Pubdate: Sat, 18 Jul 2015
Source: Victoria Times-Colonist (CN BC)
Copyright: 2015 Times Colonist
Contact: http://www2.canada.com/victoriatimescolonist/letters.html
Website: http://www.timescolonist.com/
Details: http://www.mapinc.org/media/481
Author: Katherine Dedyna
Page: D6

OTTAWA SHUNNING B.C. LEAD ON AIDS

B.C.'s successful policies for fighting HIV/AIDs are increasingly
being adopted by other countries, but not by the Canadian government,
says the director for the B.C. Centre for Excellence in HIV/AIDS.

Dr. Julio Montaner credits "unwavering support" by the B.C. Ministry
of Health in seeing the provincial infection rate drop far below the
national average. But he said that even as a special AIDS adviser to
the United Nations, he can't get Ottawa to adopt the strategies that
made it happen.

A federal spokesman responded that the government supports the
principles of B.C.'s plan, but that health care is primarily a
provincial responsibility.

The UNAIDS 90-90-90 treatment targets - referring to the percentage of
HIV cases diagnosed, treated and achieving no virus in the bloodstream
- - are aimed at rendering HIV/AIDS "a sporadic disease by 2030,"
according to the centre.

They are based on B.C.'s Treatment as Prevention policy, which seeks
to ensure 90 per cent of HIV cases are diagnosed by 2020; 90 per cent
of patients have access to free, high-quality treatment; and at least
90 per cent of patients are virally suppressed by 2020.

Panama adopted 90-90-90 on June 29. China, France, Brazil, Spain,
Argentina, Swaziland and U.S. have already adopted Treatment as
Prevention, the centre notes, and San Francisco, New York City and
Washington, D.C., have also signed on.

Montaner, a professor of medicine, helped pioneered HAART - Highly
Active Antiretroviral Therapy - which costs $15,000 per patient
annually but is provided free of charge to B.C. patients at a cost of
$100 million per year.

He said that Ottawa has allowed the standard of care for testing and
treatment to vary widely across the country. "Furthermore, they have
allowed some provinces to charge HIV-infected patients for co-payments
to access therapy, which is a proven barrier to treatment." B.C.'s
policy is to diagnose and treat HIV without charge to stop
transmission.

"In the event of a major catastrophe that affects the whole country,
you expect the feds to take a leadership position," Montaner said. "In
HIV/AIDS, they have been missing in action. This is despite the fact
that the epidemic is disproportionately affecting First Nations in
Canada, an area of their direct responsibility."

Eric Morrisette of Health Canada said that decisions on HIV/AIDS
strategy are "most appropriately based" on each province or
territory's unique pattern of disease, but that Ottawa will continue
to examine and share emerging evidence on promising
interventions.

In Saskatchewan, Ottawa provided technical support to help investigate
the way HIV/AIDS is spreading, Morrisette said.

Montaner calls on Ottawa to enact a national policy, which in turn
would set the standards of care.

"If this was anything but HIV and AIDS, they would be all over this
strategy," he said, calling the fallback on health as a provincial
jurisdiction "BS."

"When SARS came out, the PM was all over the place," he said. "There
were no cases of Ebola, but Ottawa had a national strategy.

"So I want to ask Mr. Harper, why doesn't he go on prime-time
television and take the test for HIV to show the public that we should
all be tested for HIV?"

Instead, the federal government views injection-drug users and sex
workers as enablers of the epidemic instead of people caught in an
urgent public health issue across Canada, he said. Ottawa is
"interfering with our ability to engage the most vulnerable people
because they are so focused on their pursuit of their law and order
agenda," he said.

"I want a standard of care to be set," he said.

B.C.'s work has shown that more money invested up front saves money in
a reasonable amount of time, Montaner said.

A person whose HIV becomes full-blown AIDS can incur up to $750,000 in
care costs over a lifetime, but early treatment, at $15,000 a year,
can grant that person a productive lifetime and prevent transmission.
"And when you eliminate new infections, the return on investment grows
exponentially."

