Interview: China looks to Canadian province in fight against HIV/AIDS

published on December 19, 2014 by Evan Duggan, in Shanghai Daily

VANCOUVER, Dec. 18 (Xinhua) -- China is looking to Canada's Pacific coast province of British Columbia (B.C.) for cooperation in the fight against HIV/AIDS, as the latter has become successful and experienced in dealing with spread of the deadly virus and disease.

When Chinese authorities said they were looking for new strategies and new ideas around the world to curb the spread of HIV infections and to improve treatment for those who have the illness, St. Paul's Hospital -- a leading research and treatment center in Vancouver in British Colombia -- is where they came, according to Dr. Julio Montaner, director of the British Colombia Center for Excellence in HIV/AIDS.

St. Paul's Hospital has taken major strides in defeating HIV/AIDS, and has emerged as a model for success and a partner for China and many other nations in stemming the spread of the virus, Montaner said in an interview with Xinhua on Thursday.

Chinese Premier Li Keqiang vowed last month to do more to prevent and treat HIV in China, and said he was willing to cooperate with experts in other countries to do that. He said efforts should be made in China to improve HIV screening, focus on high-risk groups, and seek breakthroughs in the development of new drugs to treat the virus.

Vancouver in the late 1980s and 90s had become ground zero for the virus in Canada, said Montaner.

He said it made sense that the center would become the world's leader in the battle against the virus.

In the lengthy interview taken in St. Paul's hospital, Montaner said that Vancouver was facing a rising tide of HIV infections -- especially among the city's large gay community, and intravenous drug users. Poverty and mental illness in the city's Downtown Eastside were also helping the virus to spread. Montaner said the center emerged as a matter of survival.

"St. Paul's was inundated by HIV. We were very few people dealing with it. We needed to put our resources all together and we needed to get organized because we were overwhelmed," he said.

They soon started treating the rising number of HIV-positive patients with a variety of new drugs. In 1996, they implemented the use of Highly Active Anti-Retroviral Therapy, or HAART, which quickly set the global standard for HIV treatment.

He said the epidemic was out of control in the 1980s and 90s. And research that they were involved with, for the first time in 1995, showed that when they combined three anti-retroviral therapy drugs, they give them together to someone who has not been previously treated, they were able to suppress the replication of the virus so that the amount of virus circulating in the blood became undetectable. When that happens the immunity comes back and therefore HIV/AIDS does not progress.

The treatment started to drive down new HIV cases despite a steady rise in the syphilis rate -- showing that infections were decreasing even though people were still taking part in risky behavior. HAART rapidly makes HIV undetectable in blood and sexual fluids in most patients, while it also prevents AIDS-related diseases and death.

But having the proper treatments was only half the battle. Within a few years, the center transitioned into what Montaner calls Treatment as Prevention - a systematic campaign to increase diagnoses and treatment throughout the population by making free and rapid HIV tests more accessible.

Elements of the program soon caught the attention of the Chinese Center for Disease Control, which sent representatives to the center at St. Paul's hospital.

"China was very intrigued early on by the work that we were doing. They approached it in a very skeptical kind of way. They basically met with us a number of times. They asked all the difficult and appropriate questions and it wasn't until they were really convinced that we had a real program and a real opportunity here that they decided to move forward and embrace our treatment operation strategy," he recalled.

He stressed that partnership is now benefiting both British Colombia and China.

"They were the first country that embraced the treatment as prevention strategy in the world, and they since then, have been producing a lot of new information that has helped us to understand how to guide the work that others are doing in this sense," he added.

The results of Montaner's Treatment as Prevention program in Vancouver and B.C. have been dramatic. According to Montaner, number of AIDS cases in British Columbia have decreased by more than 90 percent overall. Death from HIV/AIDS has decreased by more than 95 percent, all thanks to the cocktail - the Highly Active Antiretroviral Therapy.

Also, new infections have decreased by greater than 66 percent. Among injection drug users, new infections have decreased by greater than 95 percent, and particularly the transmission from mother to child, what we call vertical transmission, has been virtually eliminated.

Montaner said the center has been so effective that they virtually closed their HIV/AIDS ward this year and repurposed it support people who are living with HIV. Nowadays, they rarely discover new cases of AIDS.

The doctor says the United Nations has also called on them to develop a blueprint that can be applied to healthcare systems around the world, and has set a so-called 90-90-90 goal to boost detection, treatment and survival.

"If we meet the 90-90-90 by 2020, or by 2030, the burden of the disease globally will have decreased by 90 percent. Ninety percent less morbidity, 90 percent less mortality and 90 percent less transmission, transforming what used to be a raging pandemic into a sporadic disease that would really have relatively modest impact in the world as we know it," he said.

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Julio Montaner

BC Centre for Excellence in HIV/AIDS

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Interview: China looks to Canadian province in fight against HIV/AIDS

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