This World AIDS Day (Dec. 1), you’d be forgiven for thinking HIV is no longer a public health threat in Canada. We have new prevention options such as PrEP, a pill that HIV-negative people can take on a regular basis to stop infection. We’ve seen the good news about HIV treatments, now so effective that they can restore a normal life expectancy to a person living with HIV and completely eliminate the possibility of passing it on to a sexual partner.
But statistics tell a different story. Between 2013 and 2018, the Public Health Agency of Canada estimates that HIV infections in Canada have been climbing — a 31-per-cent increase over five years.
Why have HIV infections been increasing when we have more and better prevention options at our disposal than ever before?
Ask our federal decision-makers, who have not increased funding for the HIV response since 2008, and even fell short on spending the funds that had been allocated to the federal HIV initiative. At the same time, the federal government has broadened the scope of this fund — once dedicated to HIV — to also address hepatitis C and other sexually transmitted and blood-borne infections, an approach that could make sense if funded appropriately. But in practice, we have seen more organizations and more health issues competing for a slice of the same pie, resulting in funding reductions and service cuts for community-based HIV programs.
When adequately funded, community-based programs have the power to stop the HIV epidemic. They counsel people at risk of infection, educate them about current prevention options and help them access these tools. They support people living with HIV to start and stay on treatment, helping to improve their own health and the health of the communities around them. And some offer free HIV testing in the community, the first step towards referring HIV-negative and HIV-positive people to the prevention or treatment services they need.
Community-based programs are also better positioned to engage individuals in communities that have been marginalized from mainstream health care services, including the communities most affected by HIV in Canada: gay and bisexual men, trans women, Indigenous people, African, Caribbean and Black Canadians, and people who use drugs.
These programs have been proven to work when governments invest in them. While Canada has seen HIV infection estimates increase over the past few years, the United Kingdom has seen them decrease: 50 per cent among heterosexual men and 22 per cent among women (between 2014 and 2017), and an incredible 71 per cent among gay and bisexual men (between 2012 and 2018). These successes haven’t come out of nowhere; they have corresponded with increases in community-based HIV testing, PrEP programs and greater access to HIV treatment and care.
Are these programs expensive? Not when compared to the cost of more HIV infections, which entail a lifetime of daily medication, regular visits to the doctor and a spiralling need to invest in more prevention, testing and treatment programs. Policymakers with long-term vision see HIV funding as an investment rather than a cost, and the COVID-19 pandemic has illustrated what happens when we fail to invest proactively in our collective health.
There is no one party that deserves the blame for this approach. It is the fault of successive governments neglecting the federal HIV response and ignoring the all-party House of Commons Standing Committee on Health, which recommended a funding increase to $100 million annually for HIV programs. A drop in the bucket when compared to the cost of treating more HIV infections.
Mathematical models show that with an increased emphasis on prevention, testing and linkage to treatment and care, we could actually eliminate HIV as a public health threat by 2030. The government of Canada publicly committed to this goal in 2016, but never allocated additional funding to make it a reality.
With Canadians having sent MPs back to Ottawa with a mandate to work together to get things done, my hope is that the political will can be found to deliver on this promise and finally eliminate HIV as a public health threat once and for all.
Laurie Edmiston is executive director of CATIE, Canada’s source for HIV and hepatitis C information.