In the week leading up to Vancouver Pride, the largest gay pride event in Western Canada, it should be a time of celebration for the LGBT community, especially in a jurisdiction that has gone to great lengths claiming to be a world leader on HIV/AIDS research. A recent report of the Provincial Health Officer (PHO), reveals that over the past decade new cases of HIV are on the rise amongst gay, bisexual and men who sleep with men (MSM), and today, anti-retroviral drugs to reduce new HIV infection rates isn’t even part of the long-term strategy.
Premier Christy Clark was pleased to recently announce the AIDS epidemic is now over in British Columbia, and confirmed the AIDS ward at St. Paul’s Hospital in downtown Vancouver would be repurposed for other uses.
Awkwardly, just weeks later, the annual report released by the PMO, states new cases of HIV are on the rise in the gay target segment. Furthermore, out of all the recommendations outlined in the PHO’s report, the use of anti-retroviral drugs isn’t even mentioned as a key strategy in reducing new cases of HIV in British Columbia.
Anti-retroviral drugs have been proven to reduce the risk of HIV by up to 99%; it’s called pre exposure prophylaxis (PrEP), and it has been approved in the United States for over two years, and additionally endorsed by both the Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO).
In fairness and with full disclosure, the use of PrEP for approved in Canada requires the drug manufacture to submit an application to Health Canada for review. At this point, it is not known if a recent application has been made, but according to Positive Living BC, no known applications have been submitted to date. However; PrEP, under the brand name Truvada, is available off-label in Canada, and can be prescribed, under extremely rare circumstances, by doctors for high-risk patients. These high risk patients, primarily those who are sex workers or have partners who are HIV positive, must agree to HIV testing every three months and undergo regular kidney and liver tests. Other potential risks may include reduction in bone density over long-term periods of use in some patients.
While anti-retroviral drugs are technically available to all Canadians, British Columbia does not have a formulated strategy in how to handle PrEP, therefore anyone who is HIV negative, at high risk, and who wants to be on the preventative medication, doesn’t have a clear method to access preventative treatment. Unfortunately the health care system in British Columbia is so segments and uncoordinated that it is not as simple as going to your family doctor.
In order to quickly reduce the rate of new HIV infections in Canada there is an urgent need for both policy to be developed and lobbying of the drug manufacturers to get PeRP approved for wide spread use in Canada.
In British Columbia, key stakeholders including the Ministry of Health, BC Centre for Excellence in HIV/AIDS, AIDS Vancouver, Positive Living BC, nPEP, Spectrum Health, the Health Initiative for Men, STOP HIV, and other key organizations need to come together quickly to provide people who want preventative medication, access to the medication quickly and easily. Again, this includes the formulation of a strategy and lobbying of drug manufactures like Gilead Sciences, the manufactures of Truvada, to get the use of the drug approved by Health Canada.
“For years, governments have refused to take specific actions to target specific segments, taking a one-size-fits-all approach,” said Spencer Chandra Herbert, MLA Vancouver-West End. “Less than ten per cent of the budget from the Canadian Institute for Health is targeted for HIV health, when we are a population that takes more than 50 per cent of HIV cases. This is not helping those that truly need prevention. It’s staggering.”
While there are other segments within British Columbia where new infection rates are on the decrease, it doesn’t address the steady or increase in new HIV infections amongst gay men.
“Some would say its because of homophobia, or ignorance, or not paying attention,” stated Spencer. “There has been a focus on areas like the downtown east side and intravenous drug users, to use the stop analysis on those areas. It’s not focused on gay, bisexual, or men-who-sleep-with-men. Every time a new report comes out, with gay men, specifically young gay men, infection rates are increasing. It’s wrong. Targeting efforts have been proven. When you target a community specifically, you’ll have greater success, rather than a one-size-fits-all approach.”
While Spencer is pleased to see recommendations from the PHO, much work still needs to be done and he hopes government stops to listen to the medical, gay, lesbian, transsexual, and bisexual communities.
“We have long called for, and why BC continues to be a leader, because back in the 1990’s the government made it a priority, but the shift has comes off the gay male population,” said Spencer, explaining the BC NDP’s position on the use of PrEP to ensure that all British Columbian’s have access to anti-retroviral drugs as a preventative method for HIV risk reduction. “We have the cocktail and various drug combinations that can make it an illness and not a death sentence. Yes, we’ve made great strides in many aspects, but it is still preventable and needs to be top priority.”
At the time of this article being written, Premier Christy Clark’s office and the Ministry of Health both deferred questions to Dr. Montaner at the BC Centre for Excellence in HIV/AIDS, who is currently attending the World AIDS Conference in Australia. At the conference, PrEP has become a key area of focus and studies have shown that no one who has taken PrEP four times per week has been infected with HIV. It was also noted that demand for PrEP was strong in this large cohort of MSM/TGW, indicating a high degree of acceptability for PrEP in this population when it is offered free of charge.
As it stands today, both government and medical communities in British Columbia feel it is acceptable for more new infections of HIV to occur while they continue to put priority and focus on research to find a cure and treat people who are living with HIV. It is true that today in British Columbia, it is easier to get access to doctors and medication if you are infected with HIV, than for someone who is HIV negative and wishes to protect him or herself through the use of proven anti-retroviral drug treatments. It should not be acceptable for access to medication to be given only after an exposure, especially when preventative treatments are available and endorsed by other jurisdictions and leading health organizations around the world.