Massive increase in HIV testing contributes to effective harm reduction programs in Sask. Indigenous communities

Dr. Ibrahim Khan, regional medical health officer for Health Canada, stands for a photo during an HIV knowledge-sharing conference at the Saskatoon Inn on February 14, 2017. MICHELLE BERG

Harm reduction models in Indigenous communities across Saskatchewan have been showing signs of success even as rates of HIV infections continues to rise.

Dr. Ibrahim Khan, the chief medical health officer for Health Canada’s First Nations and Inuit Health Branch in Saskatchewan, says even though there was a 10 per cent increase in HIV cases in Indigenous communities in 2016, the massive increase of HIV testing in these communities is a positive step towards stopping the virus’s spread.

“For us this is quite an achievement,” he said. “The whole point in the HIV and Hepatitis C story is the earlier you can diagnose, the better you have a handle on stoping the spread … but we want to increase that number — we want to even double that number in the coming years — so that testing is not an barrier.”

Taking this harm reduction approach helps communities reduce the negative consequences associated with drug use by providing the care each patient needs without judgement, he said. Harm reduction can encompass anything from promoting safe drug use at injection sites and needle exchanges to beating addiction with help from opioid replacement and addictions programs.

Currently 19 Indigenous communities in Saskatchewan have implemented harm reduction programs to limit the spread of Hepatitis C and HIV. This access to care in a culturally safe space has created a centre where a patient can be immediately linked to all the necessary services they need without facing the stigma that can sometimes be attached — the biggest hurdle Khan says currently faced by Indigenous people looking for care.

One of the most successful is the New Beginning Program. Khan says although it’s a relatively new program — run and led off reserve in Kamsack by the Cote First Nation — it has shown massive success dealing with the stigma surrounding HIV, providing cultural safety for its patients, offering skills building and outreach services and limiting the main risk factor for the spread of these viruses through a needle exchange program.

Though the 19 communities that have implemented these programs are seeing positive results, Khan says Health Canada wants to see even more communities introducing safe injection sites — especially those where blood-born pathogens such as Hepatitis C and HIV are gaining a strong foothold.

Current rates of HIV infection on Saskatchewan reserves vary across the province but still sit at a much higher level than the 2016 provincial average of 14.5 people infected out of 100,000. Reserves in southern Saskatchewan currently have the highest rates of HIV infection at 108 people per 100,000, followed by those in central areas of the province at 32 per 100,000 and those in the north at 28 per 100,000.



Older antiretroviral regimens raise diabetes risk in HIV-positive adults

HIV-positive adults who initiated older formulations of antiretroviral therapy are more likely to develop type 2 diabetes than patients who initiated therapy between 2010 and 2015, according to study findings reported in BMJ Open Diabetes Research & Care.

“Combination antiretroviral therapy (ART) has dramatically increased the life expectancy of people living with HIV; however, they are now developing comorbidities associated with prolonged survival and aging, and these may be occurring at earlier ages than in the general population,” Faizal Samad, clinical trials coordinator with the AIDS Research Program at St. Paul’s Hospital in Vancouver, British Columbia, Canada, and colleagues wrote in the study background. “Many [people living with HIV], particularly those who received older antiretroviral treatments, experienced peripheral fat atrophy, visceral fat accumulation and metabolic comorbidities, including dyslipidemia and impaired glucose homeostasis, which can lead to increased risk for cardiovascular disease and other related morbidities.”

Samad and colleagues analyzed data from 1,065 patients with HIV aged at least 50 years who initiated ART before July 2015 and did not have diabetes at baseline. All participants were treated at a large urban HIV outpatient clinic at St. Paul’s Hospital through July 2015. Researchers identified diabetes incidence through database records and chart review. The rate of new-onset diabetes was defined as the number of cases of diabetes divided by the total number of person-years of follow-up. A final, multivariable analysis used data from 703 participants — excluding patients who started ART before 1997 and did not have plasma HIV viral load results in the period before initiating therapy.

During a median of 13 years, researchers observed 235 new diabetes diagnoses among the entire cohort, for an incidence rate of 1.61 cases per 100 person-years.

