Gay health advocates say the BC Liberals’ promise to spend nearly $20 million annually to expand a pilot program aimed at reducing HIV transmission through early testing and treatment is overly focused on just one piece of the prevention puzzle.
“The drawback to the seek-and-treat strategy with gay men is that we’ve been doing it for years already,” says YouthCO’s Michael Reid. “We have a very high number of gay men getting tested compared to other groups in the population.”
What gay men need is more education regarding transmission and risk, especially in the under-30 age group, where the number of new infections is highest among gay, bisexual and other men who have sex with men, Reid says.
“The STOP HIV/AIDS program is helping, but you also need to engage with the community,” he says. “We need a little bit of everything.”
According to the BC Centre for Disease Control’s 2011 HIV Annual Report, BC has seen the largest decline in new HIV diagnoses in Canada. However, new infection rates among men who have sex with men continue to increase, from 152 new cases in 2010 to 167 new cases in 2011.
In contrast, new infections among intravenous drug users declined during the same period, the report notes.
Supporters of the $48-million Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) pilot program — which aims to detect infection sooner, through regular testing, and start HIV-positive people on viral-load suppressants immediately to prevent further transmission — say it has allowed health professionals to sooner identify and treat HIV.
The program was introduced three years ago in Vancouver and Prince George and, beginning April 1, 2013, will expand throughout the province. New screening outreach programs, testing technologies, and additional staff for community groups to run prevention, testing, support and treatment programs are some of the ways regional health authorities are expected to spend the annual funds.
Ken Buchanan, former chair of Positive Living BC, supports the STOP HIV/AIDS initiative and its expansion across the province, but he doesn’t know whether it will decrease transmission rates among gay men.
He believes resources should be distributed to specific communities based on greatest need. “The populations that are having the largest number of new infections should get extra [funding and resources],” he says.
Wayne Robert, executive director of the Health Initiative for Men (HIM), agrees.
Though Robert supports the program and its expansion overall, he thinks men who have sex with men need more targeted funding.
“I feel that the dollars should be allocated according to the epidemiological findings,” he says.
A spokesperson for the BC Health Ministry says the $19.9 million will be divided annually among all the provincial health authorities. But “how the funds will be distributed has yet to be finalized,” Ryan Jabs says.
It will be up to each regional health authority to decide which initiatives and organizations benefit locally, he explains.
“While healthcare funding decisions are not based on sexual orientation, the gay male population is, without question, a specific target group,” Jabs says, “and non-profit groups have been provided funds to support and prevent transmission among this group, such as the Health Initiative for Men.”
Jabs says YouthCO and Positive Living BC have also received funding that has contributed to the creation of programs to support gay men under the STOP HIV/AIDS pilot program, “but it has not been the primary focus of the contract.”
Robert confirms that STOP HIV/AIDS funding has allowed HIM to expand its hours of operation downtown and to open another clinic in East Vancouver. As a result, 3,000 more men got tested this year, he says.
HIM is also looking into launching an online HIV information database that will provide up-to-date information to the most remote communities in BC, he adds.
YouthCO has also been working with the Vancouver Coastal Health (VCH) authority to prevent HIV transmission in the gay community. This summer the organization teamed up with VCH nurses to launch a mobile HIV-screening and information clinic. The clinic is still offering testing services and support in the gay village, Reid says.
While some members of the gay community may be benefiting from initiatives under the STOP HIV/AIDS program, others remain skeptical.
“Why aren’t we seeing a drop in infection rates among gay men since STOP HIV/AIDS has been implemented?” asks Dr Rick Marchand, executive manager of the Community-Based Research Centre in Vancouver, which co-conducted the ManCount study.
“There’s been increased HIV testing for every population in the province, including gay guys, and that’s great,” Marchand says. But infection rates are still increasing among gay men. That means a different approach is necessary when addressing HIV transmission among gay men, he emphasizes.
Understanding the social determinants of health is just as important as testing when it comes to lowering transmission rates among marginalized groups, Marchand says.
“There’s homophobia and homo-negativity in our culture,” he explains. “We want to look at these issues and support gay guys more, but this $20 million probably won’t go there. Testing is one part of the puzzle, but there are other issues to look at.”
Dr Julio Montaner, director of BC’s Centre for Excellence in HIV/AIDS, maintains that regular testing under the STOP HIV/AIDS program has been successful in decreasing the transmission of HIV in the gay community. However, he also agrees that addressing the social determinants is crucial to raising awareness of the importance of regular HIV screening.
“Recently with the MSM [men who have sex with men] group, we haven’t seen the number of new cases going down as much as we’d like,” Montaner admits.
He says unequal access to services, remaining closeted, and gaps in safer sex education all contribute to the ongoing trend of new HIV infections among men who have sex with men, especially among younger men.
Montaner says it is crucial that studies focus on how to better reach young gay men, as they make up the largest rate of new infections among BC’s gay population.
“We need to do more to look at sexual practices in a more comprehensive way,” he says. “We need to learn how to better engage with the young MSM population.”
Marchand would like to see a holistic outreach and support program tailored to men who have sex with men.
“Testing is one part, but really we should be looking at a more comprehensive plan around HIV prevention,” he says. “There are small pockets of services that are going on, but for the size of the problem it doesn’t make an impact.”
“Gay guys are so impacted and affected by HIV, but they’re so marginalized when it comes to where they can go to get resources,” Marchand continues. “There’s no coordinated effort that goes on in BC about HIV prevention. We need to look at the broader picture. What we have been doing hasn’t been effective.”
Dr Mark Gilbert, physician epidemiologist at the BC Centre for Disease Control (BCCDC), agrees.
“We do need to look a little more upstream in regard to focusing on mental health and other risks associated with HIV,” Gilbert says.
“I certainly support looking at the social determinants as they are related to risks for infection,” he says, “and I do think testing is still very important. We know that the earlier someone is diagnosed the better they will be able to prevent the spread of the virus.”
Gilbert says the BCCDC is analyzing various provincial data to comprehensively understand current trends in HIV, behaviour and social determinants for gay men. He expects a report will be released next year.
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