a crucial part of our public health infrastructure, and they must be maintained.<\/strong><\/p>\n

Sincerely,<\/p>\n

HIV Legal Network
\n<\/strong>HIV & AIDS Legal Clinic Ontario\u00a0<\/strong><\/p>\n

On behalf of the undersigned:<\/em><\/p>\n

Action Hepatitis Canada
\n<\/strong>Canada (National)<\/span><\/p>\n

AIDS Committee of Durham Region (ACDR)
\n<\/strong>Oshawa, Ontario<\/p>\n

AIDS Committee of Ottawa
\n<\/strong>Ottawa, Ontario<\/p>\n

AIDS Committee of Toronto (ACT)
\n<\/strong>Toronto, Ontario<\/p>\n

Anishnawbe Health Toronto
\n<\/strong>Toronto, Ontario<\/span><\/p>\n

ARCH Disability Law Centre
\n<\/strong>Toronto, Ontario<\/p>\n

Black Legal Action Centre
\n<\/strong>Toronto, Ontario<\/p>\n

Breakaway Community Services
\n<\/strong>Toronto, Ontario<\/p>\n

Canadian Drug Policy Coalition
\n<\/strong>Canada (National)<\/p>\n

Canadian Network on Hepatitis C (CanHepC)
\n<\/strong>Toronto, Ontario<\/p>\n

Casey House
\n<\/strong>Toronto, Ontario<\/p>\n

CATIE
\n<\/strong>Canada (National)<\/p>\n

CAYR Community Connections
\n<\/strong>York Region, Ontario<\/p>\n

Centre for Addiction and Mental Health
\n<\/strong>Toronto, Ontario<\/span><\/p>\n

Centre for Spanish Speaking Peoples
\n<\/strong>Toronto, Ontario<\/p>\n

Centretown Community Health Centre
\n<\/strong>Ottawa, Ontario<\/p>\n

Coderix Medical Clinic
\n<\/strong>Toronto, Ontario<\/p>\n

Community Legal Clinic of York Region
\n<\/strong>Richmond Hill, Ontario<\/p>\n

Community Legal Services of Ottawa\/Services juridiques communautaires d\u2019Ottawa
\n<\/strong>Ottawa, Ontario<\/p>\n