Of the 703 patients included in multivariable analyses (89% men; 73% white), 132 developed diabetes. Among those with diabetes, 43% had hepatitis C virus coinfection, 8% had hepatitis B virus coinfection and 38% had a history of injection drug use. The median HbA1c was 5.8% for the 36% of patients with diabetes who had HbA1c results available, according to researchers.

Patients who initiated ART between 1997 and 2004 were more likely to develop diabetes vs. those who initiated ART between 2010 and 2015 (30% vs. 2%; P < .001), with an adjusted OR of 48.9 (95% CI, 21.32-112.17). Increased length of time on ART also increased the odds of developing type 2 diabetes (aOR = 0.69; 95% CI, 0.64-0.74).

The patients who developed type 2 diabetes tended to be younger at the end of the study, had a viral load of at least 500 copies/mL for a greater proportion of follow-up time and had a lower CD4 count at end of follow-up compared with those who did not develop type 2 diabetes; however, these associations did not rise to significance in adjusted models, according to researchers.

“Longer exposure to ART agents and the use of older drugs were associated with a higher incidence of [diabetes] in our study,” the researchers wrote. “On the other hand, obesity, HCV coinfection, and older age were not associated with the incidence of [diabetes] in this cohort. The incidence of [diabetes] is likely to decline in [people living with HIV] who initiated ART more recently with the use of newer ART agents.” – by Regina Schaffer




The arrest of 35 accused johns in a downtown Grande Prairie sting last month brought mixed reactions from the public. While some on social media applauded the efforts of RCMP, others had questions as to why the local sex trade was being targeted and what resources are in place for the workers.

“Some people think that being on the street is a choice,” says Jen Spencer, coordinator for a women’s drop-in held by HIV North twice weekly in an undisclosed location. “Well, if you have a choice of an abusive home or a street, then sure, you’re making a choice to be on the street, but if you’re choosing from one bad thing to another, it’s not really a real choice.”

Spencer says there can be a lot of misconceptions about people in the sex trade. While some workers choose it as a profession, others have different motivations. When money is involved, she maintains sex is no longer consensual.

“When we’re at the street level sex trade, often it’s survival sex. It’s a means to an end; it’s safety for that night; it’s a place to sleep; it’s food; it’s drugs; it’s the fact that if I do this then somebody’s not going to hurt me later or I’m going to be able to be safe for now in that moment.”

In Canada, it is legal to sell sex but not buy it. However, it’s also illegal to advertise sexual services, which can lead to potentially dangerous miscommunication between workers and johns. Spencer argues prostitution laws don’t do enough to protect sex workers, and says there could be some negative effects stemming from the crack down on solicitation downtown.

“There are people who are in hotels, in homes that are being run by other people. There are people that come to our community from other communities and then they go back. Reaching 35 johns is making a difference, but are we pushing people out of where we can see them? Because we’re helping them stay safe when we can see them.”

The drop-in centre is one way HIV North is trying to keep sex workers safe. In addition to a warm meal, women over 18 years old can access clothing donations, feminine hygiene products, harm reduction supplies and naloxone for opioid overdoses. It’s also a way for them to access community services and to connect with families if they don’t have a phone or fixed address.

“It’s changing some of the socioeconomic factors of why they’re doing something,” says Spencer. “Helping people with housing, helping people with finding safety, would that change what they’re doing? Possibly.”

While some people have told Spencer she is enabling the women, she sees the drop-in as a way to try to protect them, and offer them help to get out of the sex trade when they’re ready.

“No matter where you are, these things are happening, but we can help people be safe while these things are happening. I think one of the biggest barriers is the stigma behind what’s going on.”

Anywhere between two and 35 women attend the drop-in sessions. Spencer says it’s hard to say how many people work in the sex trade in Grande Prairie, as many don’t see themselves in the profession.



Changes needed on HIV non-disclosure, but not necessarily new law: study

Ginette Petitpas TaylorMinister of Health Ginette Petitpas Taylor listens to a speaker during an event marking World AIDS Day in Ottawa, Friday December 1, 2017. (Adrian Wyld / THE CANADIAN PRESS)

Ontario will no longer criminally prosecute HIV-positive people who don’t disclose their status to sexual partners if there is no realistic possibility of transmission, the province announced on Friday as it marked World AIDS Day.

