HIV is still here, and Canada needs a united response

Sunday December 1st marks World AIDS Day, a solemn day to remember the millions of lives lost to HIV/AIDS, reflect on the progress we’ve made and focus on the work still to be done. This day is particularly poignant here in BC, the epicentre of Canada’s epidemic in the 1980s. Within a decade and a half, however, the 1996 International AIDS Conference offered the first glimmer of hope with the advent of highly active antiretroviral therapy, which for the first time allowed us to stop disease progression to AIDS and premature AIDS-related mortality. Shortly thereafter, we demonstrated that people living with HIV (PLWH) who were on effective therapy were no longer infectious, so we proposed to expand treatment coverage to all PLWH with the aim of stopping the epidemic.

The strategy was named Treatment as Prevention^® (TasP^®) and by 2015, TasP^® had been endorsed by all major international policy makers, and received unanimous ratification by the United Nations General Assembly. Shortly thereafter, we added pre-exposure prophylaxis (PrEP) to further strengthen the strategy. PrEP involves taking medication to almost fully prevent HIV infection by individuals deemed to be at increased risk of HIV infection. Together, the implementation of generalized TasP^® plus focused PrEP in BC has achieved a greater than 90% decrease in AIDS-related morbidity and mortality and HIV new infections.  Last year BC declared the epidemic phase of HIV/AIDS to be over. This is definitive proof that we have the tools to end HIV/AIDS as an epidemic of concern.

This year, however, we must raise the alarm regarding the delicate balance in which this success hangs. Over the last 18 months, BC has seen a rebound of new HIV diagnoses. Upon investigation using genetic monitoring coupled with socio-demographic studies we have confirmed the increase in cases identified are overwhelmingly due to PLWH entering the province from other Canadian jurisdictions and the rest of the world. This highlights the fact that BC cannot end the AIDS epidemic in isolation, as HIV does not respect provincial or national borders. When it comes to ending HIV/AIDS we must recognize we are all in this together.

The world has adopted the made-in-BC TasP^® plus PrEP strategy, but implementation has been uneven. Consistent with the World AIDS day theme: “Collective Action: Sustain and Accelerate HIV Progress” we urge Canada to fully and promptly deliver on the promise of TasP^® plus PrEP. In this context, we must immediately recognize that it is crucial that every person knows their HIV status, and that they are afforded equal and free access to effective treatment and prevention, supports and rights, no matter how old they are, who they are, their gender, their sexual orientation or where they are from.

Canada has observed an overall increase in HIV new cases in the last few years. The most recent available data from the Public Health Agency of Canada shows new HIV diagnoses across Canada rose 25% from 2021 to 2022. This is unacceptable. We have the tools and the resources to do better. We must urgently remove all financial and social barriers to ensure all Canadians can benefit. We must ensure that all Canadians have facilitated access to free HIV testing, treatment, prevention, and support. Only then we will be able to optimize the control of the Canadian HIV/AIDS epidemic.

Increasing HIV cases should not be viewed as a failure, but as an opportunity to renew our efforts to fully adopt the TasP^® plus PrEP strategy across Canada. The individual and societal health benefits of this will be profuse, and cost-saving within a generation. Moreover, this will demonstrate to the world that the made in Canada TasP^® plus PrEP strategy is the best way to stop the epidemic globally, while contributing to sustainable health care systems worldwide.