World AIDS Day: No time for complacency

published on December 1, 2010 in Toronto Star

By: Dr. Julio Montaner
Director, BC Centre for Excellence in HIV/AIDS and Past-President of the International AIDS Society

World AIDS Day Having been at the forefront of the battle against HIV and AIDS since the beginning, I have watched attitudes toward the disease change dramatically over the years.

From fear and conflict in the 1980s, to relief and hope in 1996 as new and effective therapies were discovered and introduced at the Vancouver International AIDS Conference, to acceptance and resilience as people learned to live with HIV and lead productive lives in the last decade.

Today, however, on World AIDS Day 2010, there are new disturbing attitudes emerging toward HIV/AIDS — complacency and disregard. There is a sense that HIV/AIDS is no longer a problem, the data are in, the treatment and prevention strategy appear to be working; let’s move on to the next agenda item.

However, we have not yet won the battle against HIV and AIDS, so this pervasive attitude threatens to undo many of the gains to date. Data released by the Public Health Agency of Canada this week clearly demonstrate there is a wide-ranging domestic HIV epidemic. In fact, new HIV infections in Canada in 2007, 2008 and 2009 were higher than the number of new infections in 1999, 2000 and 2001.

Of particular concern, we note that HIV disproportionally affects aboriginal Canadians. Consider that while aboriginals represent less than 4 per cent of Canadians, they account for approximately 13 per cent of reported new infections nationally. Recent studies involving men who have sex with men (MSM) in Toronto and Ottawa showed 20 per cent were HIV positive. Similarly, results released last week show 18 per cent of surveyed MSM in Vancouver are HIV positive and even more concerning, 23 per cent of young gay men (under 30) have never been tested for HIV.

Furthermore, an estimated 26 per cent of HIV-infected Canadians are not aware that they are infected. Effective harm reduction measures that help prevent HIV transmission among drug users — such as supervised injection sites and needle exchanges — are not generally available, and even worse, those currently in place are under constant threat of closure.

The lack of leadership and systematic opposition to evidence-based policies to combat HIV and AIDS by the federal government is flabbergasting. In contrast to the United States, we don’t even have a national HIV testing day. Expanded coverage with antiretroviral therapy has been shown to decrease morbidity and mortality as well as new HIV infections in British Columbia, yet there are no plans to roll out this program across Canada. Injection drug use remains the second most common form of HIV transmission, yet the Conservatives refuse to embrace harm-reduction strategies that have been shown to save lives, reduce drug use and promote safer communities.

Canada has an opportunity to drastically curb the impact of HIV and AIDS. In doing so we can deal with our domestic problem and at the same time show the world how this can be achieved. In order to do so we must start by strengthening sexual education and harm reduction campaigns, including safer sex and condom promotion. We must also wholeheartedly embrace harm-reduction initiatives and decriminalization of drug use. Furthermore, we urgently need a Canada-wide HIV testing campaign.

Finally, we must deploy health-care workers to engage all HIV-infected individuals into appropriate care, including antiretroviral therapy, as this will lead to better health outcomes to those infected, and it will also render them dramatically (over 90 per cent) less likely to transmit HIV to their children during pregnancy, or to their sexual partners or to those sharing needles with them.

We must do so ensuring that we access those infected, affected and at risk — including men who have sex with men, sex workers, people who use injection drugs and aboriginal Canadians and their partners in a supportive, non-discriminatory and nonpunitive fashion.

Today, as we observe World AIDS Day 2010, we must reject complacency and disregard against HIV and AIDS. Canada has led the world generating scientific evidence to move the field forward over the last three decades.

It is time to put aside biases, reject prejudice and discrimination and embrace evidence-based public health initiatives for the benefit of all Canadians. We must rally behind the UNAIDS call to achieve the “three zeros” — zero new HIV infections, zero discrimination and zero AIDS-related deaths. In doing so we will curb HIV and AIDS in Canada and lead the charge against this devastating epidemic abroad.

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Julio Montaner

BC Centre for Excellence in HIV/AIDS

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World AIDS Day: No time for complacency

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