Sean Rourke is a scientist with St. Michael’s Hospital’s MAP Centre for Urban Health Solutions and strategic advisor with the Canadian Foundation for AIDS Research (CANFAR).
Bill Flanagan is president and vice-chancellor of the University of Alberta and a CANFAR board member.
Much of the country’s attention right now is understandably focused on the COVID-19 pandemic, but another epidemic still rages.
There are approximately 8,300 people living with HIV in Canada who don’t know it and 7,840 people who have been diagnosed but are not on life-saving treatments. Yet we are in a time when ending the HIV epidemic is within our reach, but only if we can connect and serve people where they are at, regardless of who they are, their circumstances or where they live. So why haven’t we crossed the finish line?
HIV persists in Canada for the same reasons we have struggled to control COVID-19: We have failed to provide rapid self-testing so people can know their status and make decisions to prevent transmission, and our health care system is not accessible or nimble enough to reach those who need it most.
Many Canadians are disconnected from receiving timely and culturally appropriate health services. Systemic factors such as racism, the legacy of residential schools and continuing colonization, along with stigma and discrimination, can mean people do not receive necessary care. With COVID-19, we know many of these factors prevented or delayed marginalized communities from being tested and vaccinated.
Self-testing is not new. It’s common for managing diabetes or checking pregnancy status, and it gives people choices to make decisions without having to go to the doctor. A little more than six months ago, in part owing to research led by St. Michael’s Hospital, Health Canada approved Canada’s first HIV self-test. Now, anyone who needs this test can get it to use at home or wherever they want. But we need to make sure everyone knows about this option, and outside of a few programs, there is a fee.
Self-testing with instant results is a game-changer for personal and public health because it offers personal choice and democratizes access to sensitive health information without any stigma. Plus, it can reach those who typically don’t (or can’t) come forward to seek care.
When people living with HIV are on treatment and their virus is suppressed, there is a zero-per-cent chance of infecting their sexual partners. This is known as “treatment as prevention,” a highly effective public-health intervention. Experts estimate that 80 per cent of new HIV infections can be prevented by reaching and treating those who are undiagnosed and those who are diagnosed but not in care.
When other Group of Seven countries (such as the United States and Britain) approved HIV self-testing years ago and made testing more widely available, new HIV infections declined significantly. We are way behind. We can catch up, but not with the status quo.
That is why the I’m Ready program was developed by the research group REACH Nexus, together with our partners, to harness the best of Canada to tackle the HIV epidemic. It combines innovative technologies with easy access to HIV self-tests, resources for care and prevention, plus optional peer support so people can choose what, when and where is best for them to address their health concerns.
COVID-19 has laid bare how acutely social status, race, poverty, geography and other health equity factors are directly linked to rates of infections and access to rapid testing, care and vaccinations. This is nothing new for us – we’ve known for years that these factors are the reasons why new cases of HIV persist in Canada, while in other G7 countries they are dropping significantly.
We can’t expect a health care system that doesn’t meet everyone’s needs to reach Canada’s remaining undiagnosed. More than ever, we need to adapt while the solutions to HIV are right before us.
Will the I’m Ready HIV self-testing program or Test@home, another recently launched HIV self-testing study, be enough to reach everyone? No. We need more options for self-testing – such as access in pharmacies – and we need it to be free when people can’t pay. Moreover, we need the commitment and co-ordination of all governments working to reach the communities that are most affected, as has happened with COVID-19, and funding to scale so we can cross the finish line.
We have the science and tools necessary for Canada to stop the transmission of HIV and achieve its UNAIDS targets before 2030, which include reaching certain thresholds of infection monitoring and treatment.
We all win when health care is more accessible and equitable so we can live up to our potential. I’m Ready – are you?
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