Ending AIDS by 2030: The doctor who found the key

On World Aids Day today, Rod Mickleburgh profiled Julio Montaner, the Argentine/Canada doctor who’s led the successful fight against HIV/AIDS using harm reduction strategies.

The United Nations agency UNAIDS said in a release its goal of “ending the AIDS epidemic by 2030 is possible, but only by closing the gap between people who have access to HIV prevention, treatment, care and support services and people who are being left behind.” The numbers from UNAIDS are so stark it’s hard to believe the epidemic can be ended in 16 years:

• In 2013, there were 35 million [33.2 million–37.2 million] people living with HIV. Since the start of the epidemic, around 78 million [71 million–87 million] people have become infected with HIV and 39 million [35 million–43 million] people have died of AIDS-related illnesses.
• Worldwide, 2.1 million [1.9 million–2.4 million] people became newly infected with HIV in 2013.
• Worldwide, 240 000 [210 000–280 000] children became newly infected with HIV in 2013.
• In 2013, 1.5 million [1.4 million–1.7 million] people died from AIDS-related illnesses worldwide.
• In 2013, around 12.9 million people living with HIV had access to antiretroviral therapy.
• This represents 37% [35–39%] of all people living with HIV, yet only 24% [22–26%] of all children living with HIV are receiving the life-saving medicines.
• Tuberculosis remains the leading cause of death among people living with HIV, with an estimated 320 000 [300 000–340 000] deaths in 2012.
• HIV is the leading cause of death among women of reproductive age.
• In 2013, 54% of pregnant women in low- and middle-income countries did not receive an HIV test.
• In 2013, almost 60% of all new HIV infections among young people aged 15–24 occurred among adolescent girls and young women.
• AIDS-related illnesses are the leading cause of death among adolescents aged 10–19 years in Africa.
• Globally, gay men and other men who have sex with men are 19 times more likely to be living with HIV than the general population.
• HIV prevalence among sex workers is 12 times greater than among the general population.
• Transgender women are 49 times more likely to acquire HIV than all adults of reproductive age.
• HIV prevalence is estimated to be up to 28 times higher among people who inject drugs than the general population.

Writes Mickleburgh, in JULIO MONTANER: doctor led harm reduction in global HIV/AIDS fight:

 … it was Dr. Montaner who first championed the powerful anti-retroviral drug cocktail therapy that has turned HIV/AIDS into a manageable, chronic disease.

And it was Dr. Montaner who then went on to develop the groundbreaking Treatment as Prevention strategy, as he realized that these anti-retroviral drugs reduced the viral load of HIV patients to such minimal levels the danger of passing the virus on to others was eliminated. Hence, if enough patients were treated, transmission could be stopped in its tracks.

In British Columbia, aggressive employment of Treatment as Prevention, seeking out those on the margins of society, has slashed the number of new infections by more than 70 per cent. This in a province whose drug-riddled, impoverished Downtown Eastside area in Vancouver once had the highest HIV infection rate in the developed world.

Dr. Montaner’s once controversial strategy has now been adopted by the World Health Organization and is being pursued in a growing number of countries, including China and Brazil. Thanks to these advances, the dream of a world without AIDS is no longer just fantasy.  Read JULIO MONTANER: doctor led harm reduction in global HIV/AIDS fight (no charge*)