While Canada continues to pump unprecedented resources into combatting the COVID-19 pandemic, some health experts wish the federal government would have the same sense of urgency when it comes to the ongoing epidemic of HIV/AIDS.
Vancouver’s Community-Based Research Centre (CBRC) is linking with 20 community organizations across Canada to provide 1,500 free HIV self-test kits to the public.
The Test Now community distribution project aims to “evaluate the efficacy and uptake of new HIV testing technologies while increasing access among gay, bi, trans, and queer men and Two-Spirit and non-binary (GBT2Q) people.”
“HIV testing dropped significantly in Canada as clinics closed due to the pandemic,” says Brook Biggin, CBRC’s Program Development Director. “And this says nothing about folks who have had trouble accessing testing for years – whether it be because they live in rural areas, do not have adequate resources in the cities where they live, or experience stigma when they navigate the health care system.”
Still need to focus on blood-borne and sexually transmitted diseases
Chris Draenos’ title is long and complicated, but his job is crucial.
Draenos is the CBRC’s National Sexually Transmitted and Blood-Borne Infection (STBBI) Testing and Linkage Implementation Manager.
Before working at the CBRC, Draenos was a sexually transmitted infection case manager for Toronto Public Health. He also worked at Casey House, Canada’s only hospital for people living with HIV.
Draenos says Test Now will allow possibly HIV-positive people to get tested without going to a clinic. It will also save time for health care professionals who are busy coping with Canada’s fifth wave of COVID-19.
Last June, the CRBC shared a video demonstration of a self-HIV test with Canada’s Drag Race contestant Travis L’Henaff, who is HIV-positive. While the self-HIV test is much different from the COVID-19 rapid test, both are easy and take roughly the same amount of time.
Each self-HIV test kit contains three bottles, a lancet to prick your finger, and a testing device.
“Someone would prick their finger, pour a large drop of blood into the first bottle, shake that, put that into the testing device, and add bottle two and bottle three,” Draenos explains. “Shortly afterward, they would receive a result.”
In 2018, the Public Health Agency of Canada (PHAC) reported an estimated 2,242 new HIV infections, up from 1,950 cases two years earlier in 2016.
Canada wide, there were an estimated 62,050 people living with HIV as of 2018. While 87 per cent of those with HIV/AIDS are aware of their status, roughly 8,300 Canadians living with the disease have no idea they have it.
Incarcerated people living with HIV/AIDS face added layers of stigma and discrimination when it comes to accessing sexual health care.
In 2018, there were 141 people living with diagnosed HIV in correctional institutions across the country. More than one in four those were Indigenous, despite Indigenous people representing only about 5 per cent of the total population.
Chris Draenos points to a variety of meaningful moves the federal government could take right now. One would be to make an effective drug called pre-exposure prophylaxis (PrEP) widely available.
This medication, which is taken as a pill, helps prevent individuals from contracting HIV, but can be extremely costly without health insurance. Many people with HIV have inadequate supplementary health insurance, or none at all. Provincial health insurance programs do not fully cover pharmaceutical drugs.
HIV self-tests would cost governments $35 each.
It is a fair bit of cash. But Draenos argues it would be much cheaper than the costs associated with potential HIV/AIDs patients seeing a physician, having someone draw blood, shipping the blood to the lab for processing, and returning results to the health care provider.
“It comes down to the funding priorities of the provinces – what they choose to spend their money on,” says Draenos.
The 90-90-90 targets – still unmet
CBRC is calling on the federal government to increase funding for HIV to $100 million annually. The Senate passed a motion supporting such a plan in December 2020.
Additional funding would support community-based organizations across the country which work to prevent the spread HIV, as well as resources and care for those now living with HIV.
But the federal role is only a small part of the story.
“The provinces are the ones responsible for actual testing services. There are many choices they could make to increase its accessibility,” Draenos explains. He notes that, currently, no Atlantic provinces offer rapid HIV tests. Elsewhere in the country such tests have been available for more than a decade.
As for Ottawa, Draenos argues that federal government support for the prevention of sexually transmitted and blood-borne diseases has stagnated over recent years, while the number of people living with HIV in the country has increased.
According to Draenos, the Canadian government continues to fall short of targets it set a number of years ago for the year 2020.
PHAC uses the label “90-90-90” to describe those targets:
- 90 per cent of all people living with HIV should know their status,
- 90 per cent of those diagnosed should receive antiretroviral treatment, and
- 90 per cent of those on treatment should achieve viral suppression.”
“When these three targets have been achieved,” PHAC tells us, “At least 73 per cent of all people living with HIV will be virally suppressed.”
To be virally suppressed means to have zero symptoms and not to be contagious.
PHAC confirms in an email that Canada has not met all of the 90-90-90 targets.
Despite that failure, the agency says the federal government is now committed to meeting the United Nations’ even more robust targets of 95-95-95 for the year 2025, three years from now.
The ultimate goal, according to the federal public health agency, is to end sexually-transmitted and blood-born public health threats by 2030, which is less than a decade away.
PHAC is still in the process of tabulating and processing data on HIV/AIDs in Canada for the most recent available year, 2020. It expects to be able to make those numbers public only six months from now, in July 2022.
Many are anxiously awaiting that information.
In the meantime, the federal government could immediately look at increasing availability of pre-exposure prophylaxis drugs, while governments could adopt self-testing programs tomorrow.