“HIV in Canada?”
It’s a question I often hear on World AIDS Day, Dec. 1, when much of our attention turns to the global HIV epidemic. Many of us think of HIV/AIDS as an issue affecting other countries. But an HIV epidemic in Canada?
More than 70,000 Canadians are living with HIV and, on average, seven to eight new infections happen every day. While these numbers are concerning, Canada’s overall rate of new infections is still lower than the global average. What these numbers don’t show, however, is that HIV has reached epidemic levels in key populations across the country.
In certain communities across Canada, the virus is more prevalent than in countries hardest hit by the HIV epidemic. In the Ahtahkakoop First Nation in Saskatchewan, for example, 3.5 per cent of the population is living with HIV. In Toronto, an estimated one out of every five gay and bisexual men is HIV-positive. And in Vancouver’s Downtown East Side, an estimated 27 per cent of people who inject drugs are HIV-positive.
At this year’s International AIDS Society conference in Vancouver, we heard success stories from around the world as countries scale up their efforts to meet ambitious new testing and treatment targets set by UNAIDS, the United Nations agency responsible for co-ordinating the global HIV response.
Modelling studies show that achieving these new targets will result in the end of the epidemic spread of HIV by 2030. With new targets at the global level, and new federal leadership in Canada, now is the time to renew our own HIV response and catch up with the rest of the world.
Over the past decade, Canadian harm-reduction programs were strongly opposed by the previous federal government, despite clear evidence that they save lives and prevent the spread of HIV.
An estimated 11 per cent of Canadians who inject drugs are HIV-positive. In Australia, where the early and consistent adoption of harm-reduction initiatives such as needle syringe programs was supported by their government, fewer than two per cent of people who inject drugs are HIV-positive.
In Canada, a large proportion of people living with HIV do not know their status because they have not been tested. We may be able to learn from other countries that have a strong focus on testing, including the use of new testing technologies and strategies. By similarly expanding access to testing, we can help diagnose more people living with HIV, giving them an opportunity to start treatment and take care of their health and prevent further transmission to others.
With no national pharmacare plan, access to treatment is inconsistent for Canadians living with HIV. In fact, HIV treatment access is estimated to be greater in Botswana, where a national program provides free treatment to two-thirds of people with HIV in the country, improving health and reducing deaths. And partly due to the fact that treatment also greatly reduces the chance of transmitting HIV to another person, new infections in Botswana fell 70 per cent over the 10 years following the introduction of their program.
Canada’s national HIV strategy was written over 10 years ago and doesn’t include actions related to any of the new scientific developments that should be guiding our co-ordinated national response. These new developments include the fact that people who start treatment soon after infection stand a good chance of living a near-normal lifespan and of not being infectious to others. Great news but you need to get tested to know if you need HIV treatment.
From preventing transmission, to testing and treating HIV, Canada has a lot to learn from countries around the world, including some low- and middle-income countries. This World AIDS Day is a perfect opportunity for us to think globally and act locally. Let’s create our own ambitious strategy to address HIV in Canada.
About the author: Laurie Edmiston is executive director of CATIE, Canada’s source for HIV and hepatitis C information.