sa国际传媒鈥檚 successful policies for fighting HIV/AIDs are increasingly being adopted by other countries, but not by the Canadian government, says the director for the sa国际传媒 Centre for Excellence in HIV/AIDS.
Dr. Julio Montaner credits 鈥渦nwavering support鈥� by the sa国际传媒听Ministry of Health in seeing the provincial infection rate drop far below the national average. But he said that even as a special AIDS adviser to the United Nations, he can鈥檛 get Ottawa to adopt the strategies that made it happen.
A federal spokesman responded that the government supports the principles of sa国际传媒鈥檚 plan, but that health care is primarily a provincial responsibility.
The UNAIDS 90-90-90 treatment targets 鈥� referring to the percentage of HIV cases diagnosed, treated and achieving no virus in the bloodstream 鈥� are aimed at rendering HIV/AIDS 鈥渁 sporadic disease by 2030,鈥� according to the centre.
They are based on sa国际传媒鈥檚 Treatment as Prevention policy, which seeks to ensure 90 per cent of HIV cases are diagnosed by 2020; 90 per cent of patients have access to free, high-quality treatment; and at least 90 per cent of patients are virally suppressed by 2020.
Panama adopted 90-90-90 on June 29. China, France, Brazil, Spain, Argentina, Swaziland and U.S. have already adopted Treatment as Prevention, the centre notes, and San Francisco, New York City and Washington, D.C., have also signed on.
Montaner, a professor of medicine, helped pioneered HAART 鈥� Highly Active Antiretroviral Therapy 鈥� which costs $15,000 per patient annually but is provided free of charge to sa国际传媒 patients at a cost of $100 million per year.
He said that Ottawa has allowed the standard of care for testing and treatment to vary widely across the country. 鈥淔urthermore, they have allowed some provinces to charge HIV-infected patients for co-payments to access therapy, which is a proven barrier to treatment.鈥� sa国际传媒鈥檚 policy is to diagnose and treat HIV without charge to stop transmission.
鈥淚n the event of a major catastrophe that affects the whole country, you expect the feds to take a leadership position,鈥� Montaner said. 鈥淚n HIV/AIDS, they have been missing in action. This is despite the fact that the epidemic is disproportionately affecting First Nations in sa国际传媒,听an area of their direct responsibility.鈥�
Eric Morrisette of Health sa国际传媒 said that decisions on HIV/AIDS strategy are 鈥渕ost appropriately based鈥� on each province or territory鈥檚 unique pattern of disease, but that Ottawa will continue to examine and share emerging evidence on promising interventions.
In Saskatchewan, Ottawa provided technical support to help investigate the way HIV/AIDS is spreading, Morrisette said.
Montaner calls on Ottawa to enact a national policy, which in turn would set the standards of care.
鈥淚f this was anything but HIV and AIDS, they would be all over this strategy,鈥� he said, calling the fallback on health as a provincial jurisdiction 鈥淏S.鈥�
鈥淲hen SARS came out, the PM听was all over the place,鈥� he said. 鈥淭here were no cases of Ebola, but Ottawa had a national strategy.
鈥淪o I want to ask Mr. Harper, why doesn鈥檛 he go on prime-time television and take the test for HIV to show the public that we should all be tested for HIV?鈥�
Instead, the federal government views injection-drug users and sex workers as enablers of the epidemic instead of people caught in an urgent public health issue across sa国际传媒, he said. Ottawa is 鈥渋nterfering with our ability to engage the most vulnerable people because they are so focused on their pursuit of their law and order agenda,鈥� he said.
鈥淚 want a standard of care to be set,鈥� he said.
sa国际传媒鈥檚 work has shown that more money invested up front saves money in a reasonable amount of time, Montaner said.
A person whose HIV becomes full-blown AIDS can incur up to $750,000 in care costs over a lifetime, but early treatment, at $15,000 a year, can grant that person a productive lifetime and prevent transmission. 鈥淎nd when you eliminate new infections, the return on investment grows exponentially.鈥�
He can鈥檛 tell Ottawa what to do with its money, but he asks why there are national strategies for flu and SARS and not for HIV.
鈥淲hy are they picking and choosing their winners?鈥�
听
If Ottawa officially supported 90-90-90, would it mean automatic enforcement by all provinces.