The move comes as the federal government published a study saying that the bar for someone who doesn’t disclose their HIV status to be charged with a criminal offence needs to catch up to science.

The Justice Department study pulled together scientific evidence and the current prevalence of HIV in Canada and treatment, and stacked it up against the way the criminal justice system currently handles cases of people who don’t disclose their HIV status prior to engaging in sexual activity.

While there’s no law specifically related to it in the Criminal Code, non-disclosure can lead to assault or sexual assault charges, because it’s been found to invalidate a partner’s consent. Current wisdom suggests that if they knew a person had HIV, they wouldn’t consent to sexual activity because of the risk of transmission.

Science, however, suggests the risk of transmission is basically negligible if those living with HIV are being treated or taking appropriate precautions, the study concluded.

“It can, therefore, no longer be assumed that a person living with HIV in Canada is at risk of transmitting it.”

Ontario’s attorney general and health minister on Friday urged Justice Minister Jody Wilson-Raybould to consider Criminal Code reforms to align with that evidence, something advocates have long been urging.

“The scientific conclusions reflect the growing body of evidence that shows that there is no realistic possibility of transmission of HIV if a person is on antiretroviral therapy and has maintained a suppressed viral load for six months,” Yasir Naqvi and Eric Hoskins wrote in a joint statement.

Ontario Crown attorneys will no longer proceed with criminal prosecutions against those individuals, they announced.

The provincial ministers also said Ontario will put another $2.7 million to community HIV/AIDS programs, nearly $1 million more for harm reduction outreach workers and an additional $3.4 million to improve access to harm reduction supplies.

The federal study found that the law is not being applied consistently throughout the country, and the way it is being used needs to take into account a range of factors, including the scientific risks of transmission and degree of blameworthiness. For example, the study noted, not everyone has equal access to HIV treatment or other services to help them manage the risks.

While the study’s publication coincidence with World AIDS Day, it also follows a landmark apology in the House of Commons this week for past state-sanctioned discrimination against the LGBTQ community in Canada.

The milestone saw many advocates raise concerns about the current regime of criminalization the non-disclosure of HIV, noting it had been a year since Wilson-Raybould had promised to look into it and consider providing better guidance to prosecutors.

But Wilson-Raybould only has control over federal prosecutions and while she’ll use the results of the report to develop guidelines, it remains to be seen whether other provinces will follow suit.

The Canadian Coalition to Reform HIV Criminalization had issued a statement earlier this week, endorsed by more than 150 organizations, urging the Liberal government to go beyond guidelines and also reform the Criminal Code so sexual assault charges can’t be used.

The Justice Department report said criminal law reform could result in greater legal certainty but there are other issues.

“Law reform impacts the scope of the criminal law, not decisions about how to address cases that fall within that scope,” the report said.

“Moreover, law reform may require enacting HIV-specific provisions, which many stakeholders have opposed on the basis that this would increase the stigma experienced by persons living with HIV.”

In a statement, Wilson-Raybould said the report provides an evidence-based way to address HIV non-disclosure in the criminal justice system and she’ll continue working with the provinces on next steps.

“It clearly demonstrates that our criminal justice system must adapt to better reflect this progress as well as current scientific evidence on HIV-AIDS,” she said.

The study was published also as the federal Liberals announced $36.4 million in projects designed to address AIDS.


MSM, low condom use, gov’t policies fuel HIV/AIDS rise

An average of 31 new cases a day were reported in July and August this year; risky sex practices behind the alarming figures

HIV TEST A health worker conducts an HIV screening test on a volunteer. —LYN RILLON

Risky sexual behavior and practices, as well as the lack of government policies focused on prevention, have contributed to the steep rise in the number of human immunodeficiency virus (HIV) cases among Filipinos, particularly among the youth and men having sex with men (MSM).

Based on the latest HIV/AIDS Registry of the Philippines, 1,962 new HIV cases were reported from July to August this year, or an average of 31 cases a day.

Dr. Rontgene Solante, consultant for Internal Medicine-Infectious Disease at ManilaMed Hospital also cited anal sex, multiple sexual partners and sexual encounters, and the nonuse of condoms as the main factors behind the increase in the number of HIV/AIDS cases.

