B.C.'S HIV STRATEGY HERALDED WORLDWIDE, BUT NOT IN CANADA

A dramatic drop in the number of new HIV infections in British
Columbia shows that a treatment-as-prevention strategy is making a
difference, says a leading AIDS investigator who is frustrated that
other parts of the country haven't embraced the concept to the same extent.

"The truth is that there is no reason why we should be seeing a steady
decrease in HIV new cases in British Columbia and we should not expect
to see the same thing in the rest of the country," said Dr. Julio
Montaner, director of the British Columbia Centre for Excellence in HIV-AIDS.

Saskatchewan, in particular, has been struggling with an incremental
increase in new cases almost every year since 2004.

In British Columbia, the number of deaths from AIDS since 2005 has
steadily declined to 55 in 2010, while the number of people receiving
HIV antiretroviral treatment has risen.

New HIV diagnoses fell to a low of 301 in 2010 even as testing for the
virus increased, said Dr. Montaner as he revealed previously
unpublished figures. In 1996, there were more than 700 new diagnoses
and throughout the early 2000s, the number of new HIV diagnoses each
year was above 400.

Dr. Montaner is a strong proponent of a treatment-as-prevention model
that involves seeking out people at risk for HIV infection, treating
those who are infected with antiretroviral drugs, keeping them on
treatment and supporting them.

Treatment reduces the amount of virus in the bodily fluids of someone
with HIV infection. A clinical trial of 1,763 couples in which one
partner had a known HIV infection showed that antiretroviral therapy
reduced the risk of heterosexual transmission by 96 per cent. The
findings of the HPTN 052 trial, led by a North Carolina researcher,
were reported in the New England Journal of Medicine in August.

Because of the trial's profound implications for the future response
to the AIDS epidemic, the magazine Science recently named it the
breakthrough of the year for 2011.

Dr. Montaner said this made-in-Canada strategy now has been formally
adopted by China, which has requested support to implement it, and the
United States has said treatment as prevention will become a pillar of
its international program.

His New Year's resolution, he said, is to make it clear to the rest of
Canada that "we are missing the boat."

"Hello, the rest of the world is running behind it. Science magazine
is calling it breakthrough of the year. British Columbia has been
leading the charge now for what, five years going onto six and we
in Canada, we're happy to just walk away and say that nothing
happened. This is the biggest disappointment of the last decade," he
said in an interview.

The Public Health Agency of Canada said Tuesday that no one was
available for an interview on the subject.

In Saskatchewan, Jim Myres, director of disease prevention at the
Population Health Branch, said there is no question that HIV infection
has been an issue in his province, but a four-year strategy and "an
aggressive campaign" is underway.

"We're not calling it seek and treat, but essentially that's what
we're doing. We're actually going on reserve with an ID [infectious
diseases] clinic and trying to get people to do the tests," he said.
"We're actually seeing a bit of the numbers decline in our big urban
centres, and the numbers out in the rural areas increasing as we
implement this strategy."

In 2009, there were 200 new cases of HIV in Saskatchewan and the
figure dropped to 2010 to 172, he said. It's expected to rise for 2011
because of new efforts to go out and find cases.

"We've actually had chiefs come to us and say 'We want you to come on
reserve and do an HIV ID clinic.' I don't think that's done anywhere
else in Canada."

The first ID clinic on a reserve was held last summer, Mr. Myres said,
and there have been one or two others since. Another ID clinic will be
held this month.

Saskatchewan's situation is a little different than other provinces,
he said, noting 70 per cent of new HIV cases are injection drug-use
related and a high proportion of them are from the aboriginal population.

"And when we talk about aboriginal populations, there's a lot of
stigma attached to that and therefore they don't want to come in for
treatment, so a lot of education and training is involved."

Antiretroviral treatment is "absolutely" key to stopping spread of the
virus, he agreed.

The province has been working with Health Canada to make the
medication easier for First Nations individuals to access.

Pre- and post-test counselling is involved in HIV identification, and
medication is prescribed for those identified as HIV positive. In the
past, that meant going to a pharmacy and a "long involved process with
regards to getting approval for certain HIV medications," Mr. Myres said.

Less than a month ago, the process was finally streamlined so the
antiretroviral therapy could be accessed right away.

"That was not the case with HIV medications for First Nations prior to
Dec. 16. There was a long involved process that could take up to a
week or 10 days, and this is a population that's not going to come
back. You get them there, you get the prescription, you need to be
taking it right away."

Saskatchewan is also studying practices in other provinces, and
exploring whether direct observed therapy makes sense having a
health care provider such as a pharmacist watch as individuals take
the medication.

"We haven't fully gone down that road yet but it's something we're
looking at. We do it for TB medication for example."

