Drug users who have long sought to keep others safe by voluntarily distributing sterile needles are now getting paid for their work in North Battleford, Sask., where public health workers are responding to recent outbreaks of HIV and syphilis.

The program gives people who are in contact with drug users, including some who are still users themselves, backpacks stocked with clean drug-use supplies to distribute.

Vending machines stocked with sterile drug-use equipment are also being used to provide 24-hour access to sterile needles. There are plans to do the same in the Saskatchewan cities of Lloydminster and Meadow Lake.

The first vending machine was installed outside the Battleford Indian and Métis Friendship Centre at the end of July. The supplies are free — they use tokens obtained from local services like the Friendship Centre.

It is the first time the machines and the paid backpack positions have been used to help stop the spread of sexually transmitted infections in Saskatchewan, said Danielle Radchenko, sexual health co-ordinator for the Saskatchewan Health Authority (SHA).

The health authority declared outbreaks of syphilis and HIV in North Battleford and Lloydminster, Sask. in June. (Alicia Bridges/CBC)

Radchenko won a $200,000 grant from the Public Health Agency of Canada to run the program.

"We've had quite a few people coming to the peers asking them for supplies [and] feeling comfortable to ask them how they can get more support," said Radchenko.

"Whether that's if they want to go for treatment for their use of drugs or whether or not it's just someone they can talk to that they feel like they can get connected [to] for some counselling support."

She said the program was part of her vision to have more peer workers, people with experience, involved in the response to rising STI rates. Some of the workers were identified by public health nurses as being good candidates for the positions. They work between four and six hours a week.

Danielle Radchenko, a public health nurse, researched projects in Europe and Australia when considering harm-reduction strategies to try in Saskatchewan. (Alicia Bridges/CBC)

Radchenko's team covers the Battlefords, Lloydminster and Meadow Lake in west-central Saskatchewan.

Nineteen new cases of HIV were reported in North Battleford, which has a population of about 14,000, from Jan. 1 to July 29.

During the same time, 66 new cases of syphilis were reported in the Battlefords and Lloydminster area.

The average number of HIV cases in the area is four per year. The annual number of syphilis cases is usually seven or less.

On June 14, the SHA declared an outbreak.

"It is also important to note that the increase in the numbers is expected due to increased public awareness and increased testing, in addition to the work done tracing contacts for individuals who have tested positive," SHA spokesperson Doug Dahl said in an email.

Radchenko said about five backpackers are working for the program, and about five other people want to do the same.

The vending machine and backpack programs were already in motion when the outbreak was declared. Local health workers say the cluster of cases could have happened anywhere.

McNeil says there are plans to install more needle-vending machines in Meadow Lake and Lloydminster. (Alicia Bridges/CBC)

Similar needle-vending machines were installed in Ottawa in 2017. Ottawa Public Health did not have anybody available to talk about the program before this story was published. There have been recent calls for the machines to be installed in Vancouver's Downtown Eastside. The machines cost about $5,000 each.

Increases in the prevalence of some infections have also been reported across Canada. The latest available numbers, from 2017, show 177 people, or 15 per 100,000 population, were newly diagnosed with HIV in Saskatchewan that year.

In North Battleford, workers say the new initiatives are already showing signs of success.

Malcolm McNeil, who has been HIV-positive for more than 30 years, works for SHA as a peer adviser for people with HIV and hepatitis C.

McNeil is dedicated to the backpack and vending machine project, which he said enables people to access sterile needles without fear of judgment.

"If somebody is doing, you know, morphine or another drug they're considered an addict if they're walking into harm reduction [services]," said McNeil.

'We're seeing great advances in how quickly people are getting onto treatment,' says Kelly Greenwald, the HIV strategy co-ordinator in the region. (Alicia Bridges/CBC)

McNeil also educates the people he speaks to about how they can get access to treatment. Doctors in Saskatchewan have spoken out about how HIV patients in Saskatchewan are still dying because they are not aware that antiretroviral treatment could save their lives.

"It was only last year that I also had a brother that was HIV-positive, and he went and passed away," said McNeil.

"He wasn't aware of the services that are available."

McNeil said a local detox centre is sorely needed.

He said people who go into detox can also start regular HIV treatment. Often, he said, people hold back from getting testing or treatment for fear of judgment. Sometimes, he said, they feel they have to leave town if they are from a small community.

"Some of these individuals are young and they feel that they're going to lose their friends and the people around them, but after they speak with a peer mentor for two or three times, hang around, have a game of pool, whatever, they start to relax," said McNeil.

Other responses in the Prairie North region include using the SHA child immunization van to travel to communities daily. Additional workers were brought into the team to help respond to the outbreak.

The needle-vending machines contain boxes with sterile needles and other supplies. (Alicia Bridges/CBC)

The nurses in the van can do immediate testing if a person agrees.

The SHA has also started tracking the location of STIs in the Prairie North region to identify where their services are needed most.

Kelly Greenwald, the HIV strategy co-ordinator for SHA, monitors new cases of HIV in that region.

She said the local teams acted after the outbreak to help them respond more effectively.

"We're seeing great advances in how quickly people are getting onto treatment," said Greenwald.

For the past 20 years, the Prairie North region of the SHA has had a partnership with the Battle River Treaty 6 Health Centre, which is owned and operated by First Nations communities.

Indigenous Services Canada also works with Battle River Treaty 6 and SHA.

The SHA has also made syphilis treatment available through emergency rooms since the outbreak. Greenwald said several people have been given a rapid start to their HIV treatment.

Greenwald said there have been more new cases of HIV since the end of May, but she believes the numbers will go down.

Adele Sperle supervises community health nurses who work at six member First Nations covered by the Battle River Treaty 6 Health Centre.

She said the stigma surrounding STIs continues to make their work challenging, but the outbreak has strengthened the combined efforts of local services.

"Let's make it normal to go for an HIV or hep C or syphilis test," said Sperle. "Let's make it normal so everybody can come in to do it. Let's reduce the fear."

Sperle said the dark cloud cast by the outbreak has a silver lining.

"We're seeing that actually people are getting tested," she said. "More people know their status, so more people are getting access to early treatment."

The Battleford RCMP declined to comment on drug trends in the area.