It’s time to retire Canada’s AIDS epidemic

Treatment can be used for disease prevention

It’s time for Canada’s leaders and policy-makers to get serious, step up, and do what can be done now.

Having turned 60 two months ago, I know there’s nothing quite like a milestone birthday to force you to get serious about your priorities and your future. The HIV response is facing our own wake-up call this Dec. 1 as we mark the 30th World AIDS Day — a milestone I never imagined we would reach when I started working in the HIV field 30 years ago.

I have spent more than half of my life working in the HIV response, and while our goals have remained unchanged — reducing HIV infections and keeping people healthy — they have sometimes felt lofty and long-term: something to strive toward, but always just out of reach.

That is no longer the case. Hundreds of prominent HIV leaders and organizations have now endorsed a new consensus based on years of scientific research: a person living with HIV who takes treatment — to the point where the amount of the virus in their body is undetectable in blood tests — does not transmit the virus to their sexual partners. In short, undetectable equals untransmittable (U=U).

This new scientific consensus has tremendous implications for people living with HIV. But it also demonstrates that ending the AIDS epidemic in Canada is much more attainable than we previously thought.

If treatment has the potential to eliminate the risk of HIV transmission, it can not only save the lives of people living with HIV, but it can also be used as a tool to prevent further infections.

This concept — treatment as prevention — is not new. Researchers at the British Columbia Centre for Excellence in HIV/AIDS coined the term in 2006 when they published data showing that increased access to modern HIV treatments was often accompanied by a decrease in new HIV infections.

In some countries, governments took the concept and ran with it. Swaziland, the country with the highest HIV prevalence in the world, doubled the number of people on HIV treatment since 2011. Researchers announced this year that new HIV infections were cut in half over the same period.

But for this approach to work, there are two key challenges to overcome: people need to know their HIV status, and those who are diagnosed HIV-positive need to have access to treatment and care.

In Canada, we are falling behind on both of these measures. One out of every five HIV-positive Canadians doesn’t even know they have the virus. Among Canadians who have been diagnosed, only three out of four are accessing treatment. Unless we do something drastically different in our approach to HIV testing and treatment in the next three years, Canada will not meet the global targets set by the Joint United Nations Program on HIV/ AIDS to end the AIDS epidemic by 2030.

As we enter what should be the final decade of the global AIDS epidemic, it’s time for Canada’s leaders and policymakers to get serious, step up, and do what can be done now.

Step up HIV testing campaigns. Offer HIV screening to everyone as part of routine doctor’s appointments. Approve HIV self-testing kits and make them as accessible as a home pregnancy test. Make sure all people living with HIV can get the treatment and care they need to stay healthy and remain “untransmittable.”

Let’s retire this epidemic once and for all.

Laurie Edmiston is executive director of CATIE, Canada’s source for HIV and hepatitis C information.