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Treating Social Determinants Of Health Can Help End HIV/AIDS

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By Dr. Julio Montaner, OC, OBC, MD, FRCPC, FCCP, Director of the BC Centre for Excellence in HIV/AIDS

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Picture this scenario: An individual living with HIV in British Columbia, "Doug" (whose name has been changed for privacy), was being "shuffled around" through care. As a result, he had grown tired and had mostly given up on treating his HIV. Sadly, he had begun telling family and friends that he wouldn't be around much longer. Can you see a solution to a situation like this?

There was an answer for Doug. An outreach worker, with the province of B.C.'s STOP® Program (Seek and Treat for Optimal Prevention of HIV/AIDS), knocked on his door and started to connect him to services to help support his medical adherence.

Doug needed to have a regular health care provider, and the outreach worker set him up with one. Beyond that, he needed the supports to help him stay consistent with care. He was placed in supportive housing, as well as in an integrative care program where he could develop his interests in music. Eventually, Doug (an electrician by trade who plays and builds musical instruments) became healthy, fully adherent to HIV medications and achieved an undetectable viral load.

In Canada, it's time to be a national leader on ending AIDS globally.

Stories like Doug's are very personal and individual victories; however, they show the changes that can take place when addressing systemic social and economic barriers. B.C.'s STOP® Program, based on principles of the Treatment as Prevention® (TasP) strategy developed at the B.C. Centre for Excellence in HIV/AIDS (BC-CfE), acknowledges the importance of addressing social and economic inequities -- termed social determinants of health. The STOP® Program aims to expand and offer access to HIV testing, care and treatment for medically eligible B.C. residents, particularly for populations experiencing difficulties in accessing traditional services.

The concept behind STOP® is to immediately offer universal HIV treatment to those diagnosed with the disease. This TasP® approach has led to improved health outcomes and to a consistent drop in new HIV cases in B.C.. Once on sustained and consistent treatment, an individual's viral load declines making it highly unlikely they will transmit the virus. B.C. is the only province to implement TasP® and the only one to see a consistent drop in new HIV cases. Globally, the United Nations has adopted a plan to end AIDS by 2030 that is based on principles of TasP®. Organizations like the Global Fund are on board with this plan to #EndItForGood and make the next generation AIDS-free.

In B.C., through TasP® and STOP® we have seen successes like Doug's. We have seen people living with HIV who use injection drugs, a population some doubted could maintain consistent treatment, achieve improved health and see significant reductions in HIV transmission. (In B.C., through consistent access to HIV treatment, the number of people who inject drugs who achieved an undetectable viral load increased from 30 per cent in 2006 to 71 per cent in 2012.)

How does the STOP® program work? It all starts with using resources to build more pathways to care and treatment. Even in a largely resource-rich nation like Canada, mental health, addiction, homelessness and poverty can present obstacles to this goal.

Across the province, members of multi-disciplinary, collaborative outreach teams under the STOP® program -- which can include nurses, outreach workers, social workers and others -- serve the most vulnerable populations. Clients may have suffered trauma and lack trust in traditional health care systems. For example, people who inject drugs and sex workers may feel stigmatized or discriminated against within the health care setting.

Many clients are confronting an intersection of challenges: They may simultaneously be facing addiction and homelessness problems, while dealing with access to HIV treatment and care. Individuals living with HIV may also have mental health disorders, like depression or anxiety, leaving them unable to take the steps towards self-care. According to previous research, individuals living with HIV are two to ten times more likely to have at least one mental health condition, in comparison to the general population.

Despite such challenges, the STOP® program, conducted through B.C.'s health authorities has made headway in the fight against HIV/AIDS: After initial success as a pilot program in Vancouver and Prince George, STOP® was expanded provincially along with a $19.9 million investment from the provincial government. In September, Northern Health, a B.C. health authority providing health services to 300,000 people over an area of 600,000 square kilometers, awarded $1.59 million to eight agencies and 23 First Nations communities as part of the provincial STOP® initiative.

Success stories from STOP® show how effectively addressing underlying social, economic or other needs can lead to improved HIV treatment outcomes. Sometimes it takes a caring visit, a knock on the door. Sometimes it takes repeated visits, food vouchers, or access to housing.

Globally, the Canadian government has endorsed the UN's plan to end AIDS by 2030. This year, Prime Minister Justin Trudeau boosted Canada's pledge to the Global Fund by 20 per cent, in a commitment to globally end AIDS, TB and Malaria for good. The BC-CfE is proud the Canadian federal government has made such commitments. It is important to invest in change so that barriers to care can be even across resource-limited settings.

In Canada, it's time to be a national leader on ending AIDS globally. We have the tools and strategies to provide treatment to all those living with HIV -- the province of B.C. has the successes to prove it. A nationwide Treatment as Prevention is a way forward, and we must continue to open doors to care and treatment for society's most vulnerable. Together, we can stop HIV/AIDS.

Dr. Julio Montaner is the Director of the British Columbia Centre for Excellence in HIV/AIDS (BC-CfE), the Chair in AIDS Research and Head of Division of AIDS in the Faculty of Medicine at UBC, and the Past-President of the International AIDS Society (IAS).

This blog is part of the blog series: AIDS, TB and Malaria: It's High Time for Us to End It. For Good by the Interagency Coalition on AIDS and Development (ICAD) in recognition of The Global Fund's Fifth Replenishment. The blog series features a selection of blogs written by our member and partner organizations. Contributors share their broad range of perspectives and insight on the work of The Global Fund and the opportunity that this moment presents us one year following the inauguration of the global Sustainable Development Goals (SDGs).

Disclaimer: The views and opinions expressed in this blog series are those of the authors and do not necessarily reflect those of ICAD.

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