In 1981, AIDS was first recognized as a new disease. Caused by the HIV virus, it first presented as a strange kind of pneumonia. Doctors soon realized that although the pneumonia was treatable, the destruction of the immune systems of AIDS patients meant that new complications were always waiting. Treating the symptoms alone only extended lives by weeks or months. The world watched as AIDS grew to a global pandemic.
Soon, researchers turned to treating the virus itself, instead of just the symptoms it caused. Controlling the HIV virus not only brought AIDS symptoms under control, but also drastically reduced its transmission. This new paradigm of treatment as prevention has reduced the global AIDS pandemic to a rare occurrence, and revolutionized the way we approach infectious diseases.
Dr. Julio Montaner, Director of the BC Centre for Excellence in HIV and AIDS and special United Nations advisor on HIV, was at the forefront of this revolution, and his work has established a new global standard of care for HIV and AIDS patients. When his work in this field started in 1986, researchers knew very little about the origin or nature of HIV. By 1995, clinical trials revealed that anti-retroviral therapy could reduce an HIV infection to undetectable levels in patients. By 2000, a growing body of data started to reveal that this treatment also reduced transmission, blocking the spread of new infections. In 2006, Montaner and other Canadian scientists were formally calling for treatment as prevention, which has changed the course of this global pandemic.
HIV was a public health crisis that “affected communities that traditionally have poor access to healthcare. We needed to tailor access programs that were culturally and socially sensitive, so that we could have the greatest positive impact,” says Montaner.
These treatment strategies went beyond just pills, finding ways to penetrate communities that are traditionally underserved. In British Columbia, anti-retroviral therapy is now available to every person affected by HIV. Moreover, the United Nations is committed to expanding treatment globally through its 90-90-90 target. Montaner explains, “The 90-90-90 calls for 90% of people affected by HIV globally to be diagnosed, 90% of those to get basic treatment, and 90% of those to be virology undetectable. If we meet that target by 2020, by 2030, we should be able to decrease the burden of the disease by 90% and eradicate mortality by approximately 90% globally.”