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New STOP HIV guidelines include gay men

'We feel that is a positive development,' says HIM executive director

"It is good as far as it goes, but it doesn't go far enough," Positive Living BC chair John Bishop says of BC's STOP HIV/AIDS program. Credit: Courtesy of John Bishop

Vancouver’s Health Initiative for Men (HIM) is applauding the inclusion of gay men’s needs in the BC government’s recently released guidelines for its expanded STOP HIV/AIDS program.

“I was pleased to see that they have made some acknowledgment of the impact it has on men who have sex with men [MSM],” says HIM executive director Wayne Robert. “We feel that is a positive development.”

The guidelines, released in January, will help provincial health authorities set their priorities for the program’s local implementation.

Originally begun as a pilot project in Vancouver and Prince George three years ago, the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) program received a funding boost last November of $20 million annually to expand provincewide.

The new funding, set to begin April 1, is expected to help regional health authorities better engage the broader community and specific at-risk groups in HIV testing, outreach and treatment. 

“The framework has many principles that we agree with,” Robert says. “I think it’s good that they are being so concrete about specific targets.”

The new guidelines specifically acknowledge that men who have sex with men continue to account for the majority of new HIV infections in BC.

“That’s a really critical point that’s been made strongly in this document,” Robert says.

The guidelines stress the importance of community collaboration in designing and implementing services to engage men who have sex with men.

The guidelines also note the importance of distributing condoms and clean needles to reduce the risks of HIV transmission.

“It certainly gives a lot of credit to the work we’ve been doing already. It’s an endorsement of what we’ve been doing with our condom distribution initiatives,” Robert says, noting that HIM distributes approximately 150,000 condoms annually, many through local bars and nightclubs.

“When the seek and treat started, it was just that — seek and treat. This has gone beyond,” he says. “It talks about public education, it talks about harm reduction, it talks about stigmatization, it talks about prevention programs.”

Robert says he’s pleased with the guidelines, though it remains to be seen how local health boards will implement them.

The chair of Positive Living BC applauds the guidelines’ inclusion of men who have sex with men for testing and service delivery. “But how do you educate that population?” John Bishop asks.

Bishop says a more in-depth initiative is needed.

“It is good as far as it goes, but it doesn’t go far enough,” he says of the STOP HIV/AIDS program.

“It is not enough to stop the spread of HIV among young MSM,” Bishop says. “We are not seeing a reduction in the number of new HIV infections in this community. The goal of STOP HIV/AIDS is to increase testing, but that simply isn’t enough. Young gay men need education and information around safer sex practices and to be made aware that this disease is not over — not by a long shot.”

Bishop says the BC government’s vision of an “AIDS-free generation” is unrealistic.

“I have a lot of trouble with the language being used,” he says. “Language like ‘It’s different now’ and ‘an AIDS-free generation’ creates a false sense in the public that HIV/AIDS is over and done with. It isn’t. I think this type of language does a huge disservice to the HIV/AIDS community.”

A spokesperson for the Ministry of Health says the goal is not so far-fetched.

“We feel that the incorporation of treatment as prevention into the existing array of prevention-based HIV modalities — such as condoms and needle distribution and recovery, along with better reach and engagement of British Columbians in HIV testing and care — will result in us achieving this vision,” Trish Rorison says.

“Since the advent of highly active antiretroviral therapy — and due to the dedicated efforts of community, regional health authorities and the BC Centre for Excellence in HIV/AIDS — we have virtually eliminated mother-to-child transmission in the province and reduced AIDS case reports by approximately 80 percent,” Rorison adds.

Bishop says more funding, resources and targeted education are still required if BC hopes to reduce the high HIV transmission rates among gay men.

“Education has to be a key piece in this, for youth and the public at large,” he says. “The fact is that they have to educate people about gay sex before people engage in gay sex.”

“Preaching doesn’t work. It’s fear-based. It simply does not engage the community we need to engage,” he says. “We’re failing this new generation miserably by not fully educating the young gay male.”