Comprehensive Treatment Clinic
\n<\/strong>Toronto, Ontario<\/p>\n

Doctors for Safer Drug Policy
\n<\/strong>Canada (National)<\/p>\n

EACH+EVERY: Businesses for Harm Reduction
\n<\/strong>Canada (National)<\/p>\n

East End Community Health Centre
\n<\/strong>Toronto, Ontario<\/p>\n

Elevate NWO
\n<\/strong>Thunder Bay, Ontario<\/p>\n

Elgin-Oxford Legal Clinic
\n<\/strong>St. Thomas, Ontario<\/p>\n

Evangel Hall Mission
\n<\/strong>Toronto, Ontario<\/p>\n

Families for Addiction Recovery (FAR)
\n<\/strong>Toronto, Ontario<\/p>\n

Family Service Toronto
\n<\/strong>Toronto, Ontario<\/p>\n

Flemingdon Health Centre
\n<\/strong>North York, Ontario<\/p>\n

Fred Victor
\n<\/strong>Toronto, Ontario<\/p>\n

Gay Men\u2019s Sexual Health Alliance
\n<\/strong>Toronto, Ontario<\/p>\n

Gerstein Crisis Centre
\n<\/strong>Toronto, Ontario<\/p>\n

Guelph Community Health Centre
\n<\/strong>Guelph, Ontario<\/span><\/p>\n

Habitat Services
\n<\/strong>Toronto, Ontario<\/span><\/p>\n

Harm Reduction Advocacy Collective
\n<\/strong>Toronto, Ontario<\/p>\n

Harm Reduction Nurses Association
\n<\/strong>Canada (National)<\/p>\n

Health Justice Program
\n<\/strong>Toronto, Ontario<\/p>\n

Health Providers Against Poverty
\n<\/strong>Toronto, Ontario<\/p>\n

Homeless Connect Toronto
\n<\/strong>Toronto, Ontario<\/p>\n

Indigenous Harm Reduction Network
\n<\/strong>Barrie, Ontario<\/p>\n

Kingston Community Health Centres
\n<\/strong>Kingston, Ontario<\/p>\n

Legal Assistance of Windsor
\n<\/strong>Windsor, Ontario<\/span><\/p>\n

Legal Clinic of Guelph and Wellington County
\n<\/strong>Guelph, Ontario<\/p>\n

Liver Health Team Timmins and District Hospital
\n<\/strong>Timmins, Ontario<\/p>\n

Manitoulin Legal Clinic
\n<\/strong>Aundeck Omni Kaning First Nation, Little Current, Ontario<\/p>\n

Mississauga Community Legal Services
\n<\/strong>Mississauga, Ontario<\/p>\n

Northumberland Community Legal Centre
\n<\/strong>Cobourg, Ontario<\/p>\n

Nurses Specialized in Wound, Ostomy and Continence Canada
\n<\/strong>Ottawa, Ontario<\/p>\n

Ontario Aboriginal HIV\/AIDS Strategy (Oahas)
\n<\/strong>Toronto, London, Barrie, Sudbury, Sault Ste. Marie, and Thunder Bay, Ontario<\/span><\/p>\n

Ottawa Inner City Health
\n<\/strong>Ottawa, Ontario<\/span><\/p>\n

PARC (Parkdale Activity Recreation Centre)
\n<\/strong>Toronto, Ontario<\/p>\n

Parkdale Queen West Community Health Centre
\n<\/strong>Toronto, Ontario<\/p>\n

Positive Living Niagara
\n<\/strong>Niagara Region, Ontario<\/p>\n

Pozitive Pathways Community Services
\n<\/strong>Windsor, Ontario<\/p>\n

Reach Out Chatham-Kent (R.O.C.K.)
\n<\/strong>Chatham, Ontario<\/p>\n

RECLAIM Collective
\n<\/strong>Guelph, Ontario<\/p>\n

Regent Park Community Health Centre
\n<\/strong>Toronto, Ontario<\/p>\n

Regional HIV\/AIDS Connection
\n<\/strong>London, Ontario<\/p>\n

Registered Nurses’ Association of Ontario (RNAO)
\n<\/strong>Toronto, Ontario<\/p>\n

R\u00e9seau ACCESS Network
\n<\/strong>Sudbury, Ontario<\/p>\n

Sandy Hill Community Health Centre
\n<\/strong>Ottawa, Ontario<\/p>\n

Shelter and Housing Justice Network
\n<\/strong>Toronto, Ontario<\/p>\n

Shelter Health Network
\n<\/strong>Hamilton, Ontario<\/span><\/p>\n

Social Planning Toronto
\n<\/strong>Toronto, Ontario<\/span><\/p>\n

South Riverdale Community Health Centre
\n<\/strong>Toronto Ontario<\/span><\/p>\n

St. Michael’s Homes
\n<\/strong>Toronto, Ontario<\/span><\/p>\n

Street Haven
\n<\/strong>Toronto, Ontario<\/span><\/p>\n

Street Health Community Nursing Foundation
\n<\/strong>Toronto, Ontario<\/p>\n

Substance Overdose Prevention and Education Network (SOPEN)
\n<\/strong>Hamilton, Ontario<\/span><\/p>\n

The Canadian Centre for Refugee and Immigrant Health Care
\n<\/strong>Scarborough, Toronto<\/p>\n

The Centre on Drug Policy Evaluation
\n<\/strong>Toronto, Ontario<\/p>\n

The Gilbert Centre for Social and Support Services
\n<\/strong>Barrie, Ontario<\/span><\/p>\n

