Last week France became the latest country to adopt the Treatment as Prevention strategy to combat HIV and AIDS.
Treatment as Prevention (TasP) has been gaining momentum as the most effective strategy to end HIV/AIDS around the world since the BC Centre for Excellence in HIV/AIDS (BC-CfE) first proposed the strategy in 2006.
British Columbia was the first jurisdiction to implement TasP. By expanding HIV testing and immediately offering pharmacare-supported, fully free, highly active antiretroviral therapy (HAART) to people living with HIV, BC has seen a 90% decline in HIV-related morbidity and mortality since 1996, and the decline persists even into 2013. We have also witnessed the virtual elimination of vertical HIV transmission. Furthermore, we have documented a decrease in the number of yearly new HIV diagnoses from more than 800 in the mid-1990s to 238 in 2012. More strikingly, thanks to the synergy between our TasP and harm reduction strategies, we have seen an impressive 90% decrease in HIV new infections diagnosed per year among injection drug users.
Global interest in TasP has been growing for some time. The Joint United Nations Programme on HIV/AIDS (UNAIDS) endorsed the strategy in 2010. Since then, with the support of the BC-CfE, China became the first nation to adopt TasP in 2011, and the following year the US identified TasP as the key to an AIDS-free generation. More recently, in July 2013, the World Health Organization fully incorporated TasP in the new Global HIV Treatment Guidelines.
The evidence is clear; we have a plan to bring the HIV/AIDS to its knees. Yet despite this overwhelming evidence, Canada, where the strategy was developed, remains without a meaningful and effective national HIV strategy. The indifference of Prime Minister Harper’s government to the proven made-in-Canada Treatment as Prevention strategy has devastating consequences domestically and internationally.
Domestically, lack of a renewed strategy has led to rising new HIV infections, particularly in Saskatchewan, Manitoba, Newfoundland, and even in the city of Ottawa.
Globally, Canada has failed to match the contributions of key donors in the fight against HIV/AIDS in resource-limited settings. This puts at risk the gains achieved over the last decade if the Global Fund fails to reach its $15bn target to help in the fight against AIDS, TB, and malaria.
Yet, there is hope: last month, the UK pledged more than $1.5 billion, adding to earlier pledges of $5 billion by the US, $1.4 billion by France, and $750 million by Nordic countries.
Canada’s leadership in the fight against HIV/AIDS is long overdue. It’s time for the Harper government to fully embrace the made-in-Canada Treatment as Prevention strategy. And it is imperative Canada develops an effective national strategy that includes replenishing the Global Fund.
Julio S.G. Montaner, MD
BC Medical Jurnal
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