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As Prevention

Apr16

Julio Montaner and Treatment as Prevention

Wednesday, 16 April 2014 Written by // Bob Leahy - Editor Categories // Activism, As Prevention , Current Affairs, Health, International , Treatment, Living with HIV, Opinion Pieces, Bob Leahy

An editorial from Bob Leahy about the most controversial figure on the Canadian HIV landscape, BC’s Dr. Julio Montaner, the world’s leading proponent of treatment as prevention and why we like him and his work.

Julio Montaner and Treatment as Prevention

Dr. Julio Montaner, Director of the British Columbia Centre for Excellence in HIV/AIDS is not a man to mince his words or spare those in power a tongue lashing when he senses they could do more – much more - to fight the epidemic. 

“All the evidence is in. What we are lacking is political leadership to implement what we know works, to do it effectively and to do it now” he says. 

Talk to him privately and he’ll name names, talk colourfully about his repeated overtures to the federal government and to his provincial colleagues that have been brushed aside. He’s clearly both frustrated by Canada in particular but at the same time buoyed by the many other countries and jurisdictions who have taken his lead as well as the support shown by organizations like the World Health Organization and UNAIDS. 

Who is Julio Montaner? Born In Argentina in 1956 – he still speaks with a thick accent – he was attached to St Paul’s Hospital in downtown Vancouver and was the first member of the HIV department at St. Paul’s Hospital when it was founded in the 1980’s. In 1996, Montaner presented the results of his pioneering research on triple therapy to treat HIV infections at the XI International AIDS Conference in Vancouver. Montaner served as the President of the International AIDS Society from 2008 to 2010. He is considered the leading HIV/AIDS expert in British Columbia and a global leader in HIV/AIDS research. 

Some people living with HIV in Vancouver know him, though, as their own HIV specialist. They speak glowingly of his compassion and knowledge. “He’s an amazing, caring man" one patient told me. They clearly love him out there. 

Few know of his family background.  A search of Wikipedia  tells us Montaner is the son of the renowned Argentinean pulmonary expert and tuberculosis specialist Julio Gonzalez Montaner, the former president of the Argentine Medical Association. He met his wife, Dorothée, at the time an X-ray technician at St. Paul’s Hospital, in the early 1980s while he was a resident. They have four children: Michaela (born 1986), Camila (born 1987), Fernando (born 1989), and Gabriela (born 1990). 

In conversation he is debonair, earnest, eloquent and entirely human. 

Universally well liked? Not so much. Montaner’s style is too blunt for some - he knows that, seemingly arrogant about the results he has achieved, too dismissive of his critics. But impassioned? Absolutely. Nobody can deny that. 

But perhaps he has reason to be impatient, to be annoyed. He told PositiveLite.com in January 2012 “Canada has this amazing made-in-Canada strategy that has now been recognized by Science (journal) as the number one scientific breakthrough for 2011. The New York Times has written about it. You name it. It’s all over the place. And I cannot get five minutes audience with the federal government to say – you know how come it‘s so easy to have a national strategy about childhood obesity, prostate cancer, breast cancer – and AIDS, we have a made-in-Canada strategy that can fix it that cannot be sorted out.” It’s reprehensible" he fumed over the phone, his voice raised in anger. 

I’ve interviewed Montaner three times. He is, frankly, a dream to interview. Talking quickly and pounding out facts and answers to his critics like a machine, he’s a man on fire. It's hard not to be both charmed by the man's eloquence and convinced he’s right. 

He’s also poised to see others feel the same. We are at a point in time when the evidence has become so overwhelming both as to the impact of ART in reducing new transmissions and its positive impact on patient health outcomes so that TasP holdouts – and they are legion – are having to re-evaluate their positions. Formerly prone to attacking everything Montaner - his data, his conclusions even his character - it is shaping up to be an interesting exercise in them collectively saving face. Because, in 2014, opposing treatment as prevention has largely become an untenable position. And who wants to be on the losing side? 

Some holdouts will say, and are saying “we are already doing (treatment as prevention)”. They aren’t of course and Montaner laughs at the suggestion. 

There remains though a huge catch up exercise for many to quickly gain literacy in a whole new prevention field. Montaner has attempted to help through a series of globally well attended International Treatment as Prevention workshops held in Vancouver like this one, but where the  attendance of Canadian HIV prevention experts has been starkly absent. That shying away from TasP knowledge exchange opportunities represents a deficit that organizations like CATIE, who appear supportive of moving forward with a greater exploration of biomedical solutions to add to the prevention arsenal, will need to address in a hurry. 

Andrew Sullivan recently said  "we can either use our medical knowledge to prevent infections, or we can allow them to continue."

PositiveLite.com is committed to being a part of the dialogue on Treatment as Prevention for the simple reason that it deeply affects all people living with HIV. We think it is full of good for people living with HIV and we think you should know about it. We also think you should support it. 

These two OHTN videos below were from a recent Casey House symposium in Toronto “Treatment as Prevention: The Key to an AIDS & HIV free Generation". First  Dr. Montaner introduces research that is showing overwhelming evidence that providing access to medications to all those affected reduces mortality, morbidity and transmission, then shows how his research has been applied internationally, while Canada continues to lag on a federal HIV policy. 

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