The Globe and Mail‘s Stephanie Nolen notes that Brazil is planning on implementing British Columbia’s pioneering program to control HIV/AIDS by making sure every HIV-positive person is on treatment, extending lifespan and reducing transmissibility of the virus. Scaling up from a Canadian province–even a large one–will have challenges, as will the ethical issues related, but this is still quite positive.
[Brazil] had national free public AIDS treatment before anywhere else, and it had huge success enlisting gay men, sex workers and drug users in the fight to stop the virus. But with a new plan launched late last year, Brazil is poised to go one step further. It wants to stop the spread of HIV by putting every single person who has the virus on treatment, whether they are sick or not.
The concept – known as “treatment as prevention” – has Canadian roots. It was pioneered by, among others, Julio Montaner, a leading AIDS physician in British Columbia and former president of the International AIDS Society who credits it with the fact that Vancouver closed its AIDS ward earlier this year. It’s policy now in B.C. – and while Canada as a whole hasn’t adopted it, China, Australia, France and the U.S. all want to use the model.
But Brazil has gone furthest, and with 720,000 people living with HIV, this country has taken the concept to a whole new scale, once again blazing an ambitious path in the response to AIDS.
Thirty years ago, Brazil’s dedicated push on HIV helped rein in the epidemic, cutting new infections sharply. But those numbers started to creep up again because Brazil got complacent, its own officials agree, and for two other key reasons. First, the virus has spread into every nook and cranny of the country, including the vast swaths of the Amazon forest where the health system struggles to provide even basic care. And second, in Brazil like everywhere else, there is a generation of young people who don’t recall the decimation AIDS wrought in the 1980s, who think of it as a treatable illness, and for whom safer-sex messages fall on deaf ears.
“Our strategies have been failing, and it’s clear we need a new one,” said Inacio Queiroz, president of the chapter of Pela Vidda (For Life) in this city across the bay from Rio de Janeiro.
That’s where the new plan comes in. Putting people on anti-retroviral therapy (ARVs) stops the spread of HIV because people on treatment have so little presence of the virus in their bodily fluids that it’s called “undetectable”; they are 90 per cent less likely to infect partners with whom they have unprotected sex or share needles. (The virus is still present in genomic material in their cells and eventually starts to circulate again, when it grows resistant to the medication.)
Daily Xtra‘s Frank Prendergast, meanwhile, notes that Truvada has still not been approved in camera for pre-exposure prophylaxis.
Manufactured by Gilead, Truvada is a drug commonly given to people who are HIV-positive as part of their treatment regimens. Two years ago, the US Food and Drug Administration (FDA) approved it for a second use: to help prevent HIV infection. The FDA decision followed the groundbreaking iPrEx study, headed by principal researcher Robert Grant, which proved its effectiveness as an HIV prevention drug if taken daily.
In an email to Daily Xtra, a Gilead representative says the company has submitted filings seeking approval for Truvada to be used as a prevention drug (in addition to its primary use as a treatment for HIV) in Brazil, South Africa, Thailand and France. But Canada seems to be in limbo.
“After initial discussions with the European Medicines Agency and Health Canada, Gilead has not received any recent communications regarding a PrEP filing from either agency,” the Gilead representative writes. The representative has not yet responded to Daily Xtra’s requests for clarification regarding what was said in these “initial discussions.”
Health Canada says it won’t provide information on what approvals drug companies may or may not be seeking at any given time, stating that this is “proprietary information.”
We contacted Eric Morrissette, senior media relations advisor at Health Canada, to ask why there may have been no “recent communications” with Gilead after “initial discussions” but were told that this, too, is confidential information. However, Morrissette tells Daily Xtra that there is “no backlog” at Health Canada that would slow down communications.