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B.C. doctors call for free HIV drugs

Giving out antiretrovirals cuts new infections

Researchers in British Columbia are calling for a national strategy to provide free access to HIV treatment after publishing a study that indicates universal antiretroviral drug coverage dramatically cuts new infections.

A team of researchers at the B.C. Centre for Excellence in HIV-AIDS examined rates of new HIV infections in B.C., Ontario and Quebec for more than a decade, and compared them with the number of patients on antiretroviral treatment.

The lowest rate of new infection was in British Columbia, where free access has meant that nearly half of all HIV patients are on a treatment known as highly active antiretroviral therapy.

What’s more, the study found a 10 per cent increase in the number of patients on the therapy led to an eight per cent decrease in new infections. That’s because patients on antiretroviral drugs are far less likely to transmit HIV through unprotected sex, needles and even between a pregnant mother and her fetus.

But researcher Dr. Julio Montaner says provinces that don’t offer fully subsidized access to the drugs, instead requiring deductibles and co-payments, have fewer patients taking the medication and, consequently, more infections.

He notes a disproportionate number of HIV patients are homeless or suffer from drug addiction or mental illness, increasing the need to ensure treatment is easy to access.

“Many people infected by HIV have many challenges to be concerned about, whether it’s homelessness or mental health or addiction or isolation,” Montaner said in an interview Tuesday.

“They have competing, urgent priorities that make it impossible for them to address their HIV.”

Montaner has long advocated a strategy known as treatment-as-prevention, pointing to data that shows treatment not only improves the lives of patients and prevents new infections, but also saves governments money in health-care costs. He also wants governments to ensure more people are routinely tested for HIV, since as many as 25 per cent of patients don’t even know they are infected.

He published a study two years ago that concluded increasing the proportion of HIV patients in B.C. taking antiretroviral drugs to 75 per cent, from about half right now, would save the province nearly $1 billion during the next 30 years.

While health-care is a provincial issue, Montaner said Ottawa should press for a national strategy. He said expanding free coverage across the country should be a no-brainer for governments looking to keep health spending under control.

“Once you understand that (antiretroviral treatment) also prevents transmission, that makes the treatment not only cost-effective, but cost-averting; in other words, it saves you money,” said Montaner.

“Unfortunately, the federal government has shown no appetite whatsoever to have a serious discussion regarding this issue, so we continue to generate data that is illustrating how an incredibly huge missed opportunity this strategy represents.”

An estimated 3,300 Canadians are diagnosed with HIV every year, though Montaner said that number could double in the next 10 to 15 years if treatment isn’t increased.

Federal Health Minister Leona Aglukkaq wasn’t available for an interview, but in a written statement, she defended her government’s response to the HIV-AIDS epidemic.

Aglukkaq’s statement said the federal government does have an HIV-AIDS strategy, which includes spending $90 million a year on research, prevention and patient support programs.

However, Aglukkaq said it’s not the federal government’s responsibility to decide which drugs are paid for by the public system.

“When it comes to deciding which drugs will be covered by health plans, clearly that is a provincial and territorial government decision,”

Dr. Perry Kendall, B.C.’s provincial health officer, said his province is looking for ways to ensure more patients are treated. Three years ago, B.C. committed $48 million for a four-year program to test and treat hard-to-reach patients, such as injection drug users in Vancouver’s Downtown Eastside.

Kendall urged other province’s to follow B.C.’s lead by taking the long view when it comes to the costs associated with treating HIV, though he said any progress appears unlikely to be driven by the federal government.

“It is a significant upfront investment to offer treatment to many more people, especially when your budgets are under constraint,” he said.

“I think (expanding free HIV drug coverage) would make a lot of sense. This particular federal government, I think, is more of the mind that health-care delivery is a provincial and territorial matter, so they’ve been less willing to step into a leadership position on a number of files.”

—James Keller

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