Dr. Julio Montaner

Dr. Julio Montaner is hailed worldwide for his critical contribution to combatting the spread of HIV/AIDS. His aggressive treatment methods are in the forefront in Africa, in Brazil, in China and in Europe. But what does he get from Canada’s political leaders, outside his own province of British Columbia? A big, fat, collective cold shoulder.

While his landmark Treatment as Prevention strategy to stop transmission of HIV is now the cornerstone of UNAIDS’ ambitious goal to eradicate the AIDS epidemic by 2030, no province except B.C. has fully embraced it. Nor is it part of Health Canada’s approach to treatment.

At the same time, despite a string of international awards that would make anyone blush, including one from, of all people, the president of Austria, Dr. Montaner is not even a member, officer or anything else of the Order of Canada. Austria, yes. His own country, no.

It’s hard to escape a conclusion that this is the reward someone gets for speaking out against the federal government over its lack of action on AIDS and its “ideological” opposition to Vancouver’s safe-injection facility, Insite.

Yet, as B.C. Health Minister Terry Lake put it last month, while announcing yet another award for Dr. Montaner, who was named to the Order of B.C. in 2010: “Nobody in Canada has made a bigger contribution to the field of HIV/AIDS research and treatment.”

I would go further than Minister Lake. Dr. Montaner may have done more than any living Canadian to save lives around the world. Although such a statement would undoubtedly make the brilliant, passionate researcher uncomfortable, it is certainly arguable.

From his modest, cluttered office among the maze of workplaces at venerable St. Paul’s Hospital in downtown Vancouver, Dr. Montaner has spearheaded treatment and programs administered to millions of Africans and others throughout the world. As a result, the impact of HIV/AIDS is slowly beginning to recede, and the dream of an AIDS-free planet is no longer mere fantasy.

Dr. Montaner is the first to point out that this has hardly been a one-man show. Many colleagues and other researchers have contributed to these advances, as well. But none perhaps with the intensity and drive of the longtime head of B.C.’s renowned Centre for Excellence in HIV/AIDS.

Under his watch, employing the powerful anti-retroviral drug cocktail (HAART), originally devised by Dr. Montaner, AIDS has gone from a virtually certain death sentence to a chronic, manageable disease. He then went on to pioneer the game-changing Treatment as Prevention.

In a recent interview, on the eve of World AIDS Day, Dr. Montaner spent most of the time celebrating the dramatic progress in the global fight against HIV/AIDS. Just this fall, UNAIDS announced its bold 90-90-90 program, with the target, as mentioned, of ending the AIDS epidemic as we know it within 15 years. Treatment as Prevention, of course, forms the core of the UN body’s stepped-up assault.

But near the end of our conversation, Dr. Montaner began to reflect on the situation back home in Canada, where other provinces and the federal government continue to shun the proven treatment program that saves lives and reduces the spread of HIV. His mood darkened.

“People are sitting around, looking the other way, because this is not a daily epidemic, or something,” he told me. “I can’t shake the feeling that is wrong. That is deeply, deeply wrong. And it tells me something about human nature that I don’t want to accept.”

In our many encounters over the years, I had never heard him sound so morose. Angry and frustrated. But never gloomy.

The premise of Treatment as Prevention is simple. HAART not only halts the killer nature of the virus, it was found to reduce a patient’s viral load to such minimal levels, the danger of passing on the virus is negligible. Hence, if enough patients are treated, transmission can be stopped in its tracks.

B.C.’s full-bore employment of Treatment as Prevention, seeking out those on the margins of society and providing drugs free of charge, has slashed the rate of new HIV infections by more than 70 per cent. This in a province whose drug-riddled, impoverished Downtown Eastside area in Vancouver once had the highest HIV infection rate in the developed world. In the rest of the country, meanwhile, the number of new cases is on the rise, highlighted by an alarming increase among First Nations individuals in Saskatchewan.

As for Ottawa, its so-called national AIDS strategy has not been updated since 2004, and Dr. Montaner, for all his global tributes, can’t even get a meeting with federal Health Minister Rona Ambrose.

No wonder his thoughts turned sombre. “When you think about the role model we have created for dealing with AIDS and HIV in British Columbia, it is probably one of the biggest public health successes in the history of Canada,” he said. “Yet we still don’t get the attention we should be getting. This little voice inside me keeps wondering why. Why is it that we have to work so hard for people to show their compassionate side?”

At 58, Dr. Montaner could retire from the field, content with an astonishing legacy of achievement. But his inability to make a similar mark in Canada propels him forward. “It drives me more perhaps than all the success we have had,” he said. “All the good stuff is all very nice, but it’s that dirty aspect of this business, that is so perverse, that is really what keeps me focused on going on.

“Because we know how to do it,” he maintained. “We know what needs to be done. It’s right there in front of us. Yet here we have an epidemic that is out of control on the prairies, and a country that is not interested in talking about it. That is not acceptable.” Quite right.

In the meantime, at this festive time of the year, let us give thanks that we have someone as tireless and committed to the good fight as Dr. Julio Montaner. Few will be surprised to learn that he is currently planning to use the principles of Treatment as Prevention for yet new campaigns, beyond HIV/AIDS: against the growing scourge of Hepatitis C and further, against socially contagious afflictions such as smoking, obesity and addiction, itself. Will the man never slow down?

May I wish the Argentinian-born, raised and trained good doctor Montaner a very hearty Feliz Navidad.

P.S. Lest you think it’s presumptuous to suggest his induction into the Order of Canada, consider the following.

For his vital efforts in the fight against HIV/AIDS, he has been showered with global recognition, including research bestowals, totaling $3.5 million. He served as president of the International AIDS Society from 2008 to 2010, and remains an elected member of its Council.

In 2010, Dr. Montaner received the Albert Einstein World Award of Science for his “leadership and development of novel HIV treatment strategies with world-wide impact”. The same year he received the Prix Galien Research Award for “spearheading clinical trials that have revolutionized the management of HIV/AIDS.”

Next year, Dr. Montaner will be inducted into the Canadian Medical Hall of Fame. The lengthy list of tributes also includes that Grand Decoration of Honour for Services to Austria. “Dr. Montaner’s leadership and innovation in HIV and AIDS research has improved the lives of thousands of people in Austria and millions of people throughout the world,” explained Austrian ambassador Werner Brandstetter.

If far-off Austria can find itself free to honour Dr. Montaner, why can’t Canada?

(A complete list is at the end of this lengthy Wikipedia entry on Dr. Montaner. http://en.wikipedia.org/wiki/Julio_Montaner )

Image: Flickr/Brent Granby