More than 60,000 Canadians and 37 million people worldwide live with HIV. In the early days of HIV and AIDS, there was enormous fear and discrimination – insofar as in British Columbia politicians it was debated to quarantine individuals with HIV.
Since then, scientific progress in HIV has been very fast. But HIV-related stigma and discrimination are not lost and the global epidemic is far from over.
There are still 2,000 new cases of HIV in Canada every year. Fundraising for AIDS service organizations has slowed and global funding for HIV research and development has declined.
We call World AIDS Day an acknowledgment that negative judgments and feelings about HIV are interrelated and entangled with racism, transphobia and homophobia.
You can have HIV and become & # 39; cannot be transmitted & # 39;
Because of access to modern antiretroviral treatment, HIV has become the most manageable condition. Research from the BC Center for Excellence in HIV / AIDS (BC-CfE) has shown that people with HIV who are taking care now have the same life expectancies as those who are HIV-negative.
Julio Montaner, Director of BC-CfE, pioneered the concept of treatment as prevention & # 39; (TasP). The medical and scientific community has reached a consensus that someone living with HIV can be "not transmitted" – which means there is no risk of them sexually transmitting the virus – if they achieve undetectable viral load through HIV treatment. People living with HIV have led the "undetected = cannot be transmitted" movement to share this message of hope and to fight HIV stigma.
According to our own research on the Momentum Health Study, the number of HIV-negative gay men in Vancouver who almost doubled this concept from 2012 to 2015. The good news is that this is not associated with a decrease in condom use.
Bad news: Key messages about HIV prevention and testing may not reach all audiences. For example, we found that bisexual men, older men and men living outside the city were significantly less likely to be tested for HIV over the past two years.
Unfortunately, efforts to stop the spread of HIV are hindered by fear and stigma. For example, some gay and bisexual men have never been tested for HIV because they are worried about the impact on their relationship and sex life, and that they may face discrimination.
Men are still afraid to tell their doctors and be examined
In Canada, it is still a criminal offense not to disclose a person's HIV status in consensual sex if a condom is not used.
This discriminatory law persists even though there is a very strong scientific consensus that an individual with an undetectable viral load cannot transmit the virus. This is evident through studies in which nearly 60,000 acts of condom-less relationships between serodiscordant couples (where one partner is HIV negative and the other is HIV positive) does not produce HIV transmission.
World AIDS Day: Let's stop criminalizing HIV status
This fear also makes it difficult for men to tell their doctors about sex with other men. At least a quarter of Momentum participants haven't told their doctors about having sex with men, and those people are half as likely to have just been tested for HIV.
Stigma also affects access to services and mental health. Men who experience more mental challenges (depression and drug use) are more likely to be involved in sex that can pass HIV.
Dissociation feelings from disease can be intertwined with discrimination. For example, HIV risk among trans men in the Momentum Health Study is shaped by difficulties in finding sexual partners safely, challenges with condom use and barriers to accessing health services including transitional-related services.
There are effective HIV prevention drugs
We now have more tools in the HIV prevention toolbox than at the peak of the epidemic. Safer sex, which was once called a condom, now considers issues such as undetectable status and pre-exposure prophylaxis, or PrEP.
PrPP HIV prevention drugs are very effective if consumed consistently and available at no cost to qualified HIV negative people in British Columbia who are at high risk of HIV.
Before PrEP was covered in B.C., only 2.3 percent of gay men in the Momentum Health Study in Vancouver used PrEP. However, PrEP awareness more than quadrupled to 80 percent from 18 percent during this period.
Although the challenges for access remain, thousands of gay men and other people are at risk of contracting HIV at B.C. now take free PrEP.
HIV has changed. And our perception must follow. Now it's time for policy makers, service providers and the country as a whole to embrace a better understanding of HIV.
Satisfied, ignorance and continuing to see HIV as something embarrassing will make us not progress in our efforts to support people living with HIV and reduce new infections.