World AIDS Day: Prevention measures could reduce new HIV cases 95 per cent by 2020

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Today is World AIDS Day. This year's UNAIDS theme is "Getting to Zero: zero new HIV infections, zero discrimination, zero AIDS-related deaths." And there's been success -- globally, annual new HIV infections fell 21 per cent between 1997 and 2010. The number of AIDS-related deaths has also decreased from a peak of 2.2 million per year in the mid-2000s to 1.8 million in 2010. A key game-changer has been getting more HIV treatment to more people who need it.

Research at the internationally renowned B.C. Centre of Excellence in HIV/AIDS now shows that HIV Treatment is also HIV Prevention. Daily HIV treatment has proven to be 96 per cent effective in reducing HIV transmission. In addition to condoms, clean syringes, and other prevention measures -- it's a new tool in the prevention toolbox. Bill Gates, at the 2010 International AIDS Conference in Vienna, noted that, while there's no cure, there's no excuse. He estimated that if, globally, all prevention measures were used, the number of new cases of HIV could be reduced by 95 per cent by 2020.

Canada has approximately 3,300 new HIV infections per year. Each new HIV infection is estimated to cost Canadians $1.3 million in lifetime treatment costs and lost productivity. We have an ethical and economic imperative. Canada needs to apply all the prevention tools -- which is the right thing to do anyways -- and, by doing so, save multi-millions in the years ahead, even after factoring in the treatment costs. It is one of the few times in health care when it is correct to say an intervention will save health dollars.

At a time when the provinces and federal government are re-visiting how we finance health care, it's time to take an innovative approach to HIV/AIDS. One of the single biggest challenges Canada faces in Getting to Zero is successfully engaging in HIV treatment, individuals struggling with serious mental illness, long-standing addictions, and homelessness. Aboriginal Canadians have the highest proportion of HIV reports attributed to injection drug use (60 per cent). A decade ago, there were 10 new cases of HIV per year due to injection drug use in Saskatchewan. In 2009, there were 149 new cases. Almost 75 per cent of all new cases of HIV in the province were related to injection drug use.

Getting a firm grip on the epidemic in this vulnerable population is complex. Just as the solution to homelessness is not as simple as an apartment, so, too, the solution to the HIV epidemic is not as simple as HIV treatment for all who need it. It takes innovative ways of successfully engaging individuals in their care.

British Columbia leads the country, by far, in reducing new HIV diagnoses -- down by approximately 60 per cent since 1996. Even more remarkable, new cases of HIV in the injection drug user population declined from 137 in 2000 to 64 in 2009. Recently, British Columbia took a further bold and innovative step to dramatically reduce HIV transmission in the province by being the first government globally to undertake an HIV Treatment as Prevention initiative. Other countries are stepping up.

Vancouver was the first city in North America to respond to its out-of-control HIV epidemic in the injection drug-using population by establishing a supervised injection site. A plethora of internationally acclaimed research has demonstrated Insite's effectiveness.

As well, Vancouver's Dr. Peter Centre has integrated supervised injection service into a broad range of health services in its downtown neighbourhood HIV/AIDS health clinic. It's a therapeutic setting which includes nutritious meals, assistance with daily medication and other nursing care, along with art, music, and other therapies -- an opportunity to go beyond supervised injection service to engage more fully in health care.

In a March 2011 report, B.C.'s Provincial Health Officer noted there's ample evidence on the individual and health system benefits that supervised injection service provides. He recommended that supervised injection service should be integrated into public health clinics where needed throughout the province using the Dr. Peter Centre model.

Insite and the Dr. Peter Centre have been visited by local, national, and international health care and political leaders interested in learning how to harmoniously integrate such service into their communities. The recent Supreme Court of Canada Insite decision opens up the possibility.

An innovative approach to HIV/AIDS in Canada means innovative programs to successfully engage individuals in their HIV treatment and care. With political leadership, such innovation can lead to transformational social change and assist Canada in Getting to Zero.

Maxine Davis is the Executive Director of the Dr. Peter AIDS Foundation, which operates the Dr. Peter Centre, a not-for-profit HIV/AIDS health care facility in Vancouver, B.C.

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