He can't tell Ottawa what to do with its money, but he asks why there
are national strategies for flu and SARS and not for HIV.

"Why are they picking and choosing their winners?"

If Ottawa officially supported 90-90-90, would it mean automatic
enforcement by all provinces.

"We will cross that bridge when we have to," Montaner said. "But the
fact that there is no federal leadership makes it even more difficult
to have the conversation across the land."

He said he has met with two provincial ministers of health other than
B.C.'s Terry Lake, but it's a national epidemic that requires national
leadership, he said.

"Imagine tomorrow we have Ebola outbreaks in seven cities across
Canada," Montaner said. "Would the feds say it is provincial
responsibility? Even if they were not to pay for it, they would set
the standard by which everyone would be expected to control the outbreak."

Morrisette said that Health Canada has been "working very closely"
with Saskatchewan, where the majority of new cases are among
aboriginal people.

Montaner cited several ways that he said illustrate that Ottawa is
interfering with public health efforts.

"They are using procedural steps to stop supervised injecting
facilities from opening and discouraging harm-reduction initiatives
across the country. They are going out of their way to criminalize
commercial sex workers or their patrons, and in doing so making it
harder for us to bring services to these communities.

"They have failed to pass legislation to protect against stigma and
discrimination of key affected populations and those infected with
HIV. They withdraw services from immigrants which are
disproportionately at risk or affected. They have failed to pass
legislation to ensure that trivial [non-infectious] exposure to HIV is
not criminalized."

"At the international level, they have failed to embrace the
made-in-B.C. Treatment as Prevention strategy that has now become the
standard of care around the world."

Following the Panama sign-on, Montaner said he has yet to make contact
with federal Health Minister Rona Ambrose or her representatives
regarding the strategy.

Montaner said he believes that Conservative politicians are
sacrificing public health to social prejudices.

"They view the work that we do as facilitating or promoting conduct
that they feel are responsible for the epidemic," he said.

Prevention strategies for men having sex with men, commercial sex
workers and injection-drug users - such as Vancouver's Insite that
battles strong Conservative opposition - are necessary to reduce the
risks of transmission, he said. But all adults need to be tested for
HIV because up to 20 per cent of people do not know they have it and
can transmit it, he said.

"B.C. had the worst epidemic in the country in the 1980s and '90s and
since then, today we are happy to report that we are way below the
average," Montaner said.

"I have literally written a letter since 2006 to the [federal]
minister of health once a year where I outline the progress that we
have made (in B.C.) and requesting a conversation with them regarding
these issues," Montaner said. "And to be honest with you, this has not
happened."

Morrisette responded that Canada's chief public health officer has met
with Montaner and his team several times and facilitated presentations
to the Council of Chief Medical Officers of Health.

Victoria MLA Murray Rankin, NDP Opposition health critic, called on
Ottawa to go further.

"I would urge the federal government to adopt this ambitious strategy
and work with the provinces to do all we can to prevent and treat
HIV/AIDS," Rankin said in a statement.

Morrisette said that the Canadian government supports the principles
of the Treatment as Prevention approach, which include improved access
to testing, treatment and support, as well as continuity of care.

"We are following with interest the implementation of the Treatment as
Prevention approach in British Columbia." Montaner disagreed.

Ottawa is not on side in principle, despite official statements to
that effect, he said.

"Ottawa sits on the side. They don't make any commitment and they are
not accountable."

Ottawa told him it would not send a representative to the formal
endorsement of 90-90-90 by the UN secretary general last Sept. 25, but
noted it would not object.

"[U.S. Secretary of State] John Kerry himself stood up to formally
endorse the proposal on behalf of the United States, and it was
endorsed immediately after by President [Jacob] Zuma of South Africa,"
Montaner said.

In December 2014, Morrisette said, a representative of Foreign
Affairs, Trade and Development Canada attended the UNAIDS Program
Co-ordinating Board meeting and endorsed the principles behind the
90-90-90 global treatment targets.

Ottawa's public health agency is exploring "the potential work to
develop national indicators and methods," he said.
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MAP posted-by: Matt