With strained healthcare resources, self-testing for HIV/AIDS could be a valuable resource

As Canada continues to inject unprecedented resources into the fight against the COVID-19 pandemic, some health experts want the federal government to have the same sense of urgency regarding the current HIV epidemic. /AIDS.

The Community Research Center (CBRC) of Vancouver is partnering with 20 community organizations across Canada to provide 1,500 free HIV self-test kits to the public.

The Test Now community distribution project aims to “evaluate the effectiveness and uptake of new HIV testing technologies while increasing access among gay, bi, trans and queer men and two-spirit and non-binary people (GBT2Q )”.

“HIV testing has dropped significantly in Canada as clinics have closed due to the pandemic,” says Brook Biggin, director of program development at CBRC. “And that says nothing about the people who have struggled to access testing for years – whether it’s because they live in rural areas, they don’t have adequate resources in the cities where they live. or that they are stigmatized as they navigate the health care system.”

Still need to focus on blood-borne and sexually transmitted diseases

Chris Draenos’ title is long and complicated, but his work is crucial.

Draenos is the National Lead for Testing Implementation and Linkage Implementation for CBRC’s Sexually Transmitted and Blood Borne Infections (STBBIs).

Prior to working at CBRC, Draenos was a Sexually Transmitted Infections Case Manager for Toronto Public Health. He also worked at Casey House, the only hospital in Canada for people living with HIV.

Draenos says Test Now will allow people who may be HIV-positive to get tested without going to a clinic. It will also save time for healthcare professionals who are busy dealing with the fifth wave of COVID-19 in Canada.

Last June, the CRBC shared a video demonstration of an HIV self-test with Canada’s Drag Race competitor Travis L’Henaff, who is HIV positive. Although the HIV self-test is very different from the rapid COVID-19 test, both are easy and take about the same time.

Each HIV self-test kit contains three vials, a finger-prick lancet and a test device.

“Someone would prick their finger, pour a big drop of blood into the first bottle, shake it, put it in the test device, and add bottle two and bottle three,” says Draenos. “Soon after that they would receive a result.”

In 2018, the Public Health Agency of Canada (PHAC) reported approximately 2,242 new HIV infections, up from 1,950 cases two years earlier in 2016.

Across Canada, there were an estimated 62,050 people living with HIV in 2018. While 87% of people living with HIV/AIDS know their status, approximately 8,300 Canadians living with the disease have no no idea they have it.

Prisoners living with HIV/AIDS face additional levels of stigma and discrimination when it comes to accessing sexual health care.

In 2018, there were 141 people living with an HIV diagnosis in correctional facilities across the country. More than one in four people were Aboriginal, although Aboriginal people make up only about 5% of the total population.

Chris Draenos points to a variety of meaningful steps the federal government could take right now. One would be to make widely available an effective drug called pre-exposure prophylaxis (PrEP).

This drug, which is taken in pill form, helps prevent individuals from contracting HIV, but can be extremely expensive without health insurance. Many people living with HIV have inadequate or non-existent health insurance. Provincial health insurance programs do not fully cover pharmaceutical drugs.

HIV self-tests would cost governments $35 each.

It’s a little money. But Draenos argues it would be much cheaper than the costs associated with potential HIV/AIDS patients seeing a doctor, having someone draw blood, shipping the blood to the lab for processing, and returning the results to the healthcare provider. health.

“It comes down to provincial funding priorities — what they choose to spend their money on,” says Draenos.

The 90-90-90 targets – still not achieved

The CBRC is calling on the federal government to increase funding for HIV to $100 million per year. The Senate passed a motion supporting such a plan in December 2020.

Additional funding would support community organizations across the country working to prevent the spread of HIV, as well as resources and care for those currently living with HIV.

But the federal role is only a small part of the story.

“Provinces are responsible for actual testing services. They could make many choices to increase its accessibility,” says Draenos. He notes that currently no Atlantic province offers rapid HIV testing. Elsewhere in the country, such tests have been available for more than a decade.

As for Ottawa, Draenos argues that federal government support for the prevention of sexually transmitted and blood-borne diseases has stagnated in recent years, as the number of people living with HIV in the country has increased.

According to Draenos, the Canadian government continues to fall short of the goals it set itself several years ago for the year 2020.

PHAC uses the label “90-90-90” to describe these targets:

• 90% of all people living with HIV should know their status,
• 90% of those diagnosed should receive antiretroviral treatment, and
• 90% of people on treatment should achieve viral suppression. »

“When these three targets are achieved,” PHAC tells us, “at least 73% of all people living with HIV will have a suppressed viral load.”

Being virally suppressed means having no symptoms and not being contagious.

PHAC confirms in an email that Canada has not met all of the 90-90-90 targets.

Despite that setback, the agency says the federal government is now committed to meeting the even more robust United Nations targets of 95-95-95 by the year 2025, three years from now.

The ultimate goal, according to the federal public health agency, is to end sexually transmitted and blood-borne public health threats by 2030, less than a decade from now.

PHAC is still compiling and processing data on HIV/AIDS in Canada for the most recent year available, 2020. It expects to be able to release these numbers in just six months, July 2022. .

Many are eagerly awaiting this information.

In the meantime, the federal government could immediately consider increasing the availability of pre-exposure prophylaxis drugs, while governments could adopt self-testing programs tomorrow.