British Columbia’s STOP HIV/AIDS program was launched in 2010 as a four-year pilot in Prince George and Vancouver and expanded in 2013 to include the whole province.
Gina McGowan, of the British Columbia Ministry of Health, explained that, as of 2007, British Columbia had the highest rate of new HIV infections in Canada, concentrated among Indigenous people, people who inject drugs, men who have sex with men and people who have immigrated from countries where HIV is endemic. Mortality rates were highest in Prince George and the downtown east side of Vancouver.
By 2009, mathematical modelling had demonstrated the potential cost effectiveness of treatment as prevention, and there was support to develop innovative approaches to testing and linkage to care. The STOP HIV/AIDS pilot was given $48 million in new funding and made data-driven decisions to invest those funds in the introduction of routine HIV tests in primary care settings, outreach teams, online technologies, a peer navigation program, wrap around nursing and pharmacy care.
Successful initiatives from the pilot program became part of the From Hope to Health strategic policy, which includes collaboratively-developed goals, milestones and three-year targets for the province. The province has also invested an additional $19 million to implement lessons learned from the pilot project across the province and introduced annual public reporting on the project’s progress.
The goals of the STOP HIV/AIDS project and strategy include ensuring consistent testing and care, increasing testing, diagnosing people earlier, and having 90% of those who are willing and eligible on antiretroviral treatment. Thus far, the program has shown an increase in testing and diagnosis, an increase in the proportion of people diagnosed with HIV who are on treatment, an increase in testing for HCV and syphilis, and a decrease in the number of people living with a detectable viral load.
McGowan explained that the health care situation in Canada, and particularly in BC, is different from that in much of the United States. In British Columbia, the Medical Services Plan covers the full cost of medically-provided services for anyone who earns less than $22,000 annually and the BC PharmaCare program provides free HIV medication to anyone who needs it.
Challenges that remain include: changing the culture in HIV testing away from risk-based testing, stigma in First Nations communities, concerns about confidentiality, and barriers to care in rural and remote areas. McGowan also noted that, compared to other groups, youth and women not seen the same improvements across the cascade, and that federal drug regulations create challenges in expanding supervised consumption services.
STOP HIV/AIDS initiative website
From Hope to Health: Toward an AIDS-free Generation
Gina McGowan’s slides