We either pay a little now, or a lot more later.
Money talks. And as we stand at a precipice in the global response to HIV, with cases rising at alarming rates, it is no longer a question about science that sits at the forefront of the conversation, but rather one of dollars and cents.
The good news: You’ve likely heard it many times before, but we have the tools to solve HIV/AIDS. Treatment advances, many pioneered here in Canada, have transformed an HIV diagnosis from a death sentence to a chronic, manageable condition.
Developed in B.C., Treatment as Prevention (TasP) is the cornerstone of the strategy that facilitates access to free antiretroviral therapy by all people living with HIV to stop disease progression to AIDS, prevent premature death, and make HIV untransmittable through sexual contact. Crucially, it has been shown to be cost-saving because it prevents morbidity, mortality and most importantly transmission of HIV all at once.
Following the advent of TasP, pre-exposure prophylaxis (PrEP) emerged as a complementary preventative strategy. Referring to the use of antiretrovirals to prevent HIV acquisition among people at risk of HIV, PrEP has over 96 per cent efficacy in preventing the acquisition of HIV when taken regularly.
The synergistic effect of pairing TasP for all people living with HIV, plus PrEP for those at elevated risk of acquiring HIV, can stop HIV transmission and bring the HIV/AIDS epidemic to its knees. Unfortunately, PrEP continues to be seriously under-utilized globally, and represents a huge missed opportunity to strengthen our HIV response. Of note, the province of B.C. has led the implementation of TasP since 2010, and added focused PrEP in 2018, with great success, leading to a greater than 90 per cent decrease of AIDS cases, HIV-related deaths and HIV new infections by 2023.
The bad news: Despite all this progress, over the last couple of years, HIV cases have been rising at alarming rates across Canada, including in B.C., and internationally. In Canada alone, new HIV diagnoses increased by 35 per cent between 2022 and 2023. Simply, we have failed to optimally roll out the strategy despite national and international commitments to do so by 2025.
Unfortunately, this is taking place as the current U.S. administration is pulling billions of dollars in funding for domestic and global health programs like the U.S.-CDC, the National Institutes of Health, Medicare, Global Fund, PEPFAR and USAID, leading to an estimate that there will be six million new cases of HIV, and four million additional AIDS-deaths by 2030.
More recently, the United Nations (UN) announced that the Joint Programme on HIV/AIDS, the UN agency responsible for coordinating global action against HIV/AIDS, will be phased out starting in the new year, four years ahead of schedule. Given that HIV knows no borders, it is hardly surprising that we are already seeing increasing rates of HIV new diagnoses in B.C., largely due to immigration from the rest of Canada and increasingly from abroad, including the United States.
Concerningly, Canada’s recent budget, announced on Nov. 4, doesn’t signal a commitment to increase funding for Canada’s HIV response, commensurate with the magnitude of the challenge posed by the pandemic. Furthermore, the budget includes “reductions in development funding to global health programming,” contrary to a pre-election promise from Prime Minister Mark Carney to not cut foreign aid. These reductions in Canadian funding will compound the cuts to global health programs announced by the U.S. and other G7 countries.
So, what must we do? Firstly, Canada needs to fully fund HIV treatment and PrEP within Pharmacare for all, and enhance social and medical supports for priority populations who remain at greatest risk. Secondly, we must set up centralized and more timely reporting of HIV, while enhancing phylogenetic monitoring to better address hotspots of transmission as they arise. Thirdly, Canada must finally address the criminalization of HIV transmission, and harmonize risk reduction policies across the country, to remove stigma that prevents people from accessing treatment. Finally, we must increase funding to global health programs like the Global Fund.
Make no mistake, the lack of investment now will cost Canadians in the long-term. Funding a national TasP + PrEP strategy now saves lives and money. With the Canadian health-care system under substantial stress, there should be no greater urgency than now.
The choice is clear. Will the government listen?