Universal HIV testing could help end HIV

published on November 23, 2015 by Julio Montaner, in Troy Media

VANCOUVER, B.C./ Troy Media/ – Have you received your regular health checkup, and did it include an HIV test?

Scientists are telling us we need to change how we think about HIV. If we don’t, thousands of cases could remain undiagnosed and untreated. About one quarter of Canadians living with HIV are unaware of their HIVpositive status, reinforcing the need for a paradigm shift in our national approach to testing.

Routine, universal HIV testing could be a key to halting the spread of the disease. Diagnosing HIV early in the course of infection is important. Early initiation of highly effective antiretroviral therapy (ART) reduces the risk of illness, promotes longevity and significantly reduces onward HIV transmission.

Today, a person living with HIV on sustained treatment can have a life expectancy approaching that of the general population.

A recent study from the B.C. Centre for Excellence in HIV/AIDS (BCCfE), published in the Journal of the International AIDS Society, found that 48 per cent of participants initiating ART between 2000 and 2012 already had a weakened immune system.

Delaying treatment costs lives and money. Direct health care costs in the year following HIV diagnosis can be in excess of 200 per cent higher for patients with weakened immune systems.

Stereotypical assumptions about who is at risk of acquiring HIV could hinder efforts to combat the disease. Over the last 15 years, there has been a significant and notable incidence escalation among Canadian women. Females accounted for 24 per cent of new HIVpositive diagnoses among adults in 2011 – double the proportion observed between 1985 and 1998.

A growing body of research shows women and older adults are among those more likely to initiate treatment late. A previous Canada-wide BC-CfE study found young adults had relatively high rates of late ART initiation, and were less likely than older adults to be retained in HIV care and achieve viral suppression.

In addition to helping to get those who need HIV treatment into care, universal testing could reduce stigma and stereotypes through normalizing the testing process. By re-framing HIV testing as a routine part of healthcare, misconceptions could be eliminated and barriers reduced.

While testing is a key component in the response to HIV, treatment must also be provided. Treatment as Prevention (TasP), the provision of full and universal access to antiretroviral therapy following an HIV diagnosis, will ensure an end to AIDS by 2030. The Canadian federal government has not yet formally endorsed TasP domestically as the new and globally recognized standard of care. During this year’s election campaign, Prime Minister Justin Trudeau endorsed the UNAIDS global 90-90-90 Target to end AIDS by 2030. The goals, based on principles of TasP, include diagnosing 90% of all those living with HIV/AIDS. Once diagnosed, 90% must have access to treatment and 90% of those on treatment must reach viral suppression by 2020 in order to set the pace to reach an AIDS-free generation.

Within Canada, BC is the only province to implement the lifesaving TasP strategy. BC is also the only province to implement a universal testing approach, despite the Public Health Agency of Canada’s recommendation for it to be a nationwide standard. Internationally, TasP has been adopted by China, France, Spain, Panama, Brazil, Sierra Leone, and several major U.S. cities - among others. Even Pope Francis has endorsed the strategy as an important tool in our global fight against HIV.

While BC has more widespread HIV testing initiatives, it is the only province to see a consistent decline in new HIV cases.

If we are to reach an AIDS-free generation in Canada, the federal, provincial and territorial governments must invest in greatly expanding access to testing and treatment. We need a national strategy to end AIDS that includes a testing approach not limited to those considered at risk of acquiring HIV.

Of course, there are important factors to be considered if universal testing is expanded across Canada. First and foremost, patient-informed consent must remain central to the testing process.

It cannot be denied the benefits of universal HIV testing are clear. A shift in practice could change out-dated misconceptions around HIV. Further, it could dramatically alter the course of this devastating disease.

So, have you been tested?

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Treatment as Prevention®

Julio Montaner

BC Centre for Excellence in HIV/AIDS

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Universal HIV testing could help end HIV

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