Pubdate: Thu, 26 Mar 2015
Source: Victoria Times-Colonist (CN BC)
Copyright: 2015 Times Colonist
Contact: http://www2.canada.com/victoriatimescolonist/letters.html
Website: http://www.timescolonist.com/
Details: http://www.mapinc.org/media/481
Authors: Julio Montaner and Ryan Meili
Note: Julio Montaner is director of the B.C. Centre for Excellence in 
HIV/AIDS. Ryan Meili is an expert adviser with EvidenceNetwork.ca and 
a medical doctor.
Page: A10

B.C.'S STRATEGY COULD HASTEN END TO AIDS

Canadians are rightly proud of the universal coverage provided by our 
national health-care system. Sadly, there are gaps in access with 
very grave consequences. In regions across the country, care and 
treatment is failing to reach those living with HIV.

Saskatchewan is among a number of regions in Canada experiencing 
alarming spikes in the spread of HIV. In 2009, the province saw rates 
of new HIV cases comparable to those in Nigeria.

Numbers have declined since this peak, partly due to Saskatchewan's 
four-year HIV strategy (concluded in 2014) that increased testing, 
treatment and support for people living with HIV and AIDS.

Unfortunately, rates of HIV in Saskatchewan continue to be the 
highest in the country. Incidence rates in 2012 were at 17 cases per 
100,000. The 2012 rates for B.C., Ontario, and Quebec were 5.1, 
6.2,and 5.6, respectively. Saskatchewan also continues to have high 
levels of HIV-related illness and death.

The province is looking for solutions. SHARE, the Saskatchewan 
HIV/AIDS Research Endeavour, is working to establish a research 
agenda and learn from successes in other provinces. They are turning 
to the trail-blazing work of the B.C. Centre for Excellence in 
HIV/AIDS for answers.

B.C. has an impressive track record for slowing the spread of 
HIV/AIDs. Indeed, between 1994 and 2013, the number of new AIDS cases 
in B.C. went from 696 to 84, or an 88 per cent decrease. AIDS-related 
deaths went from 261 to 44. And deaths attributed to an AIDS-defining 
illness decreased from 89 per cent to 20 per cent.

Over the same period, mother-to-child transmission of HIV has been 
virtually eliminated, and overall HIV transmission has decreased by two thirds.

How was this achieved? The B.C. Centre created a 
treatment-as-prevention strategy that provides widespread access to 
HIV testing, care, support and treatment. Keys to the strategy's 
success have been political commitment, program focus, innovation 
coupled with monitoring and evaluation, appropriate resourcing and 
free services, including free anti-retroviral therapy (ART).

This strategy - prioritizing full universal access to free HIV 
treatment and care - is gaining traction globally. As the 2015 
Millennium Development Goals come to fruition, the joint United 
Nations program on HIV/AIDS has proposed a new and ambitious 90-90-90 
target for 2020.

The new target calls for 90 per cent of people living with HIV 
worldwide to be diagnosed, 90 per cent of people diagnosed with HIV 
to be on ART, and 90 per cent of people receiving ART to have 
sustained viral suppression by 2020.

This would transform the HIV/AIDS pandemic into a low-level sporadic 
endemic by 2030.

The 90-90-90 target has already been formally endorsed by China, 
parts of the U.S., Brazil, South Africa, Argentina, Panama, France 
and Switzerland, among a growing number of countries. Canada, 
unfortunately, has yet to embrace the target, which means we're 
missing an important opportunity for the control of HIV and AIDS 
across the country, particularly in hard-hit regions such as Saskatchewan.

In B.C., a concerted effort to reach the high-risk and vulnerable 
population of injection-drug users, coupled with harm-reduction 
programs, led to the virtual elimination of the spread of HIV among 
this group. This extraordinary outcome could be replicated in 
Saskatchewan, and elsewhere, with the necessary infrastructure and support.

A treatment-as-prevention strategy also makes good economic sense. It 
has been estimated that acute-care costs from HIV in Saskatchewan 
alone are $40 million per year. By 2017, treatment-as-prevention in 
B.C. will result in lower drug costs for treating people with HIV and 
AIDS, with savings of up to $48 million by 2035.

An AIDS- and HIV-free generation is possible, but only if we secure 
the political will now to take full advantage of Canadian leadership.
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MAP posted-by: Jay Bergstrom