Opinion: Where we are falling behind is in linking those diagnosed with HIV to followup care and treatment. This is disturbing for many reasons.
One of the silver linings of the COVID-19 pandemic has been the number of things you can now do from the comfort of your own home. From telework to talking to a doctor, the last two years have revolutionized what is possible.
Our HIV response is no exception. HIV self-test kits, long available before the pandemic in other countries, received Health Canada approval in late 2020. Self-testing has shown promise in the countries where it had already been rolled out, especially at increasing HIV testing rates among people who are less engaged in the healthcare system. We also saw home-based testing as a potential alternative to in-person clinics during the pandemic, a need exacerbated as the healthcare system now struggles with wait times, high patient loads and worker shortages.
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But approval of self-testing was just the first step. The only HIV self-test approved in Canada is priced at $35 when purchased directly from the manufacturer, plus shipping costs. Such a price barrier will shut out exactly the types of people who most need self-testing, and who are most likely to be living with undiagnosed HIV. Self-testing won’t be a feasible alternative or even option for these individuals until the cost barrier is reduced or eliminated altogether.
This is why I applauded the government of Canada’s announcement this summer that they would invest $8.8 million to purchase and distribute HIV self-test kits to the communities most in need across Canada. To do this, they will partner with organizations, networks and service providers that already have the human resources and infrastructure to get these kits into the hands of people who need them. We at Canadian AIDS Treatment Information Exchange (CATIE) will produce easy-to-read leaflets to be inserted in kits, as well as training and education to organizations wanting to distribute them.
Recently the Public Health Agency of Canada released new estimates of how well Canada is doing in reaching its international commitment to eliminate HIV as a public health threat by 2030. The good news is that we have exceeded our most recent milestone targets for diagnosing people living with HIV, and this self-testing investment, if sustained, will ensure we continue to meet that target. Where we are falling behind is in linking those diagnosed with HIV to followup care and treatment.
This is disturbing for many reasons. Current treatments mean a person with HIV can live a long and healthy life, with a life expectancy close to their HIV-negative peers. We also now know that a person on effective treatment can’t pass HIV on to their sexual partners. So, if an individual is not taking advantage of these clear benefits of HIV treatment, I have to ask myself why. Are they lacking treatment information? Are they facing financial barriers? Or are they having trouble navigating the healthcare system? We know that the final push to end HIV will require complex interventions that address these barriers.
We also know that barriers to testing and healthcare hit some communities harder than others. Indigenous people, African, Caribbean and Black Canadians, people who use drugs and other marginalized groups are less likely to access HIV testing, and more likely to be lost to followup care. We need to invest in culturally specific services that understand the experiences of these communities and speak to them in their own languages.
Canada has a vast network of community-based HIV service providers, and this is part of their job. We are so close to ending new HIV infections in Canada, but it will require investments in the tools we know exist, like self-tests, and it will require investments in the organizations that get those tools in the hands of those that need them.
Jody Jollimore is executive director of the Canadian AIDS Treatment Information Exchange (CATIE), Canada’s source for HIV and hepatitis C information.
Letters to the editor should be sent to sunletters@vancouversun.com. The editorial pages editor is Hardip Johal, who can be reached at hjohal@postmedia.com.
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