Harley Ransom began practicing harm reduction in southeastern Ontario in the late 1980s, when he was 6 years old. His mother was injecting heroin, so he learned how to clean her wounds and shoplift syringes from pharmacies. His mother contracted HIV from her boyfriend, so Ransom also learned not to rush to help her without putting gloves on first.
Today, his harm reduction work is with his community in Vancouver’s Downtown Eastside (DTES) as progressive drug policies are dismantled, taking vital HIV resources down with them.
In the 1990s, Ransom joined the Vancouver Area Network of Drug Users (VANDU) after longtime activist Hugh Lampkin found him in an alley and roped him into volunteering by the Carnegie Community Centre. The DTES was the site of “arguably the worst AIDS epidemic in the developed world.” Ransom lost his mother and aunts to overdose.
“It was getting really bad down here for a while,” he told Filter. “It was actually quite scary.”
He recalled how hospital workers would treat HIV patients as “lower-class,” refusing to approach them or talk to them.
Ransom would go to nearby Surrey to bring “a box of syringes” to people who didn’t have the means to come downtown. “We’d trade three dirty ones for a clean one,” he said. The “night shift,” as it was called back then, is a little more formal now, known as the Surrey Union of Drug Users.
Ransom, who is Ojibwe-Cree and has strands of punchy green hair dangling over his eyes, bristles with energy. In addition to VANDU, he’s active with the Eastside Illicit Drinkers Group for Education, the P.O.W.E.R. police oversight project, and WAHRS, the oldest Indigenous harm reduction society in Canada. He spends his days bringing people sterile syringes, safer smoking kits and hand warmers, and twice-weekly sandwiches. Or looking for those who “go missing.”
Many people still only have “bits and pieces” of information about HIV and hepatitis C, Ransom said, despite there being pop-up clinics in the neighborhood. “We do need to get more awareness out there. A lot of people tend to stay away from it.” They’ve been focused on overdose, just keeping themselves and their friends alive.
Since British Columbia declared the overdose crisis a public health emergency in 2016, more than 17,500 people in the province have died of overdose. But amid escalating political backlash, on January 14 BC shuttered its historic pilot that for the past three years had decriminalized possession of small quantities of opioids, cocaine, methamphetamine and MDMA. Now, recriminalization is bringing back barriers to health care, including potential for HIV and hepatitis C prevention.
“It’s like they purposely want us to crash and burn,” Ransom said.
“Accessing safer supply supported their adherence to HIV medications,” said Ivsins. “It’s a really important relationship.”
HIV transmission surged during the COVID-19 pandemic, as people were cut off from harm reduction resources. In 2023 Canada recorded 2,434 new diagnoses—35 percent more than in 2022, and the country’s largest annual increase in a decade. Transmission appeared to drop in 2024, with 1,826 new diagnoses. But this still means thousands more people who need accessible treatment.
Andrew Ivsins, a researcher with the BC Centre on Substance Use and an assistant professor of social medicine at the University of British Columbia, has studied the impact of the province’s safer supply programs on participants with HIV.
“Accessing safer supply supported their adherence to HIV medications,” he told Filter. “It’s a really important relationship that we found, where this innovation in harm reduction has more widespread impacts on people’s health and wellbeing.”
For antiretroviral therapies (ART) like the medications that treat HIV, adherence is critical. Bundling ART together with safer supply like pharmaceutical diacetylmorphine (heroin) or fentanyl can make that possible for people who have structural barriers working against them, Ivsins said, “like being without housing or always losing their belongings.”
In Canada, medications for opioid use disorder (MOUD) and safer supply exist on a spectrum, with a broader range of options than the three MOUD approved in the United States—albeit still very limited —relative to what people actually need. Methadone, buprenorphine and slow-release oral morphine (Kadian) are examples of opioid agonist therapy, as MOUD is known in Canada. Hydromorphone (Dilaudid) tablets and other pharmaceutical opioids are “prescribed alternative,” or safer supply.
During the pandemic Health Canada loosened some of the restrictions around these medications, encouraging providers to grant more take-homes and allowing some patients to receive deliveries rather than requiring them to travel to a pharmacy—sometimes multiple times a day—for supervised dosing. So pharmacies could blister-pack someone’s antiretroviral HIV medication with their other prescriptions, and these packs could be dropped off at, for example, the front desk of the patient’s single-room occupancy building.
In 2025, by which time the political tide had turned against harm reduction, BC mandated that all dosing of prescribed alternatives be witnessed by a health care professional.
If no one is home, the medication is simply taken back.
“For folks who are unhoused or not really stabilized in their drug use at all, that daily delivery from a pharmacist is lifesaving,” Blake Edwards, a student nurse and long-time DTES outreach worker, told Filter. He said it’s also cost-effective for pharmacies, as the ones “that are handling those medications aren’t getting any financial incentive to do so.”
Now, people are more likely to miss doses. If no one is home, the medication is simply taken back.
Canada has been the only G7 country where HIV/AIDS prevalence is rising. The defunding of PEPFAR (the US President’s Emergency Plan for AIDS Relief) and the backbone of global HIV/AIDS research reached Vancouver as well—with funding cuts impacting research at the University of British Columbia on HIV treatment for women. The HIV Legal Network emphasized Canadian drug policy as a key federal election issue. Yet policies remain unaligned.
In addition to the decriminalization of drugs, Canada has moved away from decriminalization of HIV. Non-disclosure can still be prosecuted as “aggravated sexual assault,” even in cases with no risk of transmission. Though in recent years prosecutors have been directed away from such cases, more than 200 people have faced HIV-related charges since the AIDS epidemic. The federal government was expected to address this, but in 2024 abandoned the plan to do so.
Image (cropped) via Washington State Health Care Authority
