More than two decades ago when Dr. Julio Montaner began research on HIV/AIDS, little was known about an epidemic that was believed to be a death sentence.
Today, people with the illness and access to treatment are living into old age, thanks in no small measure to breakthroughs – medical and social – that have come out of Vancouver’s research community.
“We’re pretty proud of the accomplishments we have achieved over the last three decades,” said Montaner, a researcher with the B.C. Centre for Excellence in HIV/AIDS.
“A lot of that has to do with being at the right place and the right time. We have … a significant concentration of cases and a critical mass of brain power that felt compelled to approach this in a systematic way as opposed to just giving care.”
In the 1980s, which Montaner refers to as the “dark era,” the life expectancy of someone with AIDS was little more than 10 years.
By 1994, Vancouver researchers had begun work that would lead to the implementation of HAART, the cocktail of drugs widely accepted as the most effective treatment to manage and reduce the spread of the disease.
This breakthrough was unveiled at the International Conference on AIDS in 1996, which happened to be held in Vancouver.
“The world today refers to the Vancouver conference as a pivotal moment where we ... started talking about transforming (the disease) into a long-term chronic manageable condition,” Montaner said.
But finding an effective drug treatment was only half the battle, said Montaner, adding the issue now – in Canada, at least – is tackling the spread of HIV in high-risk groups like injection drug users and the homeless.
“By 2000 when treatment was really falling into place … we became (focused on) harm-reduction strategies,” Montaner said, adding that treatment and prevention need to be seen as two sides of the same coin.
Montaner said clean needle exchanges and supervised injection sites like InSite, which the federal government has repeatedly tried to close, has helped reduce new infections by 60 per cent.
This harm-reduction approach is the principle behind the Vienna Declaration, another strategy spearheaded in part by Vancouver AIDS researcher Dr. Evan Wood and adopted by the international medical community.
The Declaration calls for global leaders to adopt drug policies supported by scientific evidence rather than ideology, and has been backed by world leaders and international AIDS researchers.
Montaner said that Michel Sidibé, who leads the UNAIDS program, has shaped his program around the body of evidence developed in Vancouver.
“(Sidibé) has repeatedly and formally underscored the contribution that our programs have made to shaping the global fight against HIV and AIDS,” said Montaner.
“The revised global strategy that he put forward at the UN General Assembly and at the Vienna Convention was based on the treatment and prevention notion that we developed in Vancouver.”
Montaner said the real stumbling block in Canada is the federal government, which doesn’t support programs like InSite.
“This is not just about prescribing,” Montaner said.
“(Canada’s) medical system allows us to provide optimal care for all those infected and at risk, and we (have the opportunity) to tell the rest of the world (how) to enhance the outcomes of those infected with HIV/AIDS.”