The 19th International AIDS Conference has just come to a close amid much talk of the beginning of the end of AIDS, turning the tide on HIV and even a potential cure. It is now more certain than ever that we have the tools, medicines and expertise to stop this epidemic.
However, without the political will to expand antiretroviral treatment to everyone in need, the audacious goals set before us in Washington last week will never be met and infection may spiral out of control once again.
While we make gains in certain areas of the globe, we remain mired in a growing epidemic. For every person placed on highly active antiretroviral treatment (HAART), two more people become infected. We now have 34 million people living with HIV/AIDS and are treating only eight million of the 15 million eligible people in resource-limited countries. At least 25 per cent of HIV-infected individuals do not know they are infected and, as a result, cannot protect themselves or their loved ones. And they contribute disproportionally to the spread of HIV. When you do the math, it’s crystal clear: HIV and AIDS remain daunting foes.
However, our situation does not need to be so dire. We unequivocally know that HAART prevents death and also stops AIDS. Furthermore, HAART dramatically reduces HIV transmission. The primary benefit of a healthy person and the secondary benefit of healthier communities should be the tipping point that gets politicians falling all over themselves to mobilize and fund the universal rollout of HAART.
But that’s not happening. Politicians have paid little more than lip service to supporting the rollout of antiretroviral treatment in their home countries and around the globe. But in Washington, some strides were made. The United States, already one of the world’s largest HIV/AIDS donors, added another $150-million to get more medicine into the hands of people in resource-limited countries. And leaders such as President Barack Obama and Secretary of State Hillary Clinton reinforced their support for creating an AIDS-free generation. France pledged to support the implementation of a tax on financial transactions to generate much-needed resources to fund the universal rollout of HAART.
Regrettably, Canada’s contribution in Washington was uninspiring. Federal Health Minister Leona Aglukkaq spent more time and energy avoiding protesters and ducking out of her events than providing leadership and vision. This isn’t surprising: The federal Conservatives have done everything in their considerable power to decimate Canada’s HIV response, including trying to close the country’s only supervised injection site and further criminalizing injection drug users and sex workers. Criminalization drives these Canadians underground and away from health services, leaving them susceptible to HIV infection.
In most of Canada, the epidemic continues on or is growing, with first nations people among the hardest hit. In other words, even though we have HAART treatment to prevent AIDS in the individual and HIV transmission and we know how to curtail the epidemic, we are not doing it. This goes completely against Canada’s tradition of compassion and commitment to human rights. British Columbia stands alone as the only Canadian jurisdiction to see a significant decline in new HIV diagnoses, from approximately 900 cases per year in the early 1990s to 289 in 2011. The decline stems from B.C.’s adoption of “treatment as prevention,” pioneered by the B.C. Centre for Excellence in HIV/AIDS. The strategy includes normalizing HIV testing to help find those who are infected and don’t know it; harm reduction programs such as supervised injection sites and needle exchanges; safer sex work spaces that allow sex workers to better negotiate condom use; and contacting hard-to-reach individuals to facilitate their engagement on life-saving HAART.
In North America, other cities are starting to follow suit and implement innovative testing and harm reduction measures. In Washington, a community hit hard by the epidemic, you can now get tested for HIV in motor-vehicle offices, grocery stores and high schools and on the street corners where people with addictions congregate. San Francisco has similarly adopted treatment as prevention and is already reporting declines in new diagnoses. Globally, China, Swaziland and several districts in South Africa are moving to implement the strategy.
It is truly heartening to see more and more communities implement evidence-based policies to combat HIV and to find people from groups long marginalized come together and demand change.
We leave Washington with a clear sense of purpose. The full HIV/AIDS community has found a consensus. Treatment as prevention represents the fundamental building block to achieve our goal. We must find the resolve to deliver on the promise of an AIDS-free generation.
All Canadians, regardless of their political inclination, should demand that our political leaders join Mr. Obama’s call for an AIDS-free generation. It can be done, it should be done and it must be done.
Dr. Julio Montaner is the past president of the International AIDS Society and Director of the B.C. Centre for Excellence in HIV/AIDS.