A few weeks ago, my organization was approached by a journalist with a unique assignment. Her newspaper was preparing a special section on the future of Québec and her portion of that was to write about health issues. Would we like to talk to her about our vision of HIV in Québec in 2024? We leapt aboard.
All we saw of the piece, after an afternoon of reflection as a team and an interview that lasted at least a half hour, was a two-liner in the online edition that managed to get my name wrong (an ongoing frustration of mine). Not satisfied with that as an outcome and quite proud of our reflection on the future, I thought it might be interesting to share that reflection here.
Bear in mind that the rest of this article is written from a perspective in the year 2024.
It begins with a headline in 2024: Statistics for the year 2023 reveal that there were no new cases of transmission of HIV during the year.
So how did we get there? Many factors come together to produce that success.
First, effective treatments with few side effects have been available for more than 15 years. These treatments bring about an improvement in the quality of life and life expectancy of people living with HIV that brings them nearly to the level of their peers without HIV. Many studies have demonstrated that success in controlling viral load also translates into the elimination of the risk of transmission.
In addition, there is a worldwide public health consensus that there is no risk of transmission by a person living with HIV whose viral load is controlled on an ongoing basis.
Second, there was an intensification of prevention and awareness efforts with respect to HIV and other sexually transmitted and blood-borne infections.
The success of interventions with injection drug users — like supervised injection services, needle exchanges, links to adapted detox services and social rehabilitation (global interventions for the health of the person) — served as a model for the intensification of efforts with all of the other populations the most affected by HIV.
Sex education is well-established in schools and serves to encourage youth to develop a healthy and well-informed sexuality that responds to each of their needs and expectations. Embarrassment and judgement are not a part of this program.
Testing is readily available and adapted to the needs of different populations. Testing is seen by all as a normal activity to take charge of one’s own health, without stigma.
There have been many information and sensitization campaigns for the general public and for more targeted populations. These allow everyone to be more aware of the means of transmission and prevention as well as the realities faced by people living with HIV. These campaigns serve to destigmatize HIV and to normalize the lives of those who were infected with HIV in the past.
There is broad knowledge and availability of all of the tools and strategies to prevent HIV transmission. Condoms and syringes are readily available for those who need them, as are psychosocial support, effective treatment and pre- and post-exposure prophylaxis.
Third, a number of landmarks decisions have signalled the beginning of the end of discriminatory practices that have frustrated efforts in the past.
The UNAIDS position on criminalization is the rule of the land: prosecutions are limited to cases of intentional transmission and are extremely rare, if not non-existent. There has not been a prosecution in Québec for several years.
The positive impact of treatments on quality of life and life expectancy for people living with HIV have forced an end to discriminatory practices in employment and insurance: there is no more justification for exclusion or different treatment and in a growing number of cases people living with HIV have marked legal victories.
In all of these elements, we can see that the end of HIV transmission has been brought about by a combination of two elements: the recognition and application of current scientific knowledge and the respect of human rights. In the absence of stigma, we can come together to discuss and deploy effective prevention strategies.
HIV is not yet cured, but researchers are following some very promising leads toward a cure and a preventive vaccine in the near future.
There also remains the challenge of international solidarity. If we have succeeded in eliminating transmission in Québec, and if we are on the path to discovering a cure and a preventive vaccine, we cannot ignore the duty to share our success with other countries and populations who don’t necessarily have our financial means, helping them to put into place the same conditions for success in their contexts.
Back to now. I don’t think we came up with any pipe dreams in our reflection on the future…all of these things are achievable with a little effort and political will. We started with the headline, but I think we also traced a path that could get us there. Do our leaders have the will?