Every year we mark World AIDS Day with the hope that the news will be better with each passing year and that considerable progress will have been made towards the eradication of the human immunodeficiency virus. (HIV). In the last four decades, the gains have certainly been dizzying compared to other diseases, but there are still obstacles to overcome to end the HIV epidemic. And, unsurprisingly, these barriers are directly linked to social inequities, particularly in health and human rights.
What about today?
At the global level, UNAIDS 2022 and 2023 data remains stable: an estimated 39.9 million people are living with HIV worldwide, 1.3 million people are infected with HIV each year and that 630,000 people die each year from AIDS-related causes. On the other hand, in Quebec, the picture is different. With 422 new cases reported in 2022, there is an increase of 78% compared to the previous year. Several factors contribute to this, including the reopening of borders and the increase in the number of screenings compared to the years of the COVID-19 pandemic.
However, one constant remains: men who have sex with men (MSM) represent one of the groups most affected by HIV with nearly 40% of new diagnoses, of which 61% of cases were discovered during of a first screening. What does this data lead us to think? We can repeat ad vitam aeternam that the absence of sex education in schools and the lack of awareness among the general population are obvious reasons, but we must also recognize that there is a relaxation in the LGBTQ2+ community in relation to to the urgency and necessity of combating HIV. This is demonstrated in particular by the constant decline in interest around World AIDS Day, including at the international level. HIV is no longer fashionable and younger generations do not feel
concerned, especially since the prevailing discourse suggests that HIV is no longer a serious problem because there are drugs. Indeed, the treatments slow down the disease which has become a chronic illness. At the preventive level, pre-exposure prophylaxis (PrEP) prevents you from contracting the virus. You still need to know about its existence, have access to it and use it!
PrEP has been around for over 10 years now and it reduces the risk of contracting the virus by up to 97%. It is therefore a particularly effective prevention strategy and constitutes a major advance in preventive terms, but its effectiveness in significantly reducing HIV transmission is limited by its underuse. Underutilization of PrEP amounts to not using a vaccine, if it were available. This is a failure of public health.
However, in the absence of a vaccine, PrEP is an important tool to control the epidemic of HIV infections, but several factors limit its access. Taboos associated with sexuality prevent many people from talking about it to their doctor and vice versa. The absence of courses on STBBIs in the medical curriculum adds to the lack of knowledge and the resulting discomfort: several residents on internship at Actuel see a case of syphilis for the first time! Finally, financial issues can restrict access to PrEP: refusal of reimbursement from insurance companies or lack of financial means to cover the costs of PrEP. In this regard, Actuel participated in research demonstrating that free PrEP considerably reduces the barriers to its use. As such, Great Britain has been a leader in making PrEP free since 2020, with spectacular results in reducing HIV transmission. PrEP is also free in six Canadian provinces for all residents or for certain populations at risk, what are we waiting for to do the same? Treatments relating to HIV and its prevention must be free as for other STIs. Reducing the number of new infections is essential to significantly reduce the epidemic, so it is a major public health issue that must be taken into account. In the current context of the fight against HIV which presents multiple challenges, it is all the more important to approach the problem in an integrated manner. Although current data may be worrying, the arrival of new long-term therapies (both therapeutic and preventive) offer promising avenues for disease management and prevention. Today, people living with HIV and people on PrEP consult about four times a year, which allows them to have their blood tests done and screen for STIs. Given that chlamydia and gonorrhea have increased by 11% and 21% respectively in one year, it is essential that public health, in conjunction with front-line physicians and community organizations, urgently deploy measures appropriate to implement these new therapies efficiently and safely from a public health and overall health perspective.
“Let’s follow the path of rights” is the slogan of World AIDS Day this year. Right to social equity, access to care and non-discrimination, all factors which require a long-term commitment based on a multidisciplinary approach. In this sense, we can only encourage public health to play a leading role in this process, in order to guarantee that HIV and STBBIs become a priority and to ensure that the battles won in recent years, notably regarding harm reduction, do not disappear due to budget cuts. It is this commitment that will make it possible to respect “the path of rights”. Conversely, inaction will inevitably lead to increasing social inequities and further weakening already highly vulnerable populations.
Dr Réjean Thomas
Founder President and CEO Clinique Médicale l’Actuel
INFO | L’Actuel Medical Clinic, 1001 Boul. de Maisonneuve E office 1130 11th floor,
Montréal, QC H2L 4P9 / www.cliniquelactuel.com
