B.C. Health Minister Terry Lake, left, talks with Dr. Julio Montaner, a pioneer in the treatment-as-prevention treatment, prior to a World AIDS day event in Vancouver on Dec. 1.John Lehmann/The Globe and Mail
Neil Self found out he was HIV-positive 25 years ago following a routine test. He learned of his diagnosis in the morning and continued on to work, as a grocery store cashier, in a state of disbelief.
"I wasn't expecting [the test] to come up with that at all," said Mr. Self, now vice-chair of Positive Living BC, in an interview on Tuesday, World AIDS Day. "I was in shock. I don't even remember that day at all. I don't know how effective I was at work."
The year was 1990 and B.C. was in the grip of a full-blown HIV/AIDS epidemic. At its worst, in 1995, the rate of positive HIV tests among adults was about 18 per 100,000. Doctors were diagnosing two new cases of AIDS every day.
But in the quarter-century since, B.C. – and Vancouver, specifically – has become a world leader in the fight against HIV/AIDS. Homegrown treatment models have been heralded as the gold standard.
For instance, at Vancouver's Dr. Peter Centre, B.C.'s only HIV/AIDS day health program and 24-hour nursing care residence, enhanced engagement is credited with producing a rate of HIV viral load suppression among clients that is markedly better than provincewide figures. According to recently released figures, 80 per cent of the centre's 359 clients are virally suppressed, compared to 57 per cent of people living with HIV in B.C.
Achieving and maintaining viral suppression means improved health, forestalling the development of AIDS and reducing the risk of HIV transmission by 96 per cent.
Maxine Davis, executive director for the centre, said a therapeutic model that engages hard-to-reach clients is key to keeping them on the daily medication needed to maintain viral suppression.
"When people come here to the day health program, they are receiving far more than a place to get their medication and leave," Ms. Davis said. "The program is a place with two nutritious meals a day; the nursing care goes beyond antiretroviral therapy medication. It's a broad range of nursing care and support."
The centre also caters to clients with complex medical conditions, such as mental illness and addictions, by offering harm-reduction initiatives such as supervised injection services. A Vancouver Coastal Health clinical outreach team further helps engage clients in health care.
Meanwhile, treatment-as-prevention (TasP), a made-in-B.C. HIV treatment now considered a gold standard, is being adopted around the world. In 2012 alone, it was credited with averting 582 HIV cases per 100,000 people – the highest figure of any province.
It's the treatment that Mr. Self credits with saving his life.
TasP consists of testing widely for HIV and offering highly active antiretroviral therapy immediately to those who test positive. It forms the basis of an ambitious initiative called the 90-90-90 target, which is for at least 90 per cent of all people living with HIV to know their HIV status by 2020; at least 90 per cent of all people with the virus to have access to high-quality antiretroviral therapy; and at least 90 per cent of those on treatment to have sustained viral suppression.
Advocates say achieving it could mean "the final chapter" of the global AIDS epidemic.
Julio Montaner, who pioneered the treatment, said he is buoyed by election of Justin Trudeau's Liberal government, which has endorsed the target. As has Ban Ki-moon, Secretary-General of the United Nations.
"If we meet the 90-90-90 target by 2020, we will see a 90-per-cent decrease on the disease burden by 2030," Dr. Montaner told a crowd at a World AIDS Day event at East Vancouver's Carnegie Community Centre. "That means that the global pandemic will be no more."
A person diagnosed with HIV at the age of 25 is now expected to live for 55 years, Dr. Montaner said. This is a dramatic improvement from the mid-1990s, when a person diagnosed with HIV was expected to die within 10 years.
In attendance at Tuesday's event, Mr. Self said he found the progress remarkable.
"It's funny, because I sort of lived this along the way. I was diagnosed in 1990 and all there were were these nasty [HIV drugs] that had horrible side effects and really only prolonged your life for a little while. Now, there are all these variations, up to these one-pill, once-a-day things. I find it amazing."
Andrea Woo