Dr. Julio Montaner is the director of the BC Centre for Excellence in HIV/AIDS.
An older gentleman comes to visit the hospital complaining of a number of symptoms. While he doesn't fit the typical risk factors for HIV, he is given a routine test that reveals he is HIV-positive. When his wife is later tested, she is also shown to be HIV-positive.
Similar situations are happening in a number of B.C. hospitals where routine HIV testing has been offered since 2012 to patients (between the ages of 18 and 70 who receive blood work). As of 2015, thousands of such tests have been administered, representing 18 per cent of all admissions, and 73 new HIV cases found. Routine HIV testing, if expanded across Canada, can help to identify and treat new HIV cases in an effort to eliminate new HIV infections.
While HIV is no longer portrayed in the media as the deadly threat of the 1980s and 90s, Canadian regions are seeking spikes. Per-capita rates in some areas in the Prairies are edging toward those seen in sub-Saharan Africa. To put this into perspective, there has been broad media coverage of the Zika virus while few cases have been seen in North America.
The end of AIDS can be seen only through widespread testing and treatment. According to the Public Health Agency of Canada, about one in five of the more than 75,000 Canadians currently living with HIV are unaware of their positive status. Stereotypical assumptions about who is at risk could be hindering efforts in engaging those living with HIV in care and treatment.
A Canada-wide study from the BC Centre for Excellence in HIV/AIDS (BC-CfE) found that 48 per cent of participants living with HIV initiated antiretroviral therapy when they already had weakened immune systems (as result of advanced HIV infection). These gaps mark failures in ensuring positive health outcomes.
They also cost more money: Direct health-care costs in the year following HIV diagnosis have been documented in excess of 200 per cent higher for patients with weakened immune systems.
Starting HIV treatment early reduces the risk of illness, promotes longevity and significantly reduces HIV transmission. Earlier treatment also has public health benefits. On sustained treatment, a patient reaches an undetectable viral load, which makes it unlikely he or she will spread the virus.
This is the concept behind Treatment as Prevention (TasP), which was pioneered at the BC-CfE, implemented in British Columbia, and has led to B.C. being the only province to see consistent declines in new HIV cases.
Outside Canada, many jurisdictions have adopted TasP as a strategy against the spread of HIV, including China, Brazil, Panama, France, Spain, major cities in the United States and the state of Queensland in Australia. There is well-deserved optimism about the potential to see an AIDS-free generation through the TasP approach.
When thousands gather this week for the International AIDS Conference in South Africa, delegates will commit to meeting the UN Sustainable Development Goal of ending AIDS by 2030. On the way there, the "90-90-90" target to reach by 2020 is based on principles of TasP: diagnosing 90 per cent of all those living with HIV/AIDS; reaching 90 per cent of those diagnosed through treatment; and having 90 per cent of those on treatment with an undetectable viral load.
Prime Minister Justin Trudeau has endorsed the global goal, and U.S. President Barack Obama has repeatedly stated it is now possible for us to reach an AIDS-free future.
Expanding HIV testing beyond groups conventionally considered at risk is critical to reaching such ambitious targets. Further, routine testing helps to reframe HIV, potentially reducing misconceptions and stigma.
For instance, over the past 15 years, there has been a significant incidence escalation among Canadian women. In 2011, women accounted for 24 per cent of new HIV-positive diagnoses among Canadian adults – double the proportion observed between 1985 and 1998.
To add to this, a growing body of research shows women and older adults are among those more likely to initiate treatment late. Youth are also less likely to be retained in care and achieve viral suppression, according to research from the BC-CfE.
Delaying HIV treatment costs lives and money. The sustainability of the Canadian health care system lies in eliminating infectious diseases, such as HIV. Through the TasP approach, HIV and other costly diseases like hepatitis C can be effectively addressed.
Canada has the tools and the strategy to be a leader in achieving the 90-90-90 target. We have shared the successful, evidence-based TasP approach to eliminating HIV with the world. Now, we must fully apply it here at home, to include expanded access to testing and treatment.