For people living with HIV and their allies, 2017 was a ground-breaking year. It culminated with both the federal and Ontario governments publicly recognizing the need to limit the over-criminalization of HIV in Canada. On World AIDS Day 2017, both acknowledged that criminal prosecution for alleged HIV non-disclosure is not warranted when a person living with HIV has a “suppressed viral load” (i.e., less than 200 copies of HIV/ml of blood) because such an individual poses no “realistic possibility” of transmitting the virus—the Supreme Court’s legal test for whether a duty to disclose exists.
In his famous poem “The Blind Men and the Elephant”, John Godfrey Saxe retells an Indian parable about three blind men who went to see an elephant. Of course, being blind, they could only ‘see’ the elephant by touching it. When asked to describe the elephant, one grabbed it by its trunk and said, “An elephant is like a snake!” The second man took his turn to touch it, pulled it by the leg, and confidently determined, “No, an elephant is like a tree trunk!” The third and final person to touch the elephant grabbed it by its tusks and said, “Tsk, tsk, tsk, you are both wrong: an elephant is smooth, cold and hard.” Each of the men touched the elephant, yet from their perspectives, the experiences of the elephant were totally different.
Thanks to effective anti-HIV treatment, HIV has evolved into a chronic illness. However, people living with HIV often today also live with other physical and mental health conditions, which can be difficult to cope with, especially for those also coping with difficult socio-economic circumstances.
To provide quality care to people living with HIV and other long-term medical and social conditions, health-care providers not only need to ensure that people living with HIV are engaged in quality health care, but we also need to enhance the capacity of Canadian HIV clinics to integrate and coordinate additional resources. By integrating and coordinating resources, we help address the needs of a whole person —needs that often cut across the various disciplines, specialties, sectors and systems that we have traditionally organized care around.
The good news is that through several interconnected research studies, our research team led out of the Bruyère Research Institute in Ottawa has shown that the complex health and social care needs of people living with HIV can be met –and, in fact, are being met –by various care models, settings and teams working in HIV clinics across Canada.
People living with HIV in Canada have been charged with some of the most serious offences in the Criminal Code, even in cases of consensual sex where there was negligible or no risk of HIV transmission, no actual transmission and no intent to transmit.
The Undetectable=Untransmittable (“U=U”) campaign is based on scientific research, including the ground-breaking PARTNER study, establishing that when a person living with HIV on treatment maintains an undetectable viral load for at least six months, the risk of transmitting the virus through sex is effectively non-existent. As advocates for persons living with HIV await action from federal, provincial and territorial governments to address the overly-broad criminalization of HIV non-disclosure, how might the U=U campaign and the results of the PARTNER study impact ongoing prosecutions under the current state of the law?
All of us here at CATIE, and indeed around the world, are celebrating the most significant development in the HIV world since the advent of effective combination therapy 20 years ago – people living with HIV with sustained undetectable viral loads can confidently declare to their sexual partners “I’m not infectious!” The “fabulousness” of this news cannot be overstated. With or without a condom, if you’re undetectable you won’t pass along HIV! This is an absolute game-changer and those who live with HIV can proudly share this information. At the same time, service providers working in HIV must get up to speed fast and share this far and wide with their communities. CATIE will be developing more resources to help share this momentous news so stay tuned! In the meantime, look at the prevention resources on catie.ca and add your organization’s name to the Consensus Statement of the Prevention Access Campaign. Let’s get the word out! Get tested, get on treatment, become undetectable and have lots of great sex!
Laurie Edmiston is executive director of CATIE, Canada’s source for HIV and hepatitis C information.
The CATIE Blog hosts the views and opinions of people and organizations working and volunteering in Canada’s response to HIV and hepatitis C.