It’s a pleasure chatting with CATIE’s Laurie Edmiston. She is frank, knowledgeable, speaks with conviction – and generous with both her time and opinions.
I asked her this week for her opinion on three topics crucial to where we are in the response to HIV at this time. I asked her about CATIE’s decision to endorse U=U (Undetectable = Untransmittable) earlier this year and CATIE’s ongoing role in providing information and resources around that topic. I asked her about the status of the funding discussions with the Public Health Agency of Canada (PHAC) that has seen many agencies’ funding requests cut or denied – and what impact this had had on CATIE. Finally I asked her about the status of any Canadian HIV/AIDS Strategy – we haven’t had one for some time.
Candid as usual, here is what Laurie shared with us.
“This is groundbreaking. As I said in my blog the “fabulousness” of this scientific development can’t be over-stated. This is huge for individuals living with HIV; it’s huge for moving forward on crucial issues like advocacy surrounding criminalization of HIV non-disclosure and it’s huge for prevention messaging, for reduction of stigma and also in the push to test the undiagnosed.
Now we know that someone who is positive and is adherent to their treatment and is undetectable does not transmit HIV to their sexual partners. This has been coming for a long time - it’s been ten years that we have heard about U=U in some way, but there has been a great deal of hesitancy on the part of service providers and health care providers in particular to really embrace this and turn the old messaging – that HIV-negative partners of people living with HIV were at highest risk of transmission -- on its head.
It’s about time. The world, and in fact Canada, has been slow to celebrate the implications of this research. I think as service providers we have felt so responsible to make sure that nobody gets infected because they might take our messaging and run with it in a way that wasn’t intended, so we were very cautious. The science is conclusive now and we really have to embrace it and get the word out – and push other people to do the same.”
“Our national CATIE Forum is November 23-24 in Toronto. U=U will be a dominant theme. We also do what we call “blended learning” which is essentially a combination of webinars, online learning, discussion boards and often culminating in face-to-face meetings. A course that’s in the final stages of approval right now is on preventing the sexual transmission of HIV. We have a number of service provider resources on U=U that are already out there. One is a fact sheet on the subject.
Also, our prevention statement giving direction to service providers is here and there is this client resource here as well as other client resources in process.
Well, the total Federal Initiative was $84.4 million, or scaled up to that over a period of a few years. Part of that was carved out by Canada’s contribution to CHVI - the Canadian HIV Vaccine Initiative which was for approximately $10 million. CHVI has now “sunsetted” so we are advocating for that amount to be restored to the Community Action Fund (the $28.4 million portion of the Federal Initiative).
Everybody is on the same page that there needs to be more money put into the Community Action Fund, but it’s more complicated than that. I think there needs to be a plan; there was a Stakeholders’ meeting in Ottawa a couple of weeks ago with 120 participants (policy makers from the provincial and territorial governments, researchers, community representatives including people from newly funded CAF organizations), to identify concrete actions to address STBBIs in Canada. There were a lot of good ideas raised but it depends on how well PHAC distils that input.”
“We have not signed our contribution agreement yet (the funding contract with the federal government). But what I can tell you is that ours has been flat-lined – at one point they were cutting us back – so at this point and in principle we are talking about the same budget we have had for nine years. In that time our role was expanded beyond our original expertise on HIV treatment information; we took on prevention and we took on Hepatitis C, so what we were going to be doing was taking on population-specific work on STIs for gay men and also further developing our convening role, bringing leaders together around issues to plan around solution-focused policy. PHAC has said that’s their role and they are going to do that.
PHAC is also no longer seeing the importance of CATIE-developed client resources that we have always done in partnership with population-specific organizations. We will be doing far less travel. We have had a reduction of five staff.”
“They have never used the word :strategy". What they talk about is identifying “concrete actions” to address sexually transmitted and blood-borne infections. It is and should be a strategy. My reading of it is that the Minister is very well intentioned, very smart and very progressive but she doesn’t want to see her staff develop strategies that sit on the shelf.
Having said that, you need to have a plan to develop good actions. I think the whole Community Action Fund process is an example of something that went terribly awry partly because they didn’t have a strategic plan to guide their efforts in distributing resources. They didn’t have targets. They didn’t have a vision. They have been inconsistent, contradictory and arrogant. That’s just not OK. From CATIE’s experience and everything I hear from everyone, it’s been a miserable process.”