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Orbinski offers hope in fight against AIDS

April 15, 2011


It's not hard to listen to Canadian physician Dr. James Orbinski. It's just difficult to hear what he has to say.

As Médicins Sans Frontières' head of mission in Rwanda during the 1994 genocide, he said the water near the Kigali hospital where he worked literally ran red with blood.

He was in Somalia during the 1992-93 civil war and famine, and witnessed the scourge of AIDS first-hand as a medical student in Rwanda.

But on Thursday night, as keynote speaker at the 20th anniversary of the Canadian Association for HIV Research conference in Toronto, the award-winning humanitarian expressed hope.

In 1999, less than 40,000 people in the developing world received HIV/AIDS drugs compared to 6 million today. Thirty years into the pandemic, infection rates in 33 countries worldwide have fallen 25 per cent.

We asked Orbinski, now a University of Toronto professor and chair of global health at the university's Dalla Lana School of Public Health, about AIDS today:

Are we any closer today to preventing the spread of HIV/AIDS?

It is possible to create a vaccine. But science is an imperfect process and you're trying to discover something that you don't know. Today, scientists are looking at nanolipids, or fat-based vaccines. A year ago, nobody was talking about that.

HIV/AIDS is still an enormous problem in Africa, but some might say it is no longer a problem in countries like Canada. What do you think?

It is a global problem, and thus a Canadian problem.

Canadian Blood Services (CBS) still refuses to take blood from men who have had sex with other men since 1977. What is your position on this?

The policy is not one that is designed to achieve inclusiveness, but to minimize risk to the safety of the blood supply. In the same vein, the CBS also indefinitely defers individuals from giving blood that have spent more than three months in the United Kingdom or France between 1980 and 1996, due to the increased risk of potential exposure to Creutzfeldt-Jakob disease.

What are Canada's infection rates today?

In recent years around a quarter of new adult HIV diagnoses have been among women, half in people under 20. Although most exposure to HIV was from heterosexual sex, injecting drug use (IDU) accounted for over 19% of infections women in 2009.

The proportion accounted for by men who have sex with men (still the largest category) fell from above three-quarters in the years prior to 1994, to 40% in 2009. Conversely, the heterosexual exposure category increased from 10% to 24% over the same period. The IDU category has also risen to 24%.

Bill C-393 would have allowed Canadian generic drug manufacturers to produce cheap HIV/AIDS drugs. Why was it important?

Certain medications are produced by generic producers in India and South Korea. To buy them, governments in the developing world go through the Global Fund to Fight Aids, Tuberculosis and Malaria, which was created by the UN in 2002. But there are certain medications that aren't produced, because producers in India or elsewhere don't have the means.

Male circumcision has been recommended as an HIV/AIDS prevention strategy in Africa by the World Health Organization. Is it necessary here?

A policy recommendation of this kind would be based on population incidence and prevalence of HIV, and on the dominant modes of transmission. In Africa, prevalence and incidence is very high, and transmission is primarily heterosexual. This is not the case in Canada.


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