I was recently present at McGill University in Montreal to hear Dr Julio Montaner speak about Treatment as Prevention (TasP).
For those who are not aware, Dr. Montaner is a well known Argentinian-born Canadian physician, professor, researcher and a strong advocate for people living with HIV. He is the Director of the British Columbia Center for Excellence in HIV/AIDS, the chair in AIDS Research and Head of the Division of AIDS in the Faculty of Medicine at the University of British Columbia and the past president of the International AIDS Society. He is the Director of the John Ruedy Immunodeficiency Clinic and the Physician Program Director for HIV/AIDS at Providence Health Center.
One of his most important accomplishments has been in the development of ART, originally a triple drug cocktail which he worked on and implemented in 1996 to stop HIV from progressing into AIDS, which in turn extended life span and reduced HIV related deaths.
In 2014 Dr. Montaner helped draft an ambitious treatment target to help end the AIDS epidemic - the 90-90-90 target, which has since been adopted by UNAIDS and many countries including Canada. and by the Pope, among many others. This goal challenges us that by the year 2020, 90% of the population will have been tested for HIV, 90% of those who test positive for HIV will be on treatment and that 90% of those on treatment will have achieved viral supression. When this three-part target is achieved, at least 73% of all people living with HIV worldwide will be virally suppressed by the year 2030.
His statement on transmission risk is simple - people on treatment for HIV, who are in regular medical care, and maintain an undetectable viral load (the amount of the virus found in the blood) cannot transmit the virus.
When implemented, his strategy over the past 15 years has been responsible for the elimination of vertical transmission (parent to child) of HIV in British Columbia. His statement is backed up by two significant studies - the PARTNER Study and the START Study. The outcome of his treatment in the province of British Columbia where HIV rates have dropped drastically, making British Columbia a model for the rest of Canada and the world is more than enough proof that treatment as prevention works.
One would think this major breakthrough would be an occasion for celebration. It has been in some ways as Dr. Montaner has received prestigious awards for his work and discovery of treatment as prevention and as mentioned, the adoption of the strategy by the United Nations and several countries in the world is significant..
Canada did finally sign on to the strategy earlier this year, but as Montaner mentioned, the provinces are slow to implement the strategy and the Public Health Agency of Canada cannot provide any solid statistics on their progress.
Montaner posed the question - "If the present scientific evidence is not being accepted how do we bring new evidence?" "The only way to sustain success as we have seen in BC, where they have managed to reduce and control new rates of transmission, is to continue to apply pressure."
I assume he means targeting specific governmental departments, clinicians, health care workers, activists, advocates and the general public who are for the most part not informed of these new developments. Montaner explained how he met with Pope Francis who understood the concept and endorsed the 90 90 90 strategy.
People asked - "Why the hell are you talking to the pope about HIV?" His response is simple, because the pope speaks to and influences many people in the church and this can bring about change. It is a simple concept to understand as he explained in one of his slides - adopting TasP, targeting disease elimination will in turn lead to health care sustainability. So, why are we not addressing this HIV strategy? Is it complacency? A matter of priorities? Funding?
Montaner maintains that the strategy will save money if investment in HIV treatment is made now. It is not a case of having no funds as he presented a slide with staggering figures to indicate where money has been spent and just how much it would cost to implement his strategy on a global scale. Because "a global pandemic needs global solutions."
Montaner discussed the controversy around TasP as he explained that the lower the Gross Domestic Product of any country, the more prevalence of poverty and of HIV globally. Access to services is essential to successful treatment. We cannot wait for people to come to us, we need to go out and find people and offer them treatment. We need to reach people who do not have access to treatment, we need to remove patents and provide more generic medications. Everyone needs to get tested, regardless of who you are or where you live, as there is a percentage of the population who do not fit into the high risk population and they may already have HIV and not be aware of it.
Montaner expressed his happiness to have Justin Trudeau as our new prime minister. They met (before the election, as he jokingly said) and Trudeau understood the scientific evidence., but the public does not. Although Montaner did not speak about it, we cannot ignore how the criminal justice system in Canada with one of the highest rates of HIV criminalization in the world, ignores the science, infringes on basic human rights and implements overly broad use of criminal legislation to incarcerate people living with HIV.
In spite of Montaner's demanding schedule where he is constantly traveling around the world to promote TasP, he appears very humble, funny, compassionate and dedicated to the movement to eliminate HIV on a global scale. It is time, he says, to stop doubting the science, face the fears and learn the facts about TasP.
The video of his full presentation can be found here when it's ready to be posted.
As well check out the PositiveLite.com archives for previous interviews with Montaner and our editor Bob Leahy.