World AIDS Day is December 1
Universal HIV testing could be a key to halting the spread of the disease
Have you received your regular health checkup, and did it include an HIV test?
Scientists are telling us we need to change how we think about HIV. If we don’t, thousands of cases could remain undiagnosed and untreated. About one-quarter of Canadians living with HIV are unaware of their HIV-positive status, reinforcing the need for a paradigm shift in our national approach to testing.
Routine, universal HIV testing could be a key to halting the spread of the disease. Diagnosing HIV early in the course of infection is important. Early initiation of highly effective antiretroviral therapy (ART) reduces the risk of illness, promotes longevity and significantly reduces onward HIV transmission. Today, a person living with HIV on sustained treatment can have a life expectancy approaching that of the general population.
A recent study from the B.C. Centre for Excellence in HIV/AIDS (BC-CfE), published in the Journal of the International AIDS Society, found that 48 per cent of participants initiating ART between 2000 and 2012 already had a weakened immune system.
Delaying treatment costs lives and money. Direct health care costs in the year following HIV diagnosis can be in excess of 200 per cent higher for patients with weakened immune systems.
Stereotypical assumptions about who is at risk of acquiring HIV could hinder efforts to combat the disease. Over the last 15 years, there has been a significant and notable incidence escalation among Canadian women. Females accounted for 24 per cent of new HIV-positive diagnoses among adults in 2011 – double the proportion observed between 1985 and 1998.
A growing body of research also shows women and older adults are among those more likely to initiate treatment late. This supports a previous Canada-wide BC-CfE study that found that young adults had relatively high rates of late ART initiation, and were less likely than older adults to be retained in HIV care and achieve viral suppression.
In addition to helping to get those who need HIV treatment into care, universal HIV testing could reduce stigma and stereotypes through normalizing the testing process. By reframing HIV testing as a routine part of health care, misconceptions could be eliminated and barriers reduced.
While testing is a key component in the response to HIV, treatment must also be provided. Treatment as Prevention (TasP), the provision of full and universal access to antiretroviral therapy following an HIV diagnosis, will allow us to work toward a goal of ending AIDS by 2030.
The Canadian government has not formally endorsed TasP domestically, although it is now the globally-recognized standard of care. During the recent federal election campaign, now-Prime Minister Justin Trudeau endorsed the UNAIDS 90-90-90 target to end AIDS by 2030. The goals, based on principles of TasP, include diagnosing 90 per cent of all those living with HIV/AIDS. Once diagnosed, 90 per cent must have access to treatment and 90 per cent of those on treatment must reach viral suppression by 2020. Then we will have set the pace to reach an AIDS-free generation.
B.C. is the only Canadian province to implement the lifesaving TasP strategy. B.C. is also the only province to implement a universal testing approach. And it is the only province to see a consistent decline in new HIV cases.
Internationally, TasP has been adopted by China, France, Spain, Panama, Brazil and Sierra Leone, plus several major U.S. cities — among others. Even Pope Francis has endorsed the strategy as an important tool in the global fight against HIV.
If we are to reach an AIDS-free generation in Canada, the federal, provincial and territorial governments must invest in greatly expanding access to testing and treatment. We need a national strategy to end AIDS that includes a testing approach not limited to those considered at risk of acquiring HIV.
Of course, there are important factors to be considered if universal testing is expanded across Canada. First and foremost, patient-informed consent must remain central to the testing process.
The benefits of universal HIV testing are clear. A shift in practice could change outdated misconceptions around HIV. And it could dramatically alter the course of this devastating disease.
So, have you been tested?
By Julio Montaner
Julio Montaner is the director of the British Columbia Centre for Excellence in HIV/AIDS. World AIDS Day is on December 1.