Started December 1, 1988, World AIDS Day annually raises awareness of the AIDS pandemic and is a day to mourn those who have died of the disease. The World Health Organization chose to focus on “Global solidarity, resilient HIV services” as its theme for this year. As of 2019 there were 38 million people living with HIV infection, 690,000 deaths from HIV-related causes, and 1.7 million people were newly infected.
These numbers demonstrate that the global HIV epidemic is far from over, and there are fears that the spread of the disease may be accelerating during the COVID-19 pandemic. Tragically, the world will be missing the BC CfE-inspired, UNAIDS 90-90-90 target for 2020. That target was set to ensure that 90% of people living with HIV are aware of their status, and of that group of people diagnosed with HIV, 90% are receiving treatment, and then of all people receiving treatment 90% have achieved viral suppression.
COVID-19’s massive disruptions have made HIV services unaffordable or unobtainable for many, and the pandemic’s interference with supply chains and service delivery meant that, as of July 2020, one third of people on HIV treatment around the world had experienced interruptions in drug supplies. A WHO and UNAIDS modeling study showed that a “six-month disruption in access to HIV medicines could lead to a doubling in AIDS-related deaths in sub-Saharan Africa in 2020 alone.”
However, in the midst of this bleakness, within a surging global pandemic and the opioid overdose epidemic, BC has been able to meet and surpass the UNAIDS target. In BC, as of this writing, at least 90% of people living with HIV are diagnosed, at least 90% of those diagnosed are receiving treatment with antiretroviral therapy, and at least 90% of those on treatment have a sustained undetectable HIV viral load. Furthermore, our province has seen a greater than 90% decrease in people living with and dying from AIDS. New HIV diagnoses in BC reached their lowest level yet in 2020, down by approximately 80% from the peak in 1987, when over 900 cases were diagnosed annually in BC.
To announce and celebrate these achievements while observing COVID-19 restrictions, the BC Centre for Excellence in HIV/AIDS (BC-CfE) and the BC Ministry of Health held a virtual press conference on World AIDS Day hosted by Ms. Fiona Dalton with statements by Minister of Health Hon. Adrian Dix and Dr. Julio Montaner.
Dr. Julio Montaner, the BC-CfE’s Executive Director & Physician-in-Chief, said, “I am pleased to report BC has now surpassed the UNAIDS 90-90-90 target. Furthermore, this year BC has seen new HIV diagnoses decrease to the lowest level since the peak of the epidemic in the pre-HAART era. This is on top of this year’s announcement of a record low number of AIDS diagnoses in BC. Our success remains strictly dependent on our ability to continue to support the existing programs and people living with HIV/AIDS. Failure to do so would be devastating and severely undermine the success of our strategy.”
Fiona Dalton, President and CEO of Providence Health Care said, “The 90-90-90 target for the management of HIV/AIDS is an incredibly powerful approach and we’re proud it’s been adopted by the UN for the worldwide control of HIV/AIDS. We’re even prouder that the target has been surpassed in British Columbia, and as a result we are seeing a dramatic decrease in AIDS-related morbidity and mortality, as well as HIV transmission.”
The virtual press conference also showcased how the BC-CfE is applying Treatment as Prevention to therapeutic areas beyond HIV/AIDS, including viral hepatitis and addiction, promoting targeted disease elimination as a means to contribute to health-care sustainability. As part of this effort, Minister Dix and Dr. Montaner formally announced the opening of the Hope to Health Research and Innovation Centre in Vancouver’s Downtown Eastside.
The clinic supports people living with HIV, opioid addictions, mental health and other health issues, including hepatitis C. People can walk into the clinic without an appointment to see a nurse, social worker or a doctor, as needed. It provides support to people accessing medication for HIV and hepatitis C, as well as methadone and suboxone for opioid addictions. Take-home naloxone kits for treating overdoses from opioids such as fentanyl are also available. Additional services include referral for treatment, counselling and other health services.
The Hope to Health Research and Innovation Centre is just one of the BC-CfE led and supported initiatives to further prevent the transmission of HIV in BC. Other examples include expanded public funding for pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).
Provincial Health Officer Dr. Bonnie Henry said, “British Columbia has been at the forefront of response to the HIV/AIDS epidemic from the very beginning with the key collaborations between the health authorities and Dr. Julio Montaner and his team at the BC-CfE. This has led us to markedly reduce the impacts of what was once a death sentence not only here in BC, but also around the world.”