HIV self-testing was approved in Canada in November 2020, largely thanks to research conducted by REACH Nexus, part of Unity Health Toronto’s Map Centre for Urban Health Solutions. But approval does not mean access – the next step is getting self-tests into the hands of people who don’t know they have HIV, and linking them to follow-up treatment and care.
Testing is an essential part of the HIV cascade of care. People living with HIV can only be linked to treatment, care and support services if they have been diagnosed. Once a person is diagnosed, effective treatment will enable them to live a long and healthy life, to have HIV-negative children, and not have to worry about passing on HIV to their sex partners. People who test negative and are at ongoing risk for HIV can be linked to prevention, harm reduction and other services as necessary.
I feel like a historian sometimes, when I reflect on each meeting or conference session’s proceedings that I have attended internationally, nationally and locally on the topic of HIV self-testing in the past decade or so. I can see patterns in behaviour, consonance and dissonance of thought, speech and action, and I am left in awe and wonder why we humans don’t end up doing the right thing for other fellow humans in need. For key populations, who need our voice to get the products and services they so rightly deserve.
To end the HIV epidemic in Canada, it is important for people who are HIV-positive to know their status and to be linked to care. To do that, we have to reach people who are not testing now and make the process easier for them.
Canada has signed on to the global 90-90-90 targets to end the HIV epidemic by 2030. The aim of these targets is to diagnose at least 90% of all people living with HIV, provide treatment for 90% of those diagnosed, and for 90% of people on treatment to have an undetectable viral load by 2020. However, Canada is falling short on the first 90, lagging behind other similar countries, such as the United Kingdom and Australia.
HIV is not what it used to be. Many people with HIV describe it as a chronic condition and a manageable part of their life. HIV prevention is not what it used to be, either. The simultaneous rise of “undetectable equals untransmittable” (U=U) and pre-exposure prophylaxis (PrEP) caused a radical change in the way we talk about HIV transmission and prevention.
