The Globe and Mail reported this week that B.C. is leading the way in HIV prevention with its treatment as prevention work. While I certainly support of everyone getting appropriate, self-determined HIV care, framing treatment as prevention diverts attention from structural drivers of the epidemic and focuses on biomedical solutions to issues that are social, medical and legal. The MSMGF just published a New Study Shows Structural Factors Play Major Role in Access to HIV Services for Gay Men Worldwide. They found “homophobia, comfort with service provider, and community engagement make significant impact on access to condoms, lubricant, HIV testing, and HIV treatment.”
BC has done a great job of making treatment available across the province, and that should be celebrated at the same time as the really great work being done by harm reduction efforts such as InSite. Insite both provides direct services (supervised injection) that reduce potential for HIV transmission and gives people access to a continuum of services, including a stable network of people and programs willing to support their holistic health, including connection to food, shelter, employment, addictions treatment, and other basic services. InSite is both a medical intervention and a program that recognizes the contexts in which HIV transmission happens.
Further, while gains in treatment in BC are being celebrated amongst some sectors, the current government continues to deny developing countries more accessible treatment by voting against (or, not showing up to vote, as in the case of Justin Trudeau) Bill-C398.
Treatment alone will not solve the epidemic: we need a world that does not put people in vulnerable situations in the first place and where it is okay to ask questions about sex, to access condoms and lube, and where people living with HIV are engaged in prevention work, both as leaders and as the audience.
Dr. Barry Adam of the Ontario HIV Treatment Network responded to the Globe’s piece via a very excellent letter to the editor, excerpted here:
The fall in B.C. rates can be attributed almost exclusively to a decline in HIV diagnoses among injection-drug users. Attributing that decline to antiretroviral therapy is dubious, given the role of supervised injection sites, aggressive needle-exchange programs and other prevention outreach directed toward drug users in B.C. in the early 2000s. – Barry Adam