“There is really a problem with the sexual behavior of those newly tested,” Solante said in an Inquirer interview on the 29th observation of World AIDS Day on Friday.

“Anal sex was proven to be more risky than vaginal sex … (but) condoms were hardly being used,” he added.

Human Rights Watch (HRW) researcher for the Philippines Carlos Conde, however, blamed the “government’s policy failures” for fueling the epidemic.

“We’re not so much concerned about the sexual behavior of MSMs as the key affected population. To us that is not the issue,” said Conde, who last year wrote the report “Fueling the Philippines’ HIV Epidemic: Government Barriers to Condom Use by Men Who Have Sex with Men.”


Among the government policy failures that Conde mentioned were the lack of a national condom promotion strategy or campaign addressing MSMs, the stigma attached to the disease, the lack of sex education in schools and the government’s focus on treatment and testing instead of prevention.

The latest HIV/AIDS registry indicated that of the 1,962 new cases, 250 had developed into full-blown AIDS.  Most of the cases, or 95 percent, were males.  More than half of the cases reported were from the 24-34 age group, while 31 percent were aged 15-24.

Citing “The Special Report: State of the Philippine HIV Epidemic 2016” published by the Department of Health (DOH) and the Epidemiology Bureau, Solante estimated that currently, 56,000 Filipinos are living with HIV, a virus that infects cells of the immune system, making the patient vulnerable to infections.

HIV is usually transmitted through unprotected sexual intercourse and the transfusion of contaminated blood. It can also be transmitted between a mother and her child during pregnancy and childbirth and through breast-feeding.


According to the World Health Organization, the most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS), which can take from two to 15 years to develop, depending on the individual.

AIDS is defined by the development of certain cancers, infections and other severe clinical manifestations.

Solante said the study projected that, if unchecked, the number of HIV cases in the Philippines would balloon to 142,000 by 2022.

He added that apart from risky sexual behavior, curiosity among the young might be partly responsible for the rise in HIV/AIDS cases.

“There are so many gaps … family disconnect, peer influence, highly conservative family or society, religion. Definitely if you’re studying in a Catholic school, these things are not being discussed. (Sex is) still a taboo issue,” he added.

“Recent numbers indicate that we need to be teaching our children about this disease early.  As uncomfortable or taboo as that conversation is, it can quite literally save lives,” he said.

“Ultimately, HIV is a very behavior-centric disease. If we avoid certain behaviors, we are reasonably sure we can avoid contracting or spreading it,” Solante explained.

“All of my patients, I ask them if they are wearing condoms regularly, (and they said) they believe in using condoms but they don’t wear them,” the doctor said.

Conde, meanwhile, deplored the information campaign on HIV/AIDS that, he said, deferred too much to the Catholic Church and other conservative sectors of society.


“If you look around, you can’t see a condom advertisement that features or targets MSMs. It’s all heteronormative. The word ‘condom’ is not even used in these ads, clearly a deference by the advertising industry to the conservatives and the Catholic Church,” Conde said.

“Promoting condoms among young MSMs is crucial because of the role unsafe sex plays in HIV infection,” he added.

“There’s also hardly any safe sex education going on, particularly in high school. The key affected population is growing younger but they are not equipped with the proper knowledge on safe sex. Couple that with stigma and we really have a problem,” the country’s HRW researcher said.

The Philippine Drug Enforcement Agency (PDEA) recently came under fire for disclosing the HIV+ status of one of the suspects arrested in the agency’s drug raid on a plush hotel at Bonifacio Global City on Sunday, as this could stigmatize the suspect.  The PDEA has since apologized.

The Department of Education and DOH have not been decisive enough about promoting safe sex, including condom distribution, Conde said.

And while focusing on treatment and testing is good, “the government should give equal attention to prevention,” Conde said, adding that the government “should resist the pressure from conservatives for the sake of the public, especially the young, the marginalized and stigmatized.”

While HIV rights and support groups are filling in the vacuum left by the government on preventive measures, these nongovernment organizations can only do so much, Conde said.

“It is the responsibility of the government to take the bull by the horns and defeat the spread of HIV through massive safe sex education and condom promotion. It takes political will to do it, of course, and a willingness to stand up to the conservatives,” he added.


