After major breakthroughs that have twice changed the worldwide norm of AIDS therapy within the past 15 years, British Columbia’s pioneering treatment/research centre is taking the fight against the disease to a new level.
Feeding on its own convincing evidence that the more aggressively you treat HIV, the more you reduce the chance of the virus being spread to others, the B.C. Centre for Excellence in HIV/AIDS is the inspiration behind a bold, four-year project to seek out the most difficult and vulnerable AIDS population of all.
Those are the thousands of individuals in the province who don’t know they have the virus, or, who do know, but are not receiving treatment.
“We are going to go where the people are,” says Susan Burgess, a physician working in the drug-ravaged Downtown Eastside who has about 160 AIDS patients. “If we can find them, we can give them effective care.”
That is vital, because the powerful, anti-HIV drug cocktail that has transformed the once-lethal disease into a chronic, manageable condition not only works, it does double duty.
As well as vastly improving the health of the patient, the drugs also suppress the AIDS virus to such an extent that the chance of it being transmitted to someone else is close to nil.
If enough patients receive the cocktail, optimists can foresee a day when transmission of HIV will have been virtually stopped in its tracks.
Yet, right now in B.C., despite what is already one of the most aggressive treatment programs anywhere, only about half the estimated 13,000 persons infected with the virus receive the medication known as HAART (highly active antiretroviral therapy).
Under the pilot program, outreach teams are being formed to focus on two areas – Prince George and the Downtown Eastside. Street nurses and other groups will be used to approach people they know, on the street and in the single-room occupancy hotels where many hard-to-reach individuals live. Their goal is to persuade people to get tested and, if HIV positive, receive treatment.
At the same time, doctors and pharmacists are being encouraged to have all their patients tested, in hopes an HIV test becomes as normal as a pap smear or screening for prostate cancer.
“We need to take away the stigma of having an AIDS test and being treated,” Dr. Burgess says. “I have a cold. I have HIV. It should be looked at by the public as the same thing.”
The first of its kind in Canada and possibly the world, the pilot project is being implemented by Vancouver Coastal Health, Northern Health and Providence Health Care, which oversees St. Paul’s Hospital. The Seek and Heat program is funded by $48-million from the provincial government, spread over four years.
From his small, St. Paul’s office, where a single shelf displays framed pictures of handshakes with Bill Clinton and numerous international awards, the renowned head of the project, Julio Montaner, is a veritable ball of fire, passionately promoting the virtues of Seek and Treat.
“We know that the more people you treat, the fewer infections you see,” says Dr. Montaner, director of the B.C. Centre for Excellence in HIV/AIDS.
“So we are committed to finding these [undiagnosed, untreated] people and offering them treatment. Let’s fix their condition and make the virus undetectable. Up until now we’ve used the TLC approach. We now want to add a layer of sophistication to that, and specifically target people who have HIV.”
Dramatic proof of the value of early HAART treatment was contained in a study headed by Dr. Montaner and published in the prestigious British medical journal, The Lancet.
Between 1996 and 2009, the annual rate of new HIV infections in B.C. plummeted more than 50 per cent, at the same time as there was a five-fold increase in the number of existing AIDS patients who received HAART
