Julio Montaner: B.C.’s strategy could hasten end to AIDS

published on March 26, 2015 by Julio Montaner and Ryan Meili, in Times Colonist

Canadians are rightly proud of the universal coverage provided by our national health-care system. Sadly, there are gaps in access with very grave consequences. In regions across the country, care and treatment is failing to reach those living with HIV.

Saskatchewan is among a number of regions in Canada experiencing alarming spikes in the spread of HIV. In 2009, the province saw rates of new HIV cases comparable to those in Nigeria.

Numbers have declined since this peak, partly due to Saskatchewan’s four-year HIV strategy (concluded in 2014) that increased testing, treatment and support for people living with HIV and AIDS.

Unfortunately, rates of HIV in Saskatchewan continue to be the highest in the country. Incidence rates in 2012 were at 17 cases per 100,000. The 2012 rates for B.C., Ontario, and Quebec were 5.1, 6.2,and 5.6, respectively. Saskatchewan also continues to have high levels of HIV-related illness and death.

The province is looking for solutions. SHARE, the Saskatchewan HIV/AIDS Research Endeavour, is working to establish a research agenda and learn from successes in other provinces. They are turning to the trail-blazing work of the B.C. Centre for Excellence in HIV/AIDS for answers.

B.C. has an impressive track record for slowing the spread of HIV/AIDs. Indeed, between 1994 and 2013, the number of new AIDS cases in B.C. went from 696 to 84, or an 88 per cent decrease. AIDS-related deaths went from 261 to 44. And deaths attributed to an AIDS-defining illness decreased from 89 per cent to 20 per cent.

Over the same period, mother-to-child transmission of HIV has been virtually eliminated, and overall HIV transmission has decreased by two-thirds.

How was this achieved? The B.C. Centre created a treatment-as-prevention strategy that provides widespread access to HIV testing, care, support and treatment. Keys to the strategy’s success have been political commitment, program focus, innovation coupled with monitoring and evaluation, appropriate resourcing and free services, including free anti-retroviral therapy (ART).

This strategy — prioritizing full universal access to free HIV treatment and care — is gaining traction globally. As the 2015 Millennium Development Goals come to fruition, the joint United Nations program on HIV/AIDS has proposed a new and ambitious 90-90-90 target for 2020.

The new target calls for 90 per cent of people living with HIV worldwide to be diagnosed, 90 per cent of people diagnosed with HIV to be on ART, and 90 per cent of people receiving ART to have sustained viral suppression by 2020.

This would transform the HIV/AIDS pandemic into a low-level sporadic endemic by 2030.

The 90-90-90 target has already been formally endorsed by China, parts of the U.S., Brazil, South Africa, Argentina, Panama, France and Switzerland, among a growing number of countries. Canada, unfortunately, has yet to embrace the target, which means we’re missing an important opportunity for the control of HIV and AIDS across the country, particularly in hard-hit regions such as Saskatchewan.

In B.C., a concerted effort to reach the high-risk and vulnerable population of injection-drug users, coupled with harm-reduction programs, led to the virtual elimination of the spread of HIV among this group. This extraordinary outcome could be replicated in Saskatchewan, and elsewhere, with the necessary infrastructure and support.

A treatment-as-prevention strategy also makes good economic sense. It has been estimated that acute-care costs from HIV in Saskatchewan alone are $40 million per year. By 2017, treatment-as-prevention in B.C. will result in lower drug costs for treating people with HIV and AIDS, with savings of up to $48 million by 2035.

An AIDS- and HIV-free generation is possible, but only if we secure the political will now to take full advantage of Canadian leadership.

Julio Montaner is director of the B.C. Centre for Excellence in HIV/AIDS. Ryan Meili is an expert adviser with EvidenceNetwork.ca and a medical doctor.

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