Despite calls for the federal government to take immediate action to eradicate human immunodeficiency virus (HIV) in Canada, the 2023 budget fell short of offering new funding — and didn’t reference HIV once.
In the 41 years since the first HIV case was documented in Canada, groundbreaking medical discoveries are bringing the prospect of a cure closer than ever. But advocates say it isn’t the science that’s preventing the eradication of this virus, it’s a lack of political will to provide the funding needed to expand access to treatment.
HIV organizations tasked with growing infections and high inflation-fuelled operational costs say until the government increases funding, more Canadians will suffer unnecessarily. Under the current system, they say they are left fighting for limited government dollars.
“Half of our time is on the programs that we’ve been funded for and the other half of the time is finding new programs,” said Ken Miller, executive director of the Canadian AIDS Society.
“Otherwise we have to fold.”
Currently, the federal government spends $33.4 million annually on the HIV and Hepatitis C Community Action Fund and the Harm Reduction Fund. The fund supports organizations and projects working to prevent infections and improve access to all sexually transmitted and blood-borne infections treatment.
Last year, Canada also pledged $17.9 million to make HIV self-testing more widely available, including in northern, remote and isolated communities across Canada.
But NDP justice and LGBTQ2 critic Randall Garrison said raising the annual amount allocated for HIV treatment and prevention would be a drop in the bucket in the scheme of all government spending.
“My disappointment is that we now know what we need to do to eradicate this disease once and for all in Canada, and it would take a very small increase,” he said.
“But for some reason, we seem stuck just beyond the goalposts.”
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Advocates are calling for the federal government to increase funding to address HIV and acquired immunodeficiency syndrome (AIDS) in Canada to $100 million annually. This was unanimously recommended by the House of Commons Standing Committee on Health in 2019.
Health Minister Jean-Yves Duclos was unavailable for an interview about HIV funding but in a written statement, his office said that the ministry is committed to working with community-based organizations to end inequalities and inequities in HIV care.
“Canada supports the global goal of ending HIV and AIDS as a public health concern by 2030,” the statement said in part. “We still have a long way to go, yet we have many reasons to be optimistic—and Canada will continue to work in partnership with communities impacted by or at risk for HIV to support research and treatments.”
When asked about funding for HIV in the 2023 budget, the minister’s office pointed to the proposal to spend $36 million over three years, starting in 2024-25, to Health Canada to renew the Sexual and Reproductive Health Fund.
However, this fund supports community-based organizations on a wide range of sexual and reproductive health care information and services, including abortions and improving access to other treatments, not just HIV.
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Recent announcements of government HIV funding have also come under scrutiny.
“There have been times when the Canadian government has announced essentially the continuity of programs that have already been in service,” Miller said. “They’re really good about creating these moments where people are like, ‘Yeah, right on, awesome — we’re doing great. We’re supporting people.’ But it’s not supporting in the way that’s really necessary.”
Garrison said convincing his political colleagues to act is easier said than done.
“We’re somehow being complacent and thinking that this is no longer a crisis,” he said. “It’s very disappointing.”
Why stigma remains a major barrier
Advocates like Vimbayi Munonyara, the regional HIV/AIDS Connection coordinator in London, Ont., are working to change decision-makers’ minds.
Munonyara was born in Zimbabwe, a country with a high prevalence of HIV. At a young age, she watched family members and friends die from HIV infections. She said those losses motivate her to work on behalf of those living with the virus.
“Stigma is still the biggest barrier I see,” Munonyara said.
Although ignorance about HIV is still prevalent, she acknowledges much has changed since her early interactions with the virus, including antiretroviral therapy (ART) — a common treatment which reduces HIV to undetectable levels and prevents transmission to others.
“I’ve just seen how HIV treatment has evolved over the years and how people can live very fulfilled lives,” she said.
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While treatments have improved, most HIV infections are not curable. If left untreated, HIV can lead to AIDS, which is potentially life-threatening.
Scientists have been working to cure HIV, including virologist Marc-Andre Langlois at the University of Ottawa.
Curing HIV isn’t easy. Several vaccines are in the works to prevent HIV, but there has not been extensive progress. Globally, there are only three people considered to be cured from HIV. All three of these patients were receiving stem cell transplants with the primary goal of eliminating cancer. Stem cell transplants are not available to most HIV patients, as they are incredibly high-risk procedures.
But Langlois made a discovery in January which could eliminate the biggest barriers to finding a cure. He found that a family of proteins long thought to be antiviral and effective in reducing HIV are sometimes actually keeping the virus undetectable in the body — flipping the way researchers have been approaching this infection on its head.
“This is the major roadblock for eradicating HIV: the virus goes into latency and becomes undetectable,” Langlois said. “So it gives us a new clue to what to look at, what to target, to try to prevent HIV infection and also prevent HIV from becoming latent.”
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Some advocates say discoveries like this could have been made sooner with more funding. The pandemic also caused researchers, including Langlois’ lab, to pivot focus on combating COVID.
“After COVID, it seems that people kind of almost forgot about HIV a little bit,” Munonyara said.
But COVID didn’t slow down the number of HIV cases. There were 1,639 cases of new HIV diagnoses during 2020 alone in Canada, and that number jumped by about five per cent from 2020 to 2021. In 2018, the most recent year that data is available, it was estimated that 62,050 people in Canada were living with HIV.
Miller has seen the recent rise in cases up close.
“It’s shooting up from where it was and I can only imagine, or I can only believe, it’s due to the lack of funding,” Miller said.
The spike isn’t across the board though, and shows the key work still yet to be done.
There are priority communities, are Indigenous Peoples, African, Caribbean and Black people, gay, bisexual and other men who have sex with men, and people who use drugs, who are more impacted by HIV.
“There’s a saying HIV persists where injustices exist,” Miller said. “The prevalence and the occurrence of HIV are incredibly telling of the marginalization of people.”