A renowned local researcher says scaling up British Columbia\u2019s HIV strategy could help end the global AIDS pandemic by 2030.<\/p>\n
Otherwise, U.S. cuts to foreign aid programs could create 6.6 million new HIV infections and four million additional AIDS-related deaths around the world by 2030, according to the United Nations AIDS program, known as UNAIDS.<\/p>\n
Developing and impoverished countries around the world have, until recent cuts, depended on U.S. funds for HIV testing, treatment and prevention.<\/p>\n
\u201cUNAIDS ran a questionnaire for the main countries affected by HIV to try and understand how weak their stocks of antiviral therapy, HIV prevention and HIV testing were,\u201d said Dr. Julio Montaner.<\/p>\n
\u201cAll will run out by the end of the summer,\u201d he said.<\/p>\n
Montaner is the executive director and physician-in-chief of the BC Centre for Excellence in HIV\/AIDS and the head of the HIV\/AIDS Program at St. Paul\u2019s Hospital in Vancouver.<\/p>\n
While U.S. funding cuts have created a crisis, they have also created an opportunity for Canada to step up as a global leader in the fight against HIV, Montaner said.<\/p>\n
To do this, he said, Canada must double its HIV funding, scale up B.C.\u2019s HIV strategy to a national level, and decriminalize HIV.<\/p>\n
Doubling Canada\u2019s HIV funding<\/p>\n
Doubling Canada\u2019s HIV funding will encourage other wealthy countries to do the same and help cover the \u201c50 to more than 60 per cent\u201d loss in funding for health programs caused by U.S. cuts, Montaner said.<\/p>\n
\u201cEither we pay now or we pay later,\u201d he said. \u201cAnd if we pay later it\u2019s going to cost more \u2014 not just in money, but in death and instability. AIDS will devastate economies and it will generate more conflict.\u201d<\/p>\n
In an email to The Tyee, Health Canada said that in 2024-25 the federal government invested $99.5 million in ongoing annual funding to address sexually transmitted diseases and blood-borne infections in Canada.<\/p>\n
Health care is generally the jurisdiction of provincial and territorial governments, but multiple layers of government and community organizations work collectively to address sexually transmitted diseases and blood-borne infections.<\/p>\n
The federal government also spends $26.4 million annually to support short-term projects through its HIV and Hepatitis C Community Action Fund and $7 million annually through its Harm Reduction Fund to help reduce HIV and hepatitis C among people who use drugs, the Health Canada email said.<\/p>\n
Internationally, Canada is a founding donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the email said, and has given $4.9 billion since its inception in 2002. Health Canada said the global fund provided 28 per cent of \u201call international financing for HIV programs,\u201d and that discussions \u201care ongoing\u201d for how much Canada will contribute this year.<\/p>\n
How BC\u2019s strategy was built<\/p>\n
Montaner moved to Vancouver from Argentina in 1981 to do a fellowship in respiratory medicine.<\/p>\n
\u201cGay men, predominantly from the West End, were dropping like flies in the emergency department with pneumocystis pneumonia,\u201d he said. At the time, no one knew how to treat pneumocystis pneumonia or what was causing it.<\/p>\n
These men were some of Vancouver\u2019s first AIDS victims, and their care marked the beginning of Montaner\u2019s nearly 45-year-long career at the forefront of fighting the global HIV pandemic.<\/p>\n
Montaner would go on to build B.C.\u2019s HIV strategy around making treatment and prevention widely available for everyone in the province, regardless of whether or not they were covered by the Medical Services Plan, and bringing HIV treatment and prevention to highly marginalized populations instead of waiting for them to seek help.<\/p>\n
Montaner says that if Canada adopts and funds that strategy and encourages it and funds it on the global stage, it will become a global HIV leader.<\/p>\n
Montaner helped discover a way to treat and prevent the pneumonia and switched his focus to virology to work on a treatment for HIV \u2014 which he discovered in 1996.<\/p>\n
Combining AZT, ddI and NVP, or zidovudine, didanosine and nevirapine, was \u201cthe first time that you could shut down the replication of the virus. And when you did that, the immunity recovered,\u201d Montaner said. \u201cDeath after 1996 started dropping and death from AIDS was starting to be reasonably well controlled.\u201d<\/p>\n
It would be a couple of years before they realized treatment was also decreasing an infected person\u2019s viral load, which meant they weren\u2019t spreading HIV.<\/p>\n
\u201cThe more people we treated, the less infections there were,\u201d Montaner said.<\/p>\n
\u201cWhen we modelled that mathematically we found that for every one per cent increase in treatment coverage, you have a one per cent decrease in HIV incidence or new infections.\u201d<\/p>\n
Montaner could also map out what\u2019s known as an \u201cH mortgage,\u201d which shows that the faster a government worked to test and treat HIV cases in a given population, the sooner a government would start to benefit from having productive, healthy citizens rather than paying for sick, unproductive or dead citizens.<\/p>\n
It\u2019s just like paying off a mortgage, Montaner said, except the benefits have exponential growth.<\/p>\n
That\u2019s because protecting people from catching HIV today means protecting generations to come from the spread of the virus.<\/p>\n
Realizing that was \u201ca game-changer,\u201d Montaner said.<\/p>\n
Scaling up BC\u2019s approach<\/p>\n
With treatment made widely available, AIDS-related deaths dropped by two-thirds in B.C. between the mid-1990s to 1999, Montaner said.<\/p>\n
The final one-third of patients needed a little extra help because they were highly marginalized or didn\u2019t know how to navigate the health-care industry, he said.<\/p>\n
\u201cSo we brought the services to the people… and the death rate in B.C. virtually disappeared,\u201d he said.<\/p>\n