In British Columbia, the controversial supervised drug injection
program Insite, which allows health officials to try to identify
infected individuals and facilitate treatment, is just one element of
a multi-pronged program.

Dr. Montaner said antiretroviral treatment for HIV needs to be free,
with no co-payments or deductibles, because these costs act as a
disincentive to keep taking the pills. If a private drug plan gets
charged, the information is liable to go back to an employer and could
be an element to discourage testing and treatment, he noted.

He also said health-care providers should tell patients to have an HIV
test if they've been sexually active in the last four to five decades.

"Because the small number of people with HIV that are not aware of
their HIV infection are the ones that are most prolific HIV
transmitters, because they don't know," he said.

"My government bought into it [treatment as prevention] because of the
return on investment that all of this represents... if you consider
that one infection costs you anywhere between $250,000 and $500,000
over a lifetime you're laughing all the way to the bank," Dr. Montaner said.

Still, Dr. Montaner said Insite has been an important component.

"Only when the province made an effort to facilitate access to
treatment to people with otherwise disorganized lifestyles because of
drug abuse, etc., we saw a decrease in the new diagnoses among these
people in the order of 50 per cent," explained Dr. Montaner.

"What we learned here was the more you treat, the more you prevent.
The faster you roll out the program, the greater the impact."

Mr. Myres said he doesn't see an Insite-type program as being on the
horizon for Saskatchewan, but "we're certainly looking at some other
things we've seen elsewhere that have good value."

A dramatic drop in the number of new HIV infections in British
Columbia shows that a treatment-as-prevention strategy is making a
difference, says a leading AIDS investigator who is frustrated that
other parts of the country haven't embraced the concept to the same extent.

"The truth is that there is no reason why we should be seeing a steady
decrease in HIV new cases in British Columbia and we should not expect
to see the same thing in the rest of the country," said Dr. Julio
Montaner, director of the British Columbia Centre for Excellence in HIV-AIDS.

Saskatchewan, in particular, has been struggling with an incremental
increase in new cases almost every year since 2004.

In British Columbia, the number of deaths from AIDS since 2005 has
steadily declined to 55 in 2010, while the number of people receiving
HIV antiretroviral treatment has risen.

New HIV diagnoses fell to a low of 301 in 2010 even as testing for the
virus increased, said Dr. Montaner as he revealed previously
unpublished figures. In 1996, there were more than 700 new diagnoses
and throughout the early 2000s, the number of new HIV diagnoses each
year was above 400.

Dr. Montaner is a strong proponent of a treatment-as-prevention model
that involves seeking out people at risk for HIV infection, treating
those who are infected with antiretroviral drugs, keeping them on
treatment and supporting them.

Treatment reduces the amount of virus in the bodily fluids of someone
with HIV infection. A clinical trial of 1,763 couples in which one
partner had a known HIV infection showed that antiretroviral therapy
reduced the risk of heterosexual transmission by 96 per cent. The
findings of the HPTN 052 trial, led by a North Carolina researcher,
were reported in the New England Journal of Medicine in August.

Because of the trial's profound implications for the future response
to the AIDS epidemic, the magazine Science recently named it the
breakthrough of the year for 2011.

Dr. Montaner said this made-in-Canada strategy now has been formally
adopted by China, which has requested support to implement it, and the
United States has said treatment as prevention will become a pillar of
its international program.

His New Year's resolution, he said, is to make it clear to the rest of
Canada that "we are missing the boat."

"Hello, the rest of the world is running behind it. Science magazine
is calling it breakthrough of the year. British Columbia has been
leading the charge now for what, five years going onto six and we
in Canada, we're happy to just walk away and say that nothing
happened. This is the biggest disappointment of the last decade," he
said in an interview.

The Public Health Agency of Canada said Tuesday that no one was
available for an interview on the subject.

In Saskatchewan, Jim Myres, director of disease prevention at the
Population Health Branch, said there is no question that HIV infection
has been an issue in his province, but a four-year strategy and "an
aggressive campaign" is underway.

"We're not calling it seek and treat, but essentially that's what
we're doing. We're actually going on reserve with an ID [infectious
diseases] clinic and trying to get people to do the tests," he said.
"We're actually seeing a bit of the numbers decline in our big urban
centres, and the numbers out in the rural areas increasing as we
implement this strategy."

In 2009, there were 200 new cases of HIV in Saskatchewan and the
figure dropped to 2010 to 172, he said. It's expected to rise for 2011
because of new efforts to go out and find cases.

"We've actually had chiefs come to us and say 'We want you to come on
reserve and do an HIV ID clinic.' I don't think that's done anywhere
else in Canada."