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Gilead Sciences commits $100 million to fight HIV/AIDS in Southern states

Gilead Science of Foster City is putting $100 million toward HIV/AIDS work in Southern states. Photo: Eric Risberg, Associated Press

Photo: Eric Risberg, Associated Press

Gilead Science of Foster City is putting $100 million toward HIV/AIDS work in Southern states.

Gilead Sciences will put $100 million toward creating a program to address HIV/AIDS in the southern United States, the company announced Monday.

The Foster City biopharmaceutical giant, one of the world’s largest sellers of HIV drugs, will partner with Emory University Rollins School of Public Health, the University of Houston Graduate College of Social Work and the Southern AIDS Coalition to identify and fund local organizations that provide care and public awareness for HIV/AIDS.

Southern states account for 45 percent of all people living with an HIV diagnosis, according to the Centers for Disease Control and Prevention. Rates of new infection rival those seen in the 1980s, said Gregg Alton, Gilead’s executive vice president of corporate and medical affairs.

“In some communities, those rates are actually rising — a chilling reminder that the epidemic is far from a thing of the past,” Alton said.

By Catherine Ho


AIDS Commission Reveals HIV/AIDS Still Number One Killer In Africa

HIV and AIDS have become leading causes of death in Africa with a total of 15,116 Ghanaians killed by the disease in 2016, while 20,418 new infections were recorded, the Ghana AIDS Commission (GAC) has said.

Of the new HIV infections, 17,375 representing 85 per cent were made up of adults above 15 years and 3,043 consisting of children under 14.

In the same year, Ghana had an HIV prevalence rate of 1.62 per cent, however the prevalence rate among pregnant women was 2.4 per cent.

This was made known by Mr William Kwaku Yeboah, Central Regional Technical Coordinator of GAC during an HIV and AIDS awareness walk organised by Central Regional Ghana Red Cross Society to commemorate this year’s World AIDS day on Saturday.

The celebration was on the global theme ‘the right to health’ and a national theme ‘the right to health: know your status, seek early treatment’.

The three hour walk, which brought together more than 500 school children, volunteers and staff of the Red Cross Society and the GAC was to help raise awareness to combat HIV and AIDS in the region.

The participants displayed placards with the inscription: ‘Protect your dream, protect yourself and your partner,’ ‘It is your HIV status, seek early treatment,’ ‘Let us join hands to end AIDS by 2030 ‘Youth sex abstinence is the best’, ‘Say no to stigma and discrimination’ among others.

Mr Yeboah who was speaking in an interview with the Ghana News Agency (GNA) disclosed that a total of 2,339 new HIV infections were recorded in the Central Region in the year under review.

He was concerned that despite the high level of awareness on the disease among Ghanaians, personal risk perception was still low.

He added that majority of the youth did not perceive themselves of being at risk and continued to engage in negative activities that put them at risk.

He admonished all HIV and AIDS working partners to maximise their efforts to facilitate faster positive behavioural change to reduce the rate of its infection and to ultimately reduce it to the barest minimum by 2030.

Mr Yeboah said HIV and AIDS remained an important obstacle to the socio-economic progress of the country and all must contribute towards achieving the long term goal to end AIDS by 2030.

Mr John Aidoo, the Central Regional Manager of the Ghana Red Cross Society said there was the need for Ghana to completely wipe out discrimination and stigmatisation of persons living with HIV because it was preventing people from getting tested or disclosing their status to relatives and partners.

He said the AIDS walk was to remind Ghanaians that the disease was still prevalent and stressed the need to have an attitudinal change towards indulging in things that were likely to get people infected with the virus.

He said the Red Cross would continue to educate communities on the disease and encouraged Ghanaians to be bold to test to know their status.

By Afedzi Abdullah, GNA


New overdose emergency response centre opens in BC

In what it says is an effort to “combat the continuing crisis and spearhead urgent action to save lives,” the BC government announced on Friday that it is launching a new Overdose Emergency Response Centre.

“Every day, this overdose crisis is devastating families and communities,” said Judy Darcy, Minister of Mental Health and Addictions. “We are escalating our response… to get at the very heart of the crisis so that no one has to lose another loved one.”

