Peo­ple on ef­fec­tive HIV treat­ment can’t pass it on. What are we wait­ing for?

The Peterborough Examiner - - OPINION - LAU­RIE ED­MIS­TON

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.

Ever since the break­through of com­bi­na­tion an­tiretro­vi­ral ther­apy was an­nounced in 1996, we have seen these med­i­ca­tions trans­form the re­al­ity of liv­ing with HIV. An HIV di­ag­no­sis, once con­sid­ered a death sen­tence, is now seen by many health care providers as a chronic, man­age­able con­di­tion. Mod­ern treat­ments have given peo­ple with HIV a new lease on life, and a young Canadian di­ag­nosed with HIV to­day can ex­pect to live as long as his or her HIV-neg­a­tive peers, with prompt di­ag­no­sis and treat­ment.

And now we know that these med­i­ca­tions have an ad­di­tional ben­e­fit: the part­ners of those on ef­fec­tive HIV treat­ment are not at risk of in­fec­tion. It’s opened up pos­si­bil­i­ties once con­sid­ered un­think­able for cou­ples with one HIV-pos­i­tive 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 re­quires three tar­gets to be met by 2020: 90 per cent of HIV-pos­i­tive peo­ple di­ag­nosed, 90 per cent of those di­ag­nosed ac­cess­ing treat­ment and 90 per cent of those on treat­ment hav­ing the virus sup­pressed (90-90-90).

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 ours, a com­bi­na­tion of test­ing and treat­ment ef­forts brought the coun­try above the 90-90-90 thresh­old one year ago. Even some low- and mid­dle-in­come coun­tries, in­clud­ing Botswana, Cam­bo­dia, Eswa­tini and Namibia, reached the global tar­gets way ahead of Canada.

Why have we been punch­ing be­low our weight? In Canada, the two most sig­nif­i­cant bot­tle­necks are at the di­ag­no­sis stage — first, get­ting peo­ple tested, and then link­ing those di­ag­nosed with HIV to treat­ment and care. And these are the most ur­gent bot­tle­necks to ad­dress, as all HIV in­fec­tions orig­i­nate from peo­ple who ei­ther don’t know they have the virus or aren’t on ef­fec­tive treat­ment.

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. And these ob­sta­cles hit hard­est the com­mu­ni­ties most af­fected by HIV in our coun­try.

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 self-test­ing. Yet 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 health­care sys­tem that lacks a countrywid­e 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 health care 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?

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

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