Miami Herald, Saturday, December 30 1989
Tim Jones

He has been here before and he knows what to expect: Five clean needles and, invariably, the good wishes of the proprietors. No money changes hands. In a few moments, the man returns to the icy, bleak corridors of Montreal's red-light district.

He probably will be back tomorrow night.

This kind of transaction is a daily occurrence at CACTUS, a French acronym for a nearly six-month-old program created to help stem Montreal's alarming spread of AIDS, or acquired immune deficiency syndrome.

It also is evidence of aggressive, although isolated, moves that some Canadian cities have taken since the summer to stop what has become in Toronto the leading killer of men age 25 to 44.

"To see an infectious, sexually transmitted disease move to the top of the hit parade is very hard to accept," said Dr. Catherine Hankins, coordinator of the Center for AIDS Studies at the Department of Community Health-Montreal General Hospital.

Starting next month, the Toronto Board of Education will try to check the spread by installing condom machines in each of the city's 36 secondary schools. This move will follow the lead of a British Columbia school district and a school in Ottawa that installed the machines in the fall.

No school districts in the United States are believed to have taken this step, federal authorities say.

Toronto's decision is a partial response to a 1988 nationwide study that reported that 31 percent of ninth-grade boys and 21 percent of ninth-grade girls have had sexual intercourse at least once. By 11th grade, the figures rose to 49 percent and 46 percent, respectively.

"We don't promote sexual promiscuity," said Rosario Marchese, a Toronto school trustee, "but we do know that students have sex and a lot of them feel invulnerable."

Marchese said that before the machines are installed, officials will consult with students, teachers and parents to discuss the risks of unsafe sex. Merely installing machines without talking about AIDS will do no good, they reason.

There are more than 3,100 confirmed AIDS cases in Canada, and estimates say there might be 30,000 to 100,000 more Canadians infected with the virus.

The spread is especially alarming in Montreal, where a recent study showed that one in 394 women who gave birth in the first four months of 1989 was infected with the AIDS virus. The infection level places Montreal ahead of San Francisco (one in 777 women) and behind New York City (one in 77), according to a study led by Hankins.

"The results are higher than we had predicted and they reflect the increasing role that heterosexual transmission . . . is playing in Quebec," Hankins said.

Ontario, which has the largest number of AIDS cases in Canada, began testing of newborns Oct. 1.

Quebec has the second-highest rate of AIDS in Canada, behind British Columbia. Most of the spread stems from Montreal, where Hankins helped to set up CACTUS, a free-needle, free-condom, free-testing and counseling and referral service.

The nondescript corner storefront lies in the shadow of Hydro Quebec, the power system that fuels the Quebec economy. The symbolism is appropriate, for AIDS represents a potentially major drain on the Quebec and Canadian health-care system: An $80,000 to $100,000-per-person cost to treat AIDS, Hankins said.

CACTUS operates nightly from 9 p.m. to 4 a.m., serving an average of 125 to 150 people. Its clients range from blue-jeaned youngsters to mink-adorned prostitutes.

There are few demands made of CACTUS clients who come in for needles, condoms, answers and -- often -- friendly banter from people who care.

Each time a person enters, he or she is asked to fill out a questionnaire, which asks the type and frequency of intravenous drug use, whether the needle was shared and their sexual behavior of the past week. The questionnaire is anonymous, but each client is given a code number so that CACTUS can follow the activities of their clients.

Once clients get past the cardboard sign near the door that reads "Exchange Your Syringe for a Better Life," there is no pressure, no moralizing.

"Preaching scares them away," said Daniel Cyr, who is monitoring the progress of the program. "All we want to do is diminish the transmission of HIV," human immuno-deficiency virus, also known as the AIDS virus.

CACTUS has been popular. It used up a projected year's worth of supplies in three months. Notes from clients are overwhelmingly supportive. "It is a first step in making it a safe profession," wrote an appreciative hooker.
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