Dr. Julio Montaner, Director of the British Columbia Centre for Excellence in HIV/AIDS, poses for a photograph after speaking at the American Association for the Advancement of Science Annual Meeting in Vancouver, February 19, 2012.DARRYL DYCK/The Globe and Mail
For the second time in the past month, a foreign country has adopted a made-in-B.C. "treatment as prevention" strategy to combat HIV and AIDS. But while Brazil now joins a handful of countries in implementing the World Health Organization-backed treatment, B.C. remains the only province in Canada to do so.
This should be viewed as an embarrassment to Canada, said Julio Montaner, director of B.C.'s Centre for Excellence in HIV/AIDS (BC-CfE), which introduced the strategy in 2006.
The treatment consists of widespread HIV testing and the immediate offer of highly active antiretroviral therapy (HAART) to those who test positive. This treatment has been shown to virtually eliminate progression of the disease to AIDS and reduce transmission of the virus by 96 per cent, according to the BC-CfE.
Brazil's Ministry of Health said the treatment is under public consultation until Nov. 5, after which all adults diagnosed with HIV will be able to access the treatment, regardless of the stage of the disease. This expansion of treatment is expected to incorporate 100,000 new patients, according to the ministry.
"The new proposed treatment is both good for the individual, who will have a better quality of life, [and] for the control of the epidemic, reducing the possibility of transmission of the virus among the population," Jarbas Barbosa, health surveillance secretary for Brazil's Ministry of Health, said in a statement.
France announced three weeks ago it would adopt the "treatment as prevention" (TasP) strategy; China and the United States have also come on board within the past couple of years. While Dr. Montaner applauds the leadership of these countries, he is frustrated that Canada has not yet followed suit.
Dr. Montaner and his colleagues published a report in medical journal The Lancet in 2006 calling for global implementation of TasP, following it up in 2010 with a report on the B.C. experience. He has also written to Prime Minister Stephen Harper and Health Minister Rona Ambrose, as well as former health ministers Leona Aglukkaq and Tony Clement during their terms, with no luck, he says.
"Every time, I get the same answer: 'No, thank you,' " Dr. Montaner said. "Canada is left to explain, 'Why is this not a national priority?' If this would have been a prostate cancer strategy or a breast cancer strategy, if this would have been the flu or H1N1, they would have been all over me. But the fact that this has sexual and drug-addiction connotations makes it impossible for the current federal administration to even state the name."
The BC-CfE and other researchers have estimated that an aggressive "seek-and-treat" strategy becomes cost-neutral in three to five years. After that, it saves money, through reduced hospital costs, keeping people in the work force and so on, Dr. Montaner said.
The World Health Organization incorporated earlier antiretroviral therapy into its new global HIV treatment guidelines in June.
In a statement, the Public Health Agency of Canada (PHAC) said "more evaluation is needed to determine the feasibility, long-term sustainability, safety and effectiveness of new prevention technologies such as [TasP] in Canada and globally" and it continues to monitor the results of pilot studies and randomized control trials.
"B.C. has implemented a very comprehensive approach to reducing the HIV epidemic; as such, it is difficult to determine how much of the reduction can be attributed solely to [TasP] at this time," the statement read.
The agency said the Government of Canada has a "strong record fighting HIV/AIDS" and invested more than $93-million through the Federal Initiative to Address HIV/AIDS in Canada and the Canadian HIV Vaccine Initiative in 2012.
The rate of positive HIV tests among adults in B.C. has steadily declined since 1995, when it spiked at about 18 per 100,000. In 2011, it dropped to 7.6, according to the PHAC– a decline the BC-CfE attributes to TasP and harm-reduction measures such as clean needle distribution and Insite, the supervised injection site.
Meanwhile, Saskatchewan's rates soared from 2.8 per 100,000 in 1995 to 23.8 in 2009. In 2011, 19.6 per 100,000 were positive – more than double the national average of 7.6.
Andrea Woo