By Laurie Edmiston
This year was supposed to be the year we took control of the HIV epidemic. Four years ago, governments around the world — including Canada’s — committed to achieve three targets: 90 per cent of people with HIV diagnosed, 90 per cent of those on treatment, and 90 per cent of those on treatment managing to suppress the virus to undetectable levels. Since suppressing HIV through treatment eliminates the risk of passing it on to a sexual partner, scientists projected that meeting these targets by 2020 would eliminate HIV/AIDS as a public health threat by 2030.
Then COVID-19 happened. At first glance, you might think physical distancing to protect us from COVID-19 would similarly limit opportunities to transmit HIV. However, the reality is not so straightforward. After all, consensual sex is healthy for both the body and the mind and can offer the physical and emotional intimacy that many are craving right now. Similarly, many people use drugs to help them cope in times of stress.
People having sex or using drugs is not new. What makes this a greater risk now is that our public health infrastructure has been hampered. HIV testing clinics have had to reduce their hours or shut down entirely, either to reallocate staff and resources to the COVID-19 response or to ensure adequate distancing. Prevention and support services — supervised consumption sites, HIV prevention clinics, counselling services — have also been under strain.
At first glance, you might think physical distancing to protect us from COVID-19 would similarly limit opportunities to transmit HIV. However, the reality is not so straightforward.
Prevention, testing and treatment programs have been the cornerstone of Canada’s efforts to eliminate HIV transmission. A threat to any of these pillars could topple the entire foundation of our HIV response and trigger a resurgence. In fact, researchers from the British Columbia Centre for Excellence in HIV/AIDS recently projected that a 50 per cent disruption to HIV services due to COVID-19 could result in a nine per cent increase in new HIV infections.
It doesn’t have to be this way.
Even before COVID-19, community-based service providers had been piloting innovative approaches to delivering HIV services remotely, primarily to offer greater convenience to patients and clients, but also to find health-care efficiencies.
HIV self-testing, recently approved by Health Canada, is one tool that could be effectively leveraged to diagnose people at a time when clinics are unable to handle the same capacity of in-person appointments. Self-testing could also alleviate the burden on testing labs currently handling backlogs of COVID-19 tests by screening out negative test results and only forwarding preliminary positive results for confirmatory lab testing.
Researchers had also been investigating ways to make it easier to take PrEP — a pill taken regularly by an HIV-negative person to prevent HIV infection. Canadian guidelines recommend that those who take PrEP see their doctor and get tested for sexually transmitted infections every few months. That’s difficult during a pandemic, when clinics are full, distance must be maintained and everyone wants to avoid unnecessary visits to the doctor.
Research has already demonstrated ways to ease this burden, such as offering remote clinical consultations or allowing patients to take test samples at home and submit them to labs directly.
The same applies to preventing HIV transmission through injection drug use. Harm reduction workers already have solutions that can be leveraged in this crisis. “Satellite sites” offer similar services to community-based health centres but are delivered by the peers of people who use drugs, right in their homes. It allows people who use drugs to access the sterile equipment and prevention information they need, while reducing the risk of becoming ill with COVID-19.
Researchers and community advocates have been calling for these types programs to be supported and implemented well before COVID-19, but the pandemic has made these programs a necessity.
Rather than risk an HIV epidemic resurgence that will further strain our public health-care system during a pandemic, let’s leverage this opportunity to deliver HIV services differently.
Laurie Edmiston is executive director of CATIE, Canada’s source for HIV and hepatitis C information.