The Jean Tweed Centre
\n<\/strong>Toronto, Ontario<\/span><\/p>\n

The Neighborhood Group Community Services (TNG)
\n<\/strong>Toronto, Ontario<\/span><\/p>\n

The Ontario Network of People Who Use Drugs (ONPUD)
\n<\/strong>Port Hope, Ontario<\/span><\/p>\n

Thrive HIV Prevention and Support
\n<\/strong>Waterloo Region\u00a0 \/ Guelph, Ontario<\/span><\/p>\n

Thunderbird Partnership Foundation
\n<\/strong>Ontario<\/p>\n

Toronto Alliance to End Homelessness
\n<\/strong>Toronto, Ontario<\/p>\n

Toronto Harm Reduction Alliance
\n<\/strong>Toronto, Ontario<\/span><\/p>\n

Trip! Project
\n<\/strong>Toronto, Ontario<\/span><\/p>\n

Ubuntu Trans+ Collective
\n<\/strong>Toronto, Ontario<\/p>\n

Unison Health and Community Services
\n<\/strong>Toronto, Ontario<\/p>\n

Validate Mental Health Consultants
\n<\/strong>Toronto, Ontario<\/p>\n

Waterloo Region Community Legal Services
\n<\/strong>Kitchener, Ontario<\/span><\/p>\n

Wellington Guelph Drug Strategy
\n<\/strong>Guelph Wellington, Ontario<\/span><\/p>\n

West Neighbourhood House
\n<\/strong>Toronto, Ontario<\/span><\/p>\n

Women and HIV \/ AIDS Initiative
\n<\/strong>Toronto, Ontario<\/p>\n

_____________________________________________________________________________<\/p>\n

[i]<\/a> C. J. Strike, T. Myers, and M. Millson., \u201cFinding a place for needle exchange programs,\u201d Critical Public Health<\/em> 14, 3 (2004): pp 261-275.<\/p>\n

[ii]<\/a> Working Group on Best Practice for Harm Reduction Programs in Canada, Best Practice Recommendations for Canadian Programs that Provide Harm Reduction Supplies to People Who Use Drugs and are at Risk for HIV, HCV, and Other Harms<\/em>. 2021.<\/p>\n

[iii]<\/a> World Health Organization, Guide to Starting and Managing Needle and Syringe Programmes<\/em>. January 2007.<\/a><\/p>\n[iv] Ontario Ministry of Health, Homeless and Addiction Recovery Treatment Hubs Call for Proposals: Guideline and Application<\/em>. August 2024.<\/a><\/p>\n[v] Public Health Agency of Canada, Canada\u2019s Progress Towards Ending the HIV Epidemic.<\/em> November 2022.<\/p>\n

[vi]<\/a> Ontario HIV Epidemiology and Surveillance Initiative, HIV diagnoses in Ontario, 2022<\/em>. November 2024.<\/p>\n

[vii]<\/a> Ontario Ministry of Health, Homelessness and Addiction Recovery Treatment (HART) Hubs Client Journey<\/em>. August 2024.<\/a><\/p>\n[viii] Centers for Disease Control and Prevention, Safety and Effectiveness of Syringe Services Programs<\/em>. February 2024.<\/a><\/p>\n[ix] Ontario Ministry of Health and Long-Term Care, Substance Use Prevention and Harm Reduction Guideline<\/em>, 2018<\/em>. January 2018.<\/p>\n

[x]<\/a> Office of the Auditor General of Ontario, Performance Audit: Implementation and Oversight of Ontario\u2019s Opioid Strategy<\/em>. 2024.<\/p>\n

[xi]<\/a> Ontario Advisory Committee on HIV\/AIDS, HIV Action Plan to 2030 Closing the gaps in the HIV care cascade in Ontario<\/em>. December 2023.<\/p>\n

 <\/p>\n

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