In a few weeks, the world is invited to Montreal for AIDS 2022, the 24th International AIDS Conference. At this time of writing, no public announcement has been made as to which of Canada’s dignitaries will be present.
The last time this conference was held in Canada was 2006, in Toronto. The absence of our then prime minister, as well as the previous federal government’s abysmal record on HIV policy issues such as harm reduction, became an embarrassment for Canada on an international stage.
Since then, we have seen some indications of progress. In 2016, Health Minister Jane Philpott signed Canada on to global targets to achieve 90% HIV diagnosis, 90% HIV treatment initiation and 90% HIV suppression by 2020. At the CATIE Forum In 2017, Canada’s Chief Public Health Officer Dr. Theresa Tam publicly announced for the first time that a person with HIV on effective treatment doesn’t transmit the virus sexually – “undetectable equals untransmittable”, or U=U. Then, on World AIDS Day in 2018, Health Minister Ginette Petitpas-Taylor signed on to the Prevention Access Campaign’s U=U consensus statement, making Canada the first country to declare its government’s support. At AIDS 2018 in Amsterdam, she donned a U=U t-shirt at the podium, further demonstrating her and her government’s support for U=U.
While we have applauded these important words and statements, unfortunately Canada has not demonstrated as much success through its actions or accomplishments. Canada has not yet reached the 90-90-90 goals it set for 2020, and as of this writing, has no concrete plan to reach its second commitment to 95-95-95 by 2025.
New leadership at Canada’s health ministry
In the fall of 2021, new leadership arrived at Canada’s health ministry, with the appointment of Jean-Yves Duclos as minister of health and Dr. Harpreet Kochhar as president of the Public Health Agency of Canada.
After several requests from HIV organizations to meet with Minister Duclos and Dr. Kochhar, I attended an online meeting on June 1 with about 30 members of civil society organizations working in Canada’s HIV response. In this meeting, we expressed several concerns, including: the flat-lining of federal HIV funding for more than a decade, in the face of increasing HIV prevalence and skyrocketing inflation; the addition of hepatitis C and other sexually transmitted and bloodborne infections (STBBIs) to our mandates with no additional funding; the increasing racialization of the HIV epidemic in Canada and its disproportionate impact on marginalized communities; the commitment to global elimination targets with no additional funding or concrete action plan.
Additionally, we expressed concern that we are beginning to see the results from restricted healthcare access during the COVID-19 pandemic, including fewer HIV, hepatitis C and STI tests, and increasing numbers of overdoses. Similar to other health issues, we expect to see an increase in HIV, hepatitis C and other STBBIs as infections that went undiagnosed and untreated during the pandemic start to be uncovered.
The funding envelope for STBBIs hasn’t increased since 2007. The $100 million in annual HIV funding recommended by the House of Commons Standing Committee on Health – in 2004 and again in 2020 – has never been realized. In the meantime, in the spirit of integration, the funding originally earmarked for just HIV has been expanded to include hepatitis C and all STBBIs.
Canada’s track record on an international stage
And the world is now coming to Montreal. With no further commitments for funding and no acknowledgment of frontline service providers’ contributions and ongoing needs, it is difficult to stand proud of our track record here in Canada.
We remain grateful to previous Ministers Philpott and Petitpas-Taylor for their public commitments to global HIV targets and to the science of U=U. But the question remains for Minister Duclos and President Kochhar: what will be your legacies?
Laurie Edmiston is executive director of CATIE, Canada’s source for HIV and hepatitis C information.