HIV/AIDS series: B.C. a leader in offering free tests, treatment to reduce HIV cases

B.C. leads the country in tackling HIV, but experts worry the lack of a nationwide strategy puts all Canadians at a higher risk of contracting the infection.

If HIV were avian flu, Ottawa would mandate a national strategy to fight it, said Dr. Julio Montaner, director of the B.C. Centre for Excellence in HIV/AIDS.

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Instead, he said, “the federal government has continuously refused to get involved in the fight against HIV and AIDS. They feel that this is somebody else’s problem.”

B.C. is the only province putting up the cash to do what’s necessary to curtail new HIV infections and ultimately end what was once an epidemic, said Montaner, a professor of medicine at the University of British Columbia. Formerly an epicentre of the infection, B.C. has seen a huge drop in new HIV infections per year, to 238 in 2012 from 900 in the mid-1990s.

Experts credit that success to the province’s efforts to make early diagnosis and treatment a key part of its strategy to decrease transmission, illness and death. As part of that plan, B.C. was the first jurisdiction to offer without charge anti-retroviral drug treatment to all medically eligible residents infected with HIV, said Montaner, who helped develop the treatment.

The B.C. approach to circumventing HIV and AIDS is “a tremendous success story,” and B.C. is unquestionably the national leader in fighting the infection, said Libby Davies, an NDP MP from Vancouver and the federal Opposition health critic.

Lack of federal policy ‘short-sighted’

But Davies called the federal government both short-sighted and “incredibly irresponsible” in failing to create a national HIV policy based on Montaner’s progress.

The all-party Standing Committee on Health’s recent study on health innovations failed to even mention HIV, said Davies, vice-chairwoman of the Conservative-dominated committee. That was despite Montaner testifying to the commitee about the need for federal leadership.

Meanwhile, B.C.’s approach is being adopted all over the world, she said.

Ottawa’s failure to create a national strategy increases the chance Canadians who think they are not at risk of getting HIV could contract it, Montaner said.

“This is a foolish approach. It is ideologically motivated, is out of prejudice and is not the best clinical or the best public health practice,” he said.

However, a Public Health Agency of Canada spokeswoman noted the federal government has planned to spend a total $93 million in 2013-14 on the Federal Initiative to Address HIV/AIDS in Canada and the Canadian HIV Vaccine Initiative.

“The government of Canada is committed to a comprehensive approach to preventing HIV and other communicable diseases. [That approach] includes education, awareness, testing, diagnosis, care, treatment and support. It works with many partners to achieve these goals,” Sylwia Krzyszton said.

Province offers a model of success

Still, the government is not dealing with essential elements of HIV and AIDS issues, said Akim Ade Larcher, executive director of the Canadian Treatment Action Council, an organization that addresses access to HIV treatment, care and support.

“At the core of the conversation [are] sex and drugs — and politically, the current Conservative government is missing in action,” Larcher said. “These topics are unlikely bedfellows [for the Conservatives and it] represents political suicide for them to support any thing that is socially progressive.”

In contrast, B.C. is “an excellent model of success and hope in the Canadian HIV response,” Larcher said.

B.C.’s Ministry of Health pays the $15,000 a year it costs to provide HIV-positive people with highly active anti-retroviral therapy, known by the acronym HAART. The most recent figures show 56 per cent of those eligible in B.C. received HAART treatment in 2011.

In other provinces, the cost of treatment is a “huge barrier,” Larcher said, adding that only 37 per cent of Quebecers and 32 per cent of Ontario residents with HIV receive anti-retroviral treatment.

When the cost of treatment is a problem, Montaner said, “that discourages people from accessing the services early.”

That’s dangerous, he said, because HIV can be symptom-free for a decade, making it possible for patients without the funds for treatment to ignore their positive status, he said.

That in turn can lead to the spread of HIV and other health-care costs.

By 2016, the proportion of B.C. patients with HIV on HAART is expected to reach 90 per cent and, with early detection, the number of new HIV cases developing into full-blown AIDS is expected to eventually disappear, said a B.C. Ministry of Health document entitled From Hope to Health.

The United Nations endorsed the B.C. approach in 2010, Montaner said, and major international organizations, such as the World Health Organization and China’s Centre for Disease Control, now incorporate treatment-as-prevention into their strategies to control HIV.

Free treatment saves lives, money

Why was B.C. so far ahead on the issue?

When the HIV/AIDS epidemic started, B.C. was the most affected province, Montaner said, given the large number of men having unprotected sex with men in Vancouver.

“Very early on, it became apparent that if we did not remove all possible barriers to testing and treatment, our ability to control the epidemic was going to be compromised,” Montaner said.

Because B.C. was involved in developing the guidelines to fight HIV with HAART, it was “uniquely positioned to implement these before anybody else in the world.”

“This is a non-partisan statement, but the provincial government very quickly understood the importance of our findings and rallied behind us to strengthen our program during the financial crisis, despite the fact that they were looking at areas of potential cost savings,” he said.

“They understood that expanding outreach treatment support and free testing and free treatment was actually a cost-saving manoeuvre. Not only would it save lives, but it was also cost-saving.”

The successful strategy depends on suppression, he cautioned.

“We cannot be complacent. We need to continue to work very hard because the moment that people stop treatment, the virus comes back and all the gains are erased.”

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