Manitoba will never be able to successfully control its growing HIV problem until the provincial government seriously commits to the needs of patients, says a B.C. doctor.
This warning comes from Dr. Julio Montaner, director of the internationally renowned British Columbia Centre for Excellence in HIV/AIDS. Montaner was in Winnipeg Tuesday to advise Manitoba physicians on the unique challenges facing the province and how to implement a suitable integrated treatment program. The search for a better system of care has been in the works for five years now, but with a recent spike in HIV cases -- including three cluster outbreaks in northern Manitoba communities this year -- the need to find a better treatment program is paramount.
There are an estimated 1,100 cases of HIV in Manitoba, with only 700 of those receiving regular medical and pharmaceutical treatment.
The average cost of the medications is $20,000 to $30,000 per year for each patient.
Dr. Ken Kasper, director of the Manitoba HIV program jointly run by Nine Circles Community Health Centre and Health Sciences Centre, said each year Manitoba sees roughly 30 to 60 people infected with the virus end treatment due to financial limitations.
"So you can see the strength of trying to cost avert, trying to slow down infection, because the price of a 20-year-old getting HIV for the health-care system is tremendous, almost $750,000 to $1 million for the lifetime of that individual," he said.
At the root of the problem for Kasper and his program is funding, specifically the lack of it.
Currently, people living with the virus who remain in the workforce must pay a deductible before their medication is covered. This hurdle for the working poor, and many financial obstacles like it placed in front of those infected, often leads to discontinued use of medications and an increased burden on the health-care system down the road.
Montaner puts it this way: while HIV/AIDS is no longer the automatic death sentence it was 25 to 30 years ago, the price tag for medication forces a person to stop treatment and leads to a greater chance of being admitted to the hospital, a greater chance of becoming non-productive in society, a better chance of leaving an orphan behind if they have children and an increased likelihood of transmitting HIV to others.
It's a return on investment that can't be measured in dollars, Montaner states. "If we create a positive environment around an HIV treatment program and we support that, you have the fundamental ingredients (for) turning the epidemic around. Can it be done? Of course, we've done it already."
The B.C. model, which aggressively targets and treats patients through subsidized care, is the framework Kasper wants in Manitoba, and it's no wonder, based on its success over the last 20 years. Faced with an HIV/AIDS epidemic in the late-1980s/early-1990s, specifically on the streets of Vancouver, B.C. decided to implement a 'treatment as prevention' program.
The results have been impressive. Since 1996, B.C. boasts a 95 per cent decrease in AIDS-related morbidity and mortality, a 99 per cent decrease in mother-to-child HIV transmission, a 60 per cent decrease in new HIV infections and a more than 90 per cent decrease in infections with injection drug users.
B.C. has more than 7,000 patients receiving treatment through its HIV/AIDS program, Montaner said, adding the province covers all of the $110-million price tag.
Besides the financial barriers in Manitoba, Kasper said geographical limitations for caregivers (treatment is typically Winnipeg-centric; 77 per cent of new tests originate inside the Perimeter Highway) and the absence of regular HIV testing options are the other obstacles facing a meaningful treatment program.