"WE DON'T like the word mandatory for anything; it only drives people underground. It is important to normalize HIV testing, so that it can be widely offered in an atmosphere where people can be protected against stigma," said Dr. Julio Montaner, professor of Medicine at the University of British Columbia and director of the BC Centre for Excellence in HIV/AIDS.
It was a week of both good news and bad news, according to Dr. Julio Montaner, professor of Medicine at the University of British Columbia and director of the BC Centre for Excellence in HIV/AIDS.
The good news was that Montaner was named one of the 2011 Hope Is A Vaccine award winners by the Providence-based GAIA Vaccine Foundation; the bad news was that the Global Fund to Fight HIV, Tuberculosis and Malaria cancelled its next round of funding after donor countries failed to deliver some $2.2 billion in previously committed funds.
In the developing world, treatment for 70 percent of HIV patients is financed by the Global Fund, and for Montaner, a forceful worldwide advocate for the concept of “Treatment as Prevention,” the decision to cut funding was seen by him as “criminal negligence.”
Providence Business News spoke with Montaner from his offices in Vancouver, B.C., as he discussed the future challenges facing HIV/AIDS treatment.
PBN: Were you surprised by the Hope Is A Vaccine award? Had you ever worked with Dr. Annie DeGroot before?
MONTANER: This is the first I’ve heard of Dr. DeGroot. The award is a great honor. It honors the work that we have done in promoting the use of anti-retroviral therapy, which, when you treat a person infected with HIV, you pretty much decrease the likelihood of transmission by greater than 96 percent. This could be the answer to the spread of the AIDS epidemic.
PBN: How has the concept of “treatment of prevention” emerged from theory into practice?
MONTANER: In our work here in British Columbia, we were able to show that using the anti-retroviral treatment as prevention created a reciprocal relationship between HIV-infected patients and AIDS patients – the more you HIV patients you treat, the less diagnoses of AIDS you see. As a result, there has been a plateau of new infections.
The same results were replicated with [a population of] drug users.”
Our treatment as prevention findings have been replicated in Baltimore in a study by Johns Hopkins, in San Francisco, in Lancet [a British scientific journal].
The final piece of evidence came this summer, in the results of a randomized controlled study in Africa and India. They found that they were able to decrease HIV transmission by 96.3 percent. [Using anti-retroviral therapy] to treat more people with HIV infections is most effective treatment of HIV and AIDS. It’s the best tool in our toolkit.
It’s most important to use this treatment as a way to prevent HIV transmission from mothers to children.
PBN: Moving forward, how important is it to make HIV testing more universal?
MONTANER: We don’t like the word mandatory for anything; it only drives people underground. It is important to normalize HIV testing, so that it can be widely offered in an atmosphere where people can be protected against stigma. Then, by making anti-retroviral medications available for free, it will remove barriers for access to treatment. It is highly cost-effective because it is highly cost-averting.
PBN: What are the next steps to move forward?
MONTANER: Now, for the bad news. As much as there is global support for universal access to treatment, we are faced with a decision about a week ago to pull the plug on the Global Fund, threatening the good news that we have.
Further investments in HIV treatment [with anti-retrovirals] can change the history of the AIDS epidemic. To cut the funding is actually criminal negligence, in my opinion. What is needed is restore the funding.
We can truly stop the HIV epidemic, and we’re walking away. This is abandoning not just the people infected with HIV. [In some developing countries], 30 percent of the community is infected, but you’re abandoning the whole of it. Communities will crumble of because of the perverse penetration of HIV in the entire community.
This was the first year we were beginning to see a downward trend in new cases worldwide; we were beginning to see the beginning of the end. Now, we’re walking away from it. It would take a fraction [of resources] to do the right thing.
PBN: What can be done to change that decision? How can the public or the business community make a difference?
MONTANER: Yes, there are limited resources. Yes, of course, there is a need for public education. The best public education would be to make the politicians accountable. To send a clear signal that restoring these funds is non-negotiable.
There was a commitment to fund the Global Fund, with a pledge of universal access that has been restated every year, including again in June. It’s not just a compassionate pledge. It is a game-changer.
We can change the course of the worldwide AIDS epidemic. We shouldn’t even be having a discussion about it. This is the only means to change the direction of the epidemic, in the absence of a cure or a vaccine.
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