This was part of the Treatment as Prevention strategy, which Montaner helped create in 2006. It ran as a pilot project in 2008 and expanded in 2010, after which deaths related to HIV-AIDS dropped to fewer than five per year.<\/p>\n
This strategy took B.C. from having one of the highest number of HIV diagnoses in Canada in 1995 to having one of the lowest by 2023, Montaner said.<\/p>\n
Treatment as Prevention could be scaled up to end the AIDS pandemic by 2030, he said.<\/p>\n
Montaner defines ending the AIDS pandemic by \u201chaving a minimum of a 90 per cent decrease in morbidity related to AIDS, in AIDS deaths, and new HIV infections.\u201d<\/p>\n
To get there, by 2020 the world would need 90 per cent of people living with HIV to be diagnosed, 90 per cent of the diagnosed to be on antiviral treatment, and 90 per cent of those on treatment to have viral suppression, meaning they\u2019re not contagious.<\/p>\n
By 2025 those targets would need to increase to 95-95-95, he added.<\/p>\n
The target of 90-90-90 by 2020 was adopted by the federal government and the UN in 2015. In 2021, both updated their goals by adopting the target of 95-95-95 by 2025. Both targets were first proposed by the BC Centre for Excellence in HIV\/AIDS.<\/p>\n
As of 2023, around 86 per cent of people living with HIV had been diagnosed, 89 per cent of them were on treatment and 93 per cent of those on treatment weren\u2019t contagious, he said.<\/p>\n
That\u2019s a lot of progress made over the last several decades, Montaner told The Tyee.<\/p>\n
However, the fight is far from over, especially because it seems unlikely that the United States, under President Donald Trump, will be reinvesting in HIV treatment and prevention any time soon.<\/p>\n
\u201cTo have these guys, overnight, throw it all into the garbage without even realizing or acknowledging that, in doing so, they\u2019re throwing into the garbage the investments of the last 30 to 40 years,\u201d Montaner said.<\/p>\n
\u201cI think this is criminally negligent.\u201d<\/p>\n
Montaner pointed to Prime Minister Mark Carney\u2019s speech in which he said that \u201cif the United States no longer wants to lead, Canada will.\u201d<\/p>\n
Carney was speaking about trade, but it could be applied to HIV leadership too, Montaner said.<\/p>\n
Strengthening Canada\u2019s strategy; decriminalizing HIV<\/p>\n
Montaner said he\u2019s spoken with the Prime Minister’s Office about how Canada has an \u201cobligation\u201d to clean up its domestic HIV strategy if it wants to step into a global leadership role.<\/p>\n
He said the national strategy can be improved by following B.C.\u2019s lead in five areas.<\/p>\n
First, Canada needs to make medication for prevention and treatment free for anyone in the country.<\/p>\n
Second, Canada needs to enhance its genetic monitoring of HIV-AIDS to better identify clusters of cases and to tailor treatment for those clusters.<\/p>\n
Third, there needs to be a national policy for harm reduction so, for example, people can access sterile equipment to use drugs.<\/p>\n
Fourth, Canada needs to enhance social and medical support for marginalized populations, like the unhoused.<\/p>\n
And finally, Canada needs to decriminalize HIV.<\/p>\n
Legally, people are required to disclose they are HIV-positive to sexual partners. But if a person is taking treatment and their viral load is suppressed, they are not contagious, Montaner said.<\/p>\n
These laws discourage people from getting tested and fuel stigma and misinformation, he said.<\/p>\n
Acting globally will help Canada protect its citizens domestically, Montaner added.<\/p>\n
\u201cIf we don\u2019t help them, their infections are going to overwhelm us,\u201d he said.<\/p>\n
[Correction note: A previous verion of this story said Dr. Julio Montaner had spoken directly to Prime Minister Mark Carney about doubling Canada’s HIV funding. He has actually spoken to the prime minister’s office, not to Carney himself. The story was corrected Sept. 4, 2025 at 6:15 p.m. PDT.]<\/p>\n","protected":false},"excerpt":{"rendered":"A renowned local researcher says scaling up British Columbia\u2019s HIV strategy could help end the global AIDS pandemic…\n","protected":false},"author":2,"featured_media":124481,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[44323,44321,68735,49,48,18680,14428,18866,68730,17357,68738,84,5432,68741,6916,13930,1842,22059,14427,26093,2852,15020,2724,68737,68736,68733,55273,14426,1058,32674,3700,68732,62996,44326,2727,26459,68734,68739,32146,68740,44322,9962,68731],"class_list":["post-124480","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-animal-diseases","tag-animal-viral-diseases","tag-biological-globalization","tag-ca","tag-canada","tag-clinical-medicine","tag-diseases-and-disorders","tag-epidemics","tag-epidemiology-of-hiv-aids","tag-global-health","tag-harm-reduction","tag-health","tag-health-care","tag-health-economics","tag-health-policy","tag-health-sciences","tag-hiv","tag-hiv-aids","tag-human-diseases-and-disorders","tag-immunodeficiency","tag-immunology","tag-infection","tag-infectious-diseases","tag-joint-united-nations-programme-on-hiv-aids","tag-julio-montaner","tag-lentiviruses","tag-medical-humanities","tag-medical-specialties","tag-medicine","tag-microbiology","tag-pandemic","tag-pandemics","tag-pneumonia","tag-primate-diseases","tag-public-health","tag-sexual-health","tag-sexually-transmitted-diseases-and-infections","tag-sexually-transmitted-infection","tag-spare-news","tag-treatment-as-prevention","tag-viral-diseases","tag-virology","tag-zidovudine"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/124480","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/comments?post=124480"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/124480\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media\/124481"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media?parent=124480"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/categories?post=124480"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/tags?post=124480"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}