Closing the Gap to Reach an AIDS-Free Generation in Canada and the World

published on December 5, 2014 in ICAD-CISD

Twenty years ago, when I was treating a patient who was HIV infected, I would have to advise them of personal considerations such as shortened life span, and risk of transmitting the virus to sexual partners or during childbirth. At the time, an HIV diagnosis was a drastically life-altering event.

Today, if a young woman with HIV infection comes to me for treatment, I can tell her she can live a full life through drug treatment – up to 75 years of age or beyond – and can raise a family. This enormous progress has a lot to do with the development of highly active antiretroviral therapy (HAART), the game-changing drug cocktail we developed in the early 1990s. With HAART therapy, HIV is now a manageable chronic disease.

To close the gap in treatment of HIV, innovative HAART therapy must be made universally accessible to those living with HIV across Canada and the world. This is the concept behind the made-in-BC Treatment as Prevention (TasP) strategy I pioneered at the BC Centre for Excellence in HIV/AIDS (BC-CfE). The sooner a patient diagnosed with HIV is on sustained treatment and care, the faster their viral load will decrease to undetectable levels, reducing the chance they will transmit the virus.

The province of British Columbia has shown incredible success in implementing province-wide universal access to HIV testing and HAART treatment and care for those who are HIV positive. B.C. is the only province in Canada that has seen a consistent decline in new HIV cases. HIV/AIDS-related deaths in B.C. have decreased by more than 95 per cent since 1996. Over the same period, new HIV infections per year in B.C. have dropped from 850 in the mid-1990s to 238 by the end of 2012.

TasP makes sense from the point of view of overall patient health. Moreover, not only is it cost saving, it is cost averting. By 2017, the TasP program in B.C. will result in lower annual medical expenditures for treating people with HIV/AIDS compared to a scenario where access to HAART was restricted. By 2035, these cumulative savings could reach up to $48 million.

These successes and their resulting cost savings need to be seen across Canada, such as within the province of Saskatchewan where HIV diagnoses continue to climb. The Canadian government is falling out of step. The made-in-BC TasP strategy has been adopted in China, Spain, France, Brazil, Panama, the Australian province of Queensland, and parts of the United States – to name a few.

In keeping with the forward momentum, UNAIDS in 2014 launched a global HIV strategy, called 90-90-90, that is based on our Treatment as Prevention strategy. The UNAIDS strategy aims that by 2020, 90 per cent of all people diagnosed with HIV infection will have sustained antiretroviral therapy, 90 per cent of all people living with HIV will know their status, and 90 per cent of all people receiving antiretroviral therapy will have viral suppression. UNAIDS estimates that an AIDS-free generation could be reached by 2030.

While the outcomes for HIV may have changed over the course of the past two decades, there are still stigmas attached to the disease that can create gaps in treatment. To help remove such stigmas, the government of Canada must commit to making TasP a national strategy. Treatment pathways must be kept accessible and available, particularly to vulnerable populations that are disproportionately affected by HIV and AIDS. There is no reason that the innovative, cutting-edge and effective Treatment as Prevention strategy shouldn't be made available the rest of Canada, as it has been in B.C., and in many places around the world.

This blog is part of a World AIDS Day series produced by the Interagency Coalition on AIDS and Development (ICAD) in recognition of World AIDS Day (Dec 1). The series runs from Dec. 1-7, 2014 and will feature a selection of blogs written by our member and partner organizations. Each article will delve into a specific issue, highlight different challenges and offer diverse perspectives and insight on what must be done to Close the Gap. Disclaimer: The views and opinions expressed in this blog series are those of the authors and do not necessarily reflect those of ICAD.

Dr. Julio Montaner
ICAD-CISD
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Closing the Gap to Reach an AIDS-Free Generation in Canada and the World

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