Canada lagging behind on effective HIV treatment
In the three decades I have worked in the field of HIV prevention and treatment, I’ve never seen a breakthrough quite like it.
It’s not a vaccine. It’s not a cure. But it could mean the end of the HIV epidemic as we know it.
The science is simple. When a person living with HIV takes their medication as prescribed on an ongoing basis, the virus can be suppressed to levels so low that it can no longer be detected in blood tests. And when it’s undetectable, doctors and scientists now agree, it’s intransmissible. Let me repeat that: a person on effective HIV treatment can’t pass it on to a sexual partner.
This has opened up possibilities once considered unthinkable for couples with one HIVpositive and one HIV-negative partner, such as conceiving and having a baby, and sharing intimacy without the fear of passing on a virus. It’s now all possible, if a person living with HIV has access to effective treatment.
These benefits extend to all of us. Mathematical projections have shown that if enough people living with HIV are diagnosed and start treatment by next year, the prevention benefits of treatment could mean the end of the HIV epidemic in just over a decade.
This is a game-changer, and other countries have already taken advantage. In the United
Kingdom, which has an HIV epidemic and health-care system similar to our own, a combination of testing and treatment efforts mean the country is now on track to end HIV as a public health threat by 2030. Even some low- and middleincome countries, including Botswana, Cambodia, Eswatini and Namibia, have surpassed Canada on this measure.
Why have we been punching below our weight? Despite the lauded accessibility and universality of Canada’s health-care system, we have many barriers that make it difficult for people to get tested and start treatment.
Seventy-seven countries around the world have adopted policies that allow for HIV self-testing, meaning a person can administer an HIV test on their own, similar to a home pregnancy test. Health Canada has not yet approved HIV selftesting.
Yet by far, the most significant barrier to Canada achieving HIV epidemic elimination is linking people to treatment once they are diagnosed. According to the latest estimates from the Public Health Agency of Canada, 19 per cent of Canadians diagnosed with HIV are not accessing treatment. Compared to all other G7 countries that have published figures on this measure, Canada ranks last.
What sets us apart? For one, we are the only high-income country in the world with a public health-care system that lacks a country-wide pharmacare program. Expanding our public health-care system to include pharmacare from coast to coast would streamline drug coverage across the country, make prescription medication as accessible as public healthcare services, and achieve the buying power and efficiencies necessary to keep out-of-pocket costs to patients low.
Countries like ours – and countries unlike ours – have rolled out free HIV treatment programs at a national level, and they are already seeing significant reductions in new HIV infections. So with one year left for Canada to catch up to the rest of the world, what are we waiting for?