鈥淲e will cross that bridge when we have to,鈥� Montaner said. 鈥淏ut the fact that there is no federal leadership makes it even more difficult to have the conversation across the land.鈥�
He said he has met with two provincial ministers of health other than sa国际传媒鈥檚 Terry Lake, but it鈥檚 a national epidemic that requires national leadership, he said.
鈥淚magine tomorrow we have Ebola outbreaks in seven cities across sa国际传媒,鈥� Montaner said. 鈥淲ould the feds say it is provincial responsibility? Even if they were not to pay for it, they would set the standard by which everyone would be expected to control the outbreak.鈥�
Morrisette said that Health sa国际传媒 has been 鈥渨orking very closely鈥� with Saskatchewan, where the majority of new cases are among aboriginal people.
Montaner cited several ways that he said illustrate that Ottawa is interfering with public health efforts.
鈥淭hey are using procedural steps to stop supervised injecting facilities from opening and discouraging harm-reduction initiatives across the country. They are going out of their way to criminalize commercial sex workers or their patrons, and in doing so making it harder for us to bring services to these communities.
鈥淭hey have failed to pass legislation to protect against stigma and discrimination of key affected populations and those infected with HIV. They withdraw services from immigrants which are disproportionately at risk or affected. They have failed to pass legislation to ensure that trivial [non-infectious] exposure to HIV is not criminalized.鈥�
鈥淎t the international level, they have failed to embrace the made-in-sa国际传媒 Treatment as Prevention strategy that has now become the standard of care around the world.鈥�
Following the Panama sign-on, Montaner said he has yet to make contact with federal Health Minister Rona Ambrose or her representatives regarding the strategy.
Montaner said he believes that Conservative politicians are sacrificing public health to social prejudices.
鈥淭hey view the work that we do as facilitating or promoting conduct that they feel are responsible for the epidemic,鈥� he said.
Prevention strategies for men having sex with men, commercial sex workers and injection-drug users 鈥� such as Vancouver鈥檚 Insite that battles strong Conservative opposition 鈥� are necessary to reduce the risks of transmission, he said. But all adults need to be tested for HIV because up to 20 per cent of people do not know they have it and can transmit it, he said.
鈥渟a国际传媒 had the worst epidemic in the country in the 1980s and 鈥�90s and since then, today we are happy to report that we are way below the average,鈥� Montaner said.
鈥淚 have literally written a letter since 2006 to the [federal] minister of health once a year where I outline the progress that we have made (in sa国际传媒) and requesting a conversation with them regarding these issues,鈥� Montaner said. 鈥淎nd to be honest with you, this has not happened.鈥�
Morrisette responded that sa国际传媒鈥檚 chief public health officer has met with Montaner and his team several times and facilitated presentations to the Council of Chief Medical Officers of Health.
Victoria MLA Murray Rankin, NDP Opposition health critic, called on Ottawa to go further.
鈥淚 would urge the federal government to adopt this ambitious strategy and work with the provinces to do all we can to prevent and treat HIV/AIDS,鈥� Rankin said in a statement.
Morrisette said that the Canadian government supports the principles of the Treatment as Prevention approach, which include improved access to testing, treatment and support, as well as continuity of care.
鈥淲e are following with interest the implementation of the Treatment as Prevention approach in British Columbia.鈥� Montaner disagreed.
Ottawa is not on side in principle, despite official statements to that effect, he said.
鈥淥ttawa sits on the side. They don鈥檛 make any commitment and they are not accountable.鈥�
Ottawa told him it would not send a representative to the formal endorsement of 90-90-90 by the UN secretary general last Sept. 25, but noted it would not object.
鈥淸U.S. Secretary of State] John Kerry himself stood up to formally endorse the proposal on behalf of the United States, and it was endorsed immediately after by President [Jacob] Zuma of South Africa,鈥� Montaner said.
In December 2014, Morrisette said, a representative of Foreign Affairs, Trade and Development sa国际传媒 attended the UNAIDS Program Co-ordinating Board meeting and endorsed the principles behind the 90-90-90 global treatment targets.
Ottawa鈥檚 public health agency is exploring 鈥渢he potential work to develop national indicators and methods,鈥� he said.
