World AIDS Day: Canada’s hid­den HIV epi­demic

Truro Daily News - - OPINION - BY LAU­RIE ED­MIS­TON

Ear­lier this year, I wit­nessed a pro­found his­toric mo­ment at the In­ter­na­tional AIDS Con­fer­ence in Am­s­ter­dam.

Dr. Al­i­son Rodger, a lead­ing HIV re­searcher in the United King­dom, pre­sented the fi­nal re­sults from a study of cou­ples with one Hiv-pos­i­tive and one Hiv-neg­a­tive part­ner. Af­ter eight years of the study, she re­ported, there were zero cases of HIV trans­mis­sion from one part­ner to the other – thanks to the pre­ven­tion ben­e­fits of modern HIV med­i­ca­tions.

The ev­i­dence has been mount­ing for years. Sev­eral large clin­i­cal tri­als have con­firmed that HIV treat­ment can sup­press the virus so suc­cess­fully that sex­ual trans­mis­sion doesn’t oc­cur. Three-quar­ters of Cana­di­ans di­ag­nosed with HIV have al­ready achieved this level of vi­ral sup­pres­sion, and this num­ber could grow even fur­ther by link­ing peo­ple to treat­ment and care. The re­al­ity is that most Cana­di­ans liv­ing with HIV to­day can’t pass the virus on to their sex­ual part­ners.

So if most Cana­di­ans liv­ing with HIV can’t pass it on, why are there still more than 2,000 new in­fec­tions in our coun­try ev­ery year? Re­search tells us that most HIV trans­mis­sions orig­i­nate from peo­ple who think they are Hiv-neg­a­tive but have re­cently con­tracted the virus – the un­di­ag­nosed. There are a few rea­sons for this.

First, when some­one ac­quires HIV the virus is cir­cu­lat­ing through the body at its high­est lev­els, mak­ing them more likely to pass it on. Sec­ond, a per­son who has been di­ag­nosed is more likely to take mea­sures to pre­vent pass­ing it on to their part­ners. And fi­nally, we now know that an Hiv-pos­i­tive per­son on ef­fec­tive treat­ment does not trans­mit the virus sex­u­ally.

More than 9,000 Cana­di­ans are es­ti­mated to be liv­ing with un­di­ag­nosed HIV, and this is where most new in­fec­tions orig­i­nate. To ef­fec­tively re­spond to this hid­den HIV epi­demic, we must fo­cus our ef­forts on ex­pand­ing ac­cess to test­ing.

Yet across the coun­try, bar­ri­ers re­main. Many peo­ple have never been tested for HIV, or don’t test as of­ten as they should. Some­times this is be­cause they don’t per­ceive them­selves to be at risk, some­times it is be­cause of the stigma around HIV, and some­times it is be­cause test­ing clin­ics are dif­fi­cult to ac­cess.

Some places in Canada and abroad have shown us how we can do bet­ter. In Bri­tish Columbia, an on­line ser­vice al­lows peo­ple to or­der rou­tine HIV tests on­line and sub­mit sam­ples di­rectly to a lab, by­pass­ing clinic line­ups.

In Saskatchewan, rou­tine HIV test­ing is of­fered for all teenagers and adults ev­ery five years through both pri­mary and emer­gency health care. Dried blood spot test­ing has been in­tro­duced in some First Na­tions to over­come some of the bar­ri­ers to draw­ing blood and trans­port­ing sam­ples from ru­ral and re­mote lo­ca­tions. In the United King­dom, free HIV self-test­ing kits can be de­liv­ered to your mail­box, and many re­gions and coun­tries have em­ployed com­mu­nity ed­u­ca­tors to of­fer HIV tests to their peers, free of stigma and judg­ment.

These ini­tia­tives have only been pos­si­ble with the sup­port and fund­ing of gov­ern­ments com­mit­ted to end­ing their re­spec­tive HIV epi­demics.

We have seen shin­ing ex­am­ples from com­mu­ni­ties across the coun­try and around the world mak­ing great strides to reach the un­di­ag­nosed. Yet at a na­tional level, Canada is fall­ing be­hind other coun­tries in the adop­tion of these ap­proaches, and this has meant slow progress in reach­ing the un­di­ag­nosed – and a greater like­li­hood of new in­fec­tions con­tin­u­ing un­abated.

This World AIDS Day, I urge gov­ern­ments and lead­ers to take their calls for aware­ness one step fur­ther and turn them into ac­tion. Let’s do more than en­cour­age test­ing. Let’s make it pos­si­ble.

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

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