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
Less riskier habits were ruled out as a reason for the drop in HIV cases, since injected drug use remained steady and sexually transmitted diseases actually went up.
The findings dominated the past summer's international AIDS conference in Vienna, and they helped persuade UNAIDS to embrace B.C.'s approach – treatment equals prevention – as the new norm for combatting HIV everywhere.
"It's a game-changer," says Dr. Montaner, who also spearheaded development of HAART back in the 1990's. "It's the next major AIDS breakthrough."
Providing treatment free of charge to all HIV patients, as B.C. does, is expensive, but it is cost-effective, according to Dr. Montaner.
He estimated that B.C.'s HAART program is currently saving the province about 400 additional HIV cases a year.
Since the minimum, lifetime cost of treating an HIV-positive patient is about $250,000, that represents an annual financial benefit of $100-million, which is double the approximately $50-million the government pays in treatment costs every year.
"It makes very good sense, says Dr. Montaner.
Should Seek and Treat succeed in significantly expanding treatment, he points out that the cost savings will be even greater.
"We can further reduce AIDS-related deaths and HIV infections in B.C., and we will show the world – again – how to do it."
Seek and treat
What it is
Seek and Treat is an ambitious, four-year, $48-million pilot project to search out as many of the estimated 25 per cent of British Columbians with undiagnosed HIV as possible, and have them tested and treated.
It is also targeting those who know they have the virus, but whose lives are too disorganized to receive the regular, anti-AIDS medication known as HAART. The so-called drug cocktail has been shown, in a landmark B.C. study, to play a major role in reducing the possibility of someone with AIDS/HIV passing the virus on to someone else.
How it works
As HAART treatment is increased, the level of the AIDS virus in a patient's blood, semen or vaginal secretions becomes virtually undetectable. The so-called viral load of the disease is thus rendered sufficiently feeble to prevent transmission of the virus.
Ergo, the more patients who are treated, the fewer infections. Julio Montaner of the B.C. Centre for Excellence in HIV/AIDS estimates that a patient who receives HAART has his or her risk of transmitting the disease cut by 92 per cent.
"We already know it works, now we need to expand it," Dr. Montaner says.
Burrard Bridge bike lane update
The great Burrard Bridge bike lane experiment worked in 2009, and it's still working. At least, statistically.
Although random motorist complaints continue – there has been a mild increase in bridge fender-benders and one art gallery owner blamed the new bike lane for his business closing – cycling trips over the bridge are up, way up.
During the first 12 months after a separate, blocked-off bike lane was implemented on the bridge, bike traffic increased by 24 per cent, according to figures compiled by the city of Vancouver. July was the bridge's busiest cycling month ever, with pedal pushers making more than 160,000 crossings. Volumes are up more for women and kid cyclists than among men. However, pedestrian traffic across the bridge has remained fairly static. The number of vehicles using the Burrard Bridge has also stayed about the same.
In July, city council voted unanimously to make the lane permanent. Rod Mickleburgh