Talking treatment as prevention with Julio Montaner
Bob Leahy sits down and asks the hard questions with treatment as prevention's foremost proponent, Dr. Julio Montaner, head of the British Columbia Centre for Excellence in HIV/AIDS, while in Vancouver last week.
Author - Bob Leahy - Editor
29 April 2013
Bob Leahy: Thank you for talking to PositiveLite.com, Julio. The last time we talked was in January 2012 I think.
How have things shifted on the treatment as prevention scene in the last fifteen months. Are you starting to feel optimistic in terms
of what you'd like to see?
Dr. Montaner: Well as you know I have been feeling quite strongly for quite a number of years now that treatment as prevention
truly offers an opportunity to fully realize the potential of antiretroviral therapy, first and foremost at the individual level,
secondarily to pay a huge dividend when it comes to preventing HIV, TB and a number of other diseases. For us the challenge
was initially to get enough of a data base that the argument could be made compellingly enough so that every level of
decision making, from policy makers to community, could rally behind it. In my mind the evidence, particularly when
you weigh it against the challenge we are trying to address, was already overwhelming in 2006. Imagine how I feel now!
I think that since HPTN052 came on board that has allowed us to say this is definitive and conclusive evidence, and that
we now need to move on to implementation discussions. And in the last eighteen months we have seen a huge political evolution, from
Hilary Clinton to President Obama to (UNAIDS) Michel Sidibe progressively increasing the enthusiasm. To me, Michel Sidibe was
incredibly valuable in 2010 when he formally endorsed getting to zero through treatment as prevention but I sense that his
level of enthusiasm and eagerness today is exponentially greater, which is a great sign.
Bob: But in Canada, how do you feel about this. Have we made progress at all here in the last fifteen months?
You know British Columbia has been unique in the sense that I have been able to galvanize political support based on the
evidence exclusively and the return on investment, if you want to put it that way. The Province has been 100% behind us. Unfortunately
I have to say that I have been disappointed that the same attitude has not really panned out across the country. There has been a
whole lot of intellectual discourse, and it's incredibly frustrating, you know, when you show data regarding the evolution of
the epidemic in British Columbia and you juxtapose that against what is happening in Manitoba and Saskatchewan, for instance,
where HIV rates are continuing to rise - and it begs the question what else can I do to make my point?
I point my finger directly at the federal government. I think it is Stephen Harper's fault and the health ministers'
fault all the way from Tony Clement to Leona Aglukkaq, and PHAC's fault too because they are unable to release themselves from
their political masters to say "we have a crisis, we know how to address it, let's do it". In an area where the only answer
I get is "this is a matter for provincial jurisdiction" then that allows for all kinds of anarchy to occur and basically
we are left without a national HIV strategy.
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Source: PositiveLite.com - Canada's Online HIV Magazine
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