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Changing the Course of the Epidemic

Dr. Julio Montaner, BC Center for Excellence in HIV/AIDS.  (De Capua)
Dr. Julio Montaner, BC Center for Excellence in HIV/AIDS. (De Capua)

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Joe DeCapua
A former president of the International AIDS Society says it will take a combination of scientific and human rights advances to end the epidemic. Dr. Julio Montaner made his comments at the 19th International AIDS Conference in Washington.

Montaner pioneered Treatment as Prevention at Canada’s BC Center for Excellence in HIV/AIDS. The method of using antiretroviral drugs not only to treat infected people, but to protect uninfected as well, is now an accepted practice.



But despite having a dramatic effect on the course of the epidemic, he said, Treatment as Prevention is not enough.

“I want to be perfectly clear. While we have been strong proponents of this since our landmark call for action in 2006 in The Lancet – and since then we’ve been reporting continuously on the improvements that we have seen with this strategy in British Columbia – I’m the first one to realize that if we are going to truly control this disease we’re going to need a cure and a vaccine. In the absence of those two, the ability of Treatment as Prevention to truly control the epidemic is a bit of a rhetorical excess if you want,” he said.

Montaner said achievements in science can only work if many people change what they believe, especially when it comes to such high risk groups as men who have sex with men, sex workers and intravenous drug users.

“Well, I think it’s bigotry. I think it’s stigma. It’s discrimination. One thing is when you’re ignorant because you don’t know – so you’re an honest ignorant – but the other thing is when your ignorance is based on your preconceived biases. In other words, you’re closing your eyes to the evidence. And I think what we have today is a much more perverse situation, which is we know how to go forward and we still are unwilling or unable to implement the necessary legal reforms, for example, to make things happen,” he said.

Montaner said British Columbia, where he works, continues to take the steps necessary to tackle HIV/AIDS on many levels. And it’s paying off.

“We are the only jurisdiction in Canada that has seen decreasing HIV rates. And the reason is because we have a focused, aggressive HIV program. We have a progressive leadership in the province and we have a committed population to actually do the right thing. We can do things that are illegal in other parts of the country,” he said.

One of the programs deals with commercial sex workers. While the provincial government has not legalized brothels, Montaner says, it “tolerates” them. Some brothels are actually located in publicly subsidized housing.  As a result, sex workers are less likely to be victims of violence and more likely to receive health and HIV prevention services.

“I don’t mean it literally, but I said, look, we could stop the research, we could stop writing guidelines, and we could just say let’s implement everything that we know that works with a liberal frame of mind and this world would be a totally different world when it comes to HIV and AIDS, of course, and many other things as well,” he said.

Montaner was chair of AIDS 2010 and helped write the Vienna Declaration. It called for a decriminalization of drug use, saying it should be treated as a health issue instead.

“The war on drugs,” Montaner said, “has been an abject failure. Nobody actually believes that that’s the way to go and yet we’re still criminalizing people for the possession of small amounts of drugs for personal use. I mean these people need public health. They don’t need prisons. If they were not infected with HIV to begin with they can get HIV in the prison. This is not working.”

In British Columbia, addicts are offered clean needles, which they are not permitted to share. And they are regularly tested and, if need be, treated for HIV. The program, called Insite, has been in operation for about eight years.

He also helped write the D.C. Declaration for AIDS 2012 in Washington.

“What the D.C. Declaration is basically asking for is that we, once and for all, accept that we have the tools to change the course of the epidemic in a dramatic fashion. If we implement the things that we know – the evidence-based solutions that we have demonstrated over so many years – we are going to see a turning point in the epidemic. Could we eliminate HIV? No, that’s not the point. The point is that we’re going to see the curves bending downwards in a very dramatic way,” he said.

Dr. Montaner is calling for a redoubling of investments into finding a vaccine and a cure for HIV. He says that should be “the legacy left for generations to come.”

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