In a release, the province said staff at the emergency response centre will bring together provincial, health authority, municipal, Indigenous and law enforcement resources to tackle the overdose crisis at a community level.

The centre will also “work closely with five new regional response teams” to co-ordinate and strengthen addiction and overdose prevention programs on the ground with local teams.

The provincial centre and regional teams will prioritize four essential interventions to save lives and support a path to recovery for addicts.

Those interventions include:

  • Proactively identifying and supporting people at risk of overdose – including screening for drug use by health-care providers, clinical followup for people at risk, fast-tracked pathways to treatment and care, and connection to social supports like housing.
  • Addressing the unsafe drug supply through wider access to drug checking and substitution drug treatment, such as Suboxone and hydromorphone.
  • Expanding community-based harm reduction services, such as supervised consumption and overdose prevention sites, and outreach and mobile programs that extend the reach of harm reduction services.
  • Increasing availability of naloxone at the community level, and those trained to use the life-saving treatment.

Dr. Patricia Daly, chief medical health officer for Vancouver Coastal Health, will serve as the centre’s executive director and clinical lead for the Overdose Emergency Response Centre.

“We continue to see the tragic loss of life from overdoses across the province, and we need to intensify the response at all levels to turn this crisis around,” she said.

“This escalated emergency response strategy draws together and co-ordinates many partners – at the community, regional and provincial levels – with a common determination to save lives.”

The centre will work with the regional teams and new community action teams in hard-hit communities to intervene quickly with life-saving responses, early intervention and proactive treatment and support.

New community action teams will be in place by January 2018, in communities identified by overdose data as having most urgent need.

“The commitment and dedication poured into the provincial response over the past 18 months has saved countless lives,”said provincial health officer Dr. Perry Kendall, who declared the overdose crisis a public health emergency in 2016. “But people continue to die in record numbers, and we need to do more.”


B.C. attorney general to rethink charging people who don’t disclose HIV status prior to sex

David Eby says crown counsel to review federal report that says HIV is a health matter

B.C.'s Attorney General, David Eby, marked World AIDS Day in Vancouver on Dec. 1, 2017 at the Carnegie Community Centre.

B.C.’s Attorney General, David Eby, marked World AIDS Day in Vancouver on Dec. 1, 2017 at the Carnegie Community Centre. (Martin Diotte/CBC)

B.C. Attorney General David Eby says a new federal report that says HIV is primarily a public health issue will help the province update its guidelines on whether it pursues criminal charges against people who do not disclose that they are HIV-positive prior to sexual activity.

However, Eby would not say if B.C. will follow Ontario’s lead, which announced Friday it will no longer prosecute cases of HIV-positive people who don’t disclose their status to sexual partners if there is no realistic possibility of transmission.

In the past, people who have not disclosed they are HIV positive prior to sexual activity have faced assault or sexual assault charges. But advances in treatment have shown that the disease is now manageable. And the risk of transmission is negligible among people who are on a treatment plan.

While the province sets its own guidelines for pursuing criminal charges, Eby noted Ottawa makes the laws.

​”Our Crown counsel will be looking at this and developing and enhancing our own prosecutorial guidelines and deciding whether to prosecute, because we are bound by the federal law on this,” Eby said.

Fear of prosecution

Eby made the comments at Vancouver’s Carnegie Community Centre to mark World AIDS Day.

Eby’s announcement came in response to a new federal report that says HIV is primarily a health issue.

In a release, the Department of Justice said the report represents a “significant step forward” in addressing concerns about the the over-criminalization of HIV non-disclosure.

Fear of prosecution has prevented people from getting tested and seeking treatment, said a release from the federal Department of Justice.

The report was developed with the Public Health Agency of Canada.

Health issue, not criminal issue

The federal report says that although an HIV infection was once fatal, people receiving treatment can now live normal lives and have a low risk of risk of transmitting the virus.

“Our government is taking action to help reduce the stigmatization of persons living with HIV, including undertaking an evidence-based approach to addressing HIV non-disclosure in the criminal justice system,” said federal Justice Minister Jody Wilson-Raybould in a release.

Wilson-Raybould says the report will guide her work with provinces as Ottawa sets out to review existing charging and prosecution practices.

Eby did not comment on Ontario’s new direction, but applauded the federal report.

