For people living with HIV and their allies, 2017 was a ground-breaking year. It culminated with both the federal and Ontario governments publicly recognizing the need to limit the over-criminalization of HIV in Canada. On World AIDS Day 2017, both acknowledged that criminal prosecution for alleged HIV non-disclosure is not warranted when a person living with HIV has a “suppressed viral load” (i.e., less than 200 copies of HIV/ml of blood) because such an individual poses no “realistic possibility” of transmitting the virus—the Supreme Court’s legal test for whether a duty to disclose exists.
It’s official! The Government of Canada supports U=U, the consensus statement that a person living with HIV does not transmit the virus sexually if they take treatment and maintain an undetectable viral load (“undetectable = untransmittable”).
The news came on November 30 in a joint statement from Canada’s chief public health officer and the chief medical officers of health of all Canadian provinces and territories.
As deaths from many communicable diseases continue to decline globally, deaths caused by viral hepatitis have now surpassed all other chronic infectious diseases, including HIV/AIDS, malaria and tuberculosis. Yet it is one of the few global health threats with easy solutions. Highly effective vaccines exist for hepatitis A and B. We now have a cure for hepatitis C. With these tools at our disposal, why aren’t we seeing an impact on the epidemic?
The hepatitis C virus (HCV) is a major public health problem. Worldwide, about 70 million people are living with hepatitis C virus infection, with a higher prevalence in developing countries. In Canada, 210,753 to 461,517 people are infected with HCV, and an estimated 20 to 40 per cent of infections remain undiagnosed. Those born during the period of 1945 until 1965 have the highest rates of infection and, having acquired the virus decades ago, are now increasingly being diagnosed with serious liver-related illnesses, including liver failure and liver cancer and non-liver related illnesses such as cardiovascular disease, diabetes and kidney disease.
The possible unintended consequences of the introduction of PrEP to the sex industry is something that has been discussed in international sex work advocacy since at least 2012. So, when I saw that new PrEP prescription guidelines for Canada were being drafted, stating that “sex-trade workers” were a “significant risk of having transmissible HIV,” I was troubled that there had been no community consultation whatsoever. National guidelines required a national convening.
The CATIE Blog hosts the views and opinions of people and organizations working and volunteering in Canada’s response to HIV and hepatitis C.