Creating a comprehensive cascade: CTAC issues call to action

Published 01, Dec, 2017
Author // Guest Authors - Revolving Door

To achieve and exceed the three 90-90-90-targets, two new targets are proposed

Creating a comprehensive cascade: CTAC issues call to action

As we approach World AIDS Day on December 1, CTAC is sending a strong message that “we’re not going away” by reaching out to select policymakers and their critics at all levels of government across Canada. We are providing them with an update on the issues of access to HIV and HCV treatment and care across Canada.

CTAC was created by HIV positive leaders in 1996 to ensure access to treatment, care and support for people living with HIV/AIDS and people living with HIV/hepatitis C co-infection. We do so by working with the public, private and not for profit sectors.

This new CTAC document, “Creating a Comprehensive Cascade,” reveals the injustice created by Canada’s disjointed approach to treatment access and suggests some possible solutions. It compares costs and access for three sample patients in jurisdictions across Canada, illustrating the inequity between and within jurisdictions.

We concluded that access to HIV/HCV treatment in Canada is shaped more by where a person lives than what they need. Many Canadians are uninsured, underinsured, or uncertainly insured due to precarious or part-time employment. Each month, too many of them need to decide, do I pay my rent, or do I pay for my HIV medication?

Canada has endorsed the UNAIDS 90-90-90 goals. These international targets aim to have 90% of people with HIV diagnosed, 90% of those receiving antiretroviral treatment, and 90% of those virally suppressed by 2020. Canada is lagging behind other nations in reaching these goals.

The pan-Canadian environmental scan contained within “Creating a Comprehensive Cascade” identifies the increasing gaps in Canada’s HIV and HCV response and is a call to action to government and community leadership to adopt a more comprehensive vision of the care cascade and the three goals of the UN AIDS 90-90-90. To achieve and exceed the three 90-90-90-targets, two new targets are proposed:

The Fourth 90: 90% of those with viral load suppression will have good health-related quality of life.

People with HIV need tangible improvements to their well-being. This person-centred goal emphasizes that test tube measures cannot be the endpoint of HIV care. It will:

 Focus strategic momentum and health innovation on how care is delivered, prompting better integration of care services.

 Drive the development of more peer supports.

CTAC is advocating for a 5th 90: $90 Million in annual HIV funding for a federal HIV/AIDS Strategy that sets measurable goals every five years.

Federal and provincial HIV/AIDS funding has stagnated or been diluted for almost a decade. The $90 million annual budget proposed would reverse this trend, yet remains less than the $100 million budget recommended by the Standing Committee on Health in 2003. There should be clear funding commitments to other STBBIs beyond this strategy. This HIV specific funding is necessary to:

 Adequately support existing services.

 Achieve the goals established by international targets.

 Scale-up innovative integrated health care models that will help to address quality of life.

 Preserve and strengthen the exceptional networks of community- based organizations that respond most effectively to the needs of people at risk of or living with HIV.

 Support the engagement of people living with HIV in shaping their care

 Support the continuation of services in smaller communities.

As World AIDS Day approaches on December 1st, CTAC is asking Canadian policymakers to reflect on why Canada is not among the seven countries who have already reached these targets (Botswana, Cambodia, Denmark, Iceland, Singapore, Sweden and the United Kingdom) or the 11 other countries that UNAIDS believes are on the cusp of doing so.

Canada lacks a national AIDS strategy, and a clear commitment to the well-being and quality of life of people living with HIV. All Canadians continue to pay for HIV treatment, due to the chronic underfunding of HIV prevention efforts and the restrictions on vital prevention tools such as self-testing and pre-exposure prophylaxis (PrEP) for HIV.

We continue to seek federal and provincial leadership on these issues. We are asking the policymakers to take action on two vital issues:

 Access to HIV pre-exposure prophylaxis (PrEP)

PrEP is a safe and cost effective way to reduce HIV transmission. It has been approved by Health Canada and it needs to be made available to people at risk of infection. Only people in Quebec and Ontario, as well as the beneficiaries of some private drug plans can readily access this new prevention tool. PrEP needs to be available to all Canadians as part of a coordinated plan to make HIV transmissions rare in Canada. With the recent arrival of new generic forms of PrEP, costs are decreasing and there is an opportunity for governments to act on this innovative form of prevention.

 The availability of HIV self-testing kits

We encourage you to advocate for the approval by Health Canada of self-testing kits for HIV. This technology is widely used in other developed countries such as the United States, United Kingdom, France and Australia. Self-testing could enhance access to HIV testing for many Canadians.

Some of the most effective tools to reduce HIV transmission are within our reach, but remain beyond our grasp. Much of the work that we do here at CTAC is to support the vital work that you do, through policy research and improving access to treatment for all people living with HIV and HCV. We welcome all ideas about how we can achieve this goal and work together in the future, so please do get in touch if you would like to discuss this further.

About the Author

Guest Authors - Revolving Door

Guest Authors - Revolving Door

The Revolving Door is the place where we publish occasional articles by guest writers. If you would like to submit an article for publication, please contact editor Bob Leahy at