Modernize and enhance response

“It’s very important that the federal government has released a report and done research about the obligation of individuals to disclose their status and potential criminal liability that can result from non-disclosure,” he said.

He says Crown counsel in B.C. will review the report and he expects recommendations for policies to be “modernized and enhanced by the federal government’s report.”

Watch this news story from 1987, when a bill was introduced that sought to quarantine people who had developed AIDS.

Author: Chad Pawson


Trump wants to gut America’s progress against AIDS

The White House is decorated with a red ribbon for World AIDS Day. (Mark Wilson/Getty Images)

I am not in the “ignore President Trump’s tweets because they are a distraction from important things” camp. His most recent micro-harangues — accusing (without evidence) a news executive of wrongdoing, hinting that a television host may have been involved in murder and embracing the debunked anti-Muslim rantings of Britain’s alt-right — indicate some type of degeneration. The president seems to be in a downward spiral of anger, compulsion, conspiracy theorizing and prejudice that is alternately offensive and frightening.

But the thing is, Trump’s tweets are also distracting from other important matters of governance. And here is one that can’t get lost in the general madness: The Trump administration is proposing a reduction in funding and a shift in strategy in the fight against global AIDS that together would increase infections, cost lives and threaten the extraordinary progress of the past 15 years.

A little history. In January of 2003 — as a cresting wave of death from AIDS swept across sub-Saharan Africa — George W. Bush proposed the President’s Emergency Plan for AIDS Relief (PEPFAR), the largest initiative to fight a single disease in history. (I was one advocate for the plan within the Bush administration.) The legislation passed rapidly, with bipartisan support. The effort — including mass treatment, prevention and compassionate care — was continued and expanded under President Barack Obama.

On this World AIDS Day, the results are truly remarkable. PEPFAR supports 13 million people on lifesaving treatment. Thanks to PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria , and the increasing contributions of countries themselves, more than half of people in the world needing AIDS treatment are getting it.

But there is a predictable challenge ahead. Africa is experiencing a historic youth bulge and will have more than 800 million young people by 2050. How fast and far the AIDS virus spreads among them will determine much about the future of the epidemic. And the extent of that spread will be determined (in addition to direct outreach to young people) by the level of AIDS treatment.

This is true for two non-obvious reasons. First, the availability of treatment helps determine the level of AIDS testing. Significantly fewer men and women want to be tested for a disease that is a death sentence. And when people don’t know their status, they are more likely to transmit the virus. Second, when people living with AIDS are put on treatment, their viral load is dramatically reduced, making them less infectious to others. Treatment is an essential form of prevention. The sooner you treat someone, the more new infections you prevent.

During the George W. Bush and Obama administrations, the strategy on AIDS was pretty consistent: Put as many people on treatment as possible. Use economies within the program, and falling drug prices, to increase that number even further. Focus on the places and groups where transmission is highest, but act broadly enough to block transmission routes across the continent.

For the first time since early in the American AIDS response, a fundamental change in approach is being debated. In its 2018 budget, the Trump administration proposes an $800 million cut in America’s bilateral HIV/AIDS programs (along with a $225 million cut for the Global Fund). The State Department, in turn, has written a new AIDS strategy to reflect this lower level of funding. Resources would be concentrated on 13 “priority” countries, while current levels of treatment would be maintained in other places. Neither South Africa nor Nigeria — which together have about a quarter of AIDS cases in the world — would be in the “priority” category.

The results? According to the Kaiser Family Foundation, more than 800,000 fewer people (compared with the current trajectory) would be placed on treatment in the first year of the new strategy, and 2.7 million fewer by 2020. One recent study estimates 26 million additional AIDS infections and 4 million more preventable deaths over the next 15 years. When you are not moving forward against an epidemic, you end up moving backward, and rapidly.

All of which raises a few questions. Are Republicans in Congress prepared to squander a legacy of GOP leadership that has won the United States considerable goodwill around the world? Does Trump really want to be known for undermining an effort he praised during his campaign, as well as in his recent U.N. General Assembly speech? Among evangelical Christians, what definition of being “pro-life” does not include saving millions of lives from preventable disease and death?

There is only one AIDS strategy adequate to controlling this disease: full funding, and full speed ahead.