General HIV testing only solution to stop epidemic: Vancouver doctor

A doctor in Vancouver is urging the Canadian government to test everyone across the country for HIV as a way to eliminate the epidemic.

Dr. Julio Montaner, the director of B.C.’s Centre for Excellence in HIV and AIDS, says about 15 to 25 percent of people infected with HIV in Canada are not aware they have it, which contributes to the spread of the virus.

“The reason why the HIV epidemic persists, among other reasons, is because there’s a substantial number of people that have the infection that are not aware that they have it, and even worse, they are not even suspecting that they could have it,” says Montaner.

A few years ago Montaner and his team started noticing people walking into the emergency room with HIV who were not considered part of the “risk” group that is usually associated with the virus. So they decided to test all of those who would volunteer, rather than focus on whether they fitted the “risk” description.

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“If I find everybody that is infected with HIV in the province of British Columbia and I have access to the treatment, which we do because our government has been exemplary in that regard and the treatment is available for free,” says Montaner, who explains that by finding these people who are infected, treatment can start earlier and the virus can be controlled.

When Montaner and his team started implementing volunteer testing, they found that one in 1,000 of people coming in were testing positive without the patients having any kind of suspicion that they were carriers of the virus. Many of them didn’t even show symptoms.

Montaner’s proposal is known as the 90-90-90 Target. Meaning that by 2030 they want to hit the target of having at least 90 per cent of people infected with HIV diagnosed, at least 90 per cent of them on anti-retroviral therapy, and at least 90 per cent of them fully virologically suppressed.

“The bottom line is, we’ve done the work, we’ve done the testing, we’ve done the evaluation, and we have concluded that if we were to offer HIV screening to the population at large we will actually diminish the number of people who are HIV infected substantially.”

Montaner has been proposing this program to the federal government since 2006, but they were not interested. Every year he says he would send them an updated report but they claimed his proposal “encouraged risky activities”. Meanwhile, this approach has been accepted in many countries around the world and it’s been backed-up by the United Nations.

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“The bad news is we’ve been through a very rough decade trying to convince the federal government to do anything about this,” says Montaner. “The good news is that the dark decade is over, the new Prime Minister has met with me and has in writing stated that should he form government, he will work with us to ensure that this becomes part of the way forward in Canada.”

Read below the letter Justin Trudeau sent Montaner promising his support on the 90-90-90 Target initiative if elected:

Letter from Justin Trudeau

As a senior advisor to the United Nations Aids program, Montaner has been working with the U.N. to develop the 90-90-90 Target program to the global scene in an effort to end the AIDS pandemic.

A year ago, Ban Ki-moon, U.N.’s secretary general, endorsed Montaner’s plan of treatment and prevention. This September, Montaner met with the U.N.’s general assembly, where they committed  to end AIDS by 2030 as one of the sustainable development goals .

Montaner  says that in order for the 90-90-90 Target program to be effective, testing shouldn’t be mandatory, but rather doctors should encourage people to embrace this strategy and the only way to do this he says, is through a supportive environment.

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“If I make it mandatory [people] are going to run away, but if on the other hand I explain we are doing this for the benefit of the community by confirming you’re HIV negative… if I start prosecuting and persecuting that doesn’t work.”

When asked about the cost of testing everyone in Canada, he says asking about the cost is the wrong way of approaching this, saying the government will have to pay eventually, it is just a matter of when and how.

“The real question is, what is the cost effectiveness of this strategy, what is the return of the investment?,” he says. “We call it the H mortgage.”

In Canada, treating a person per year, costs about $10,000 to $15,000 dollars. The government of B.C. today spends between $100 to $120 million dollars every year Montaner explains, while an HIV test can be as low as $5 dollars per person.

“What we have been able to show is that if you invest a little bit more upfront then what happens is the savings are exponential because you are preventing death, you’re preventing disability, but more importantly, from a financial perspective you are preventing the spread of the disease.”

“It’s the first time in a long, long, long, time that a major global public health initiative has emerged from Canada,” he says, despite the own Canadian government having ignored it for almost 10 years.

He’s been having conversations with the government in Ottawa recently and people from the Liberal party. “We are extremely delighted, enthusiastic and positive about everything that we’re hearing . Having gone from persona non grata to actually having these conversations about how to move this forward in Canada and globally, is incredibly gratifying,” says Montaner.

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Justin Trudeau and Dr. Julio Montaner discussing the 90-90-90 Target strategy.
Justin Trudeau and Dr. Julio Montaner discussing the 90-90-90 Target strategy.