The AIDS Memorial in Toronto, part of the Barbara Hall Park at 519 Church Street, has 2,700 names of people lost to AIDS engraved on plaques arranged by year. It's a stately, digniified monument, a gathering place for those of us affected and infected by HIV and AIDS.

Today, December 1, is the 35th annual World AIDS Day.

It's a day to reflect on the progress made in preventing of the spread of HIV.

It's also a day to consider how to finally stop all HIV infections, and how to respond to the global necessity of equitably sharing the treatments that prevent the development of AIDS. These advanced drugs are readily available in Canada, less available through the American health system, and are scarce among the world's most vunerable communities.

The Equalize theme of the 2022 Joint United Nations Programme on HIV/AIDS (UNAIDS) investigates the numerous global inequalities that have slowed the prevention, diagnosis and treatment of HIV/AIDS. Progress against the AIDS pandemic has stumbled in the face of COVID and other global crises, risking the health and lives of millions worldwide.

World AIDS Day began in 1988, an initiative of the United Nations. With the terrors of an unknown disease still fresh, the initial flush of AIDS-related deaths not yet peaking, and the revolutionary but primitive treatments just beginning to make a difference, HIV positive patients were shunned by families and reviled by just about everyone else. A Canadian Member of Parliament stood in the House to propose that men with the virus be shipped off to "camps" on the Prairies, where we would be welcome to "amuse" ourselves to death. This was not an uncommon solution in the 1980s.

Testing for the virus was discovered and adopted but the whole concept was often rejected by those vunerable to infection. Being aware of an HIV infection meant family and societal rejection, sudden bankruptcy, and legal obligations. Not knowing, however, just meant ... not knowing. (Editor's note: Please get tested. Not knowing about the virus will not stop its progress, nor will it prevent your own personal copies of the virus from infecting anyone else.)

The healthcare system itself took a lengthy time to actively work against the spread of HIV.

As late as 2014 treatment did not start with a positive HIV test, it was only authorized when bloodwork showed the patient was very close to developing AIDS. This could span months, sometimes years, leaving the virus open to additional exposure in the community. A Canadian team based at the BC Centre for Excellence in HIV/AIDS (BC-CfE) finally put a stop to this. Their research and analysis proved to the global medical community that an aggressive viral suppression for every patient made a big dent in overall community transmission.

This essential research was of course distilled into a new motto: Treatment as Prevention (TasP).

In 1988 the newly developed official treatment for HIV/AIDS was in its second year of saving lives. AZT reduced the number of opportunistic infections and deaths, and kept patients alive until the next generation of treatments arrived, but it also produced some serious adverse reactions.

The early drug regimens were toxic; managing the dosages was complicated. Some pills were taken hourly, more pills followed those on a timed schedule, others were mixed in as research progressed. The treatments were not covered by insurance; many patients needed to quit employment and divest themselves of all assets in order to qualify for welfare and its associated healthcare provisions.

During the 1980s the average life expectancy following an AIDS diagnosis was approximately one year. Today, with combination antiretroviral drug treatments started early in the course of HIV infection, people living with HIV can expect a near-normal lifespan. There is no cure for HIV infection, the virus is suppressed to the point of not being transmittable but is not eliminated from the body. Stopping treatment allows the virus to reproduce and renew its cycle of disease and death.

Current antiretroviral therapy (ART) solutions began in 2012 with the introduction of a one-pill-per-day drug. That large four-drug pill cost about $75 in Canada, and patients would need one of them a day, for the rest of their lives, costing $28,000 a year.

Private health insurance gradually took over the payments and, as the inequities revealed themselves, senior governments finally stepped up with community solutions such as Ontario's Trillium Drug Program. (Today's version of the 2012 pill runs closer to $40 each ... just under $15,000 per year.) Newer methods such as micro-array patches allow a monthly delivery of treatment, replacing the daily pill. Some toxicity remains however, as part of treatment the kidney and liver functions are closely monitored for signs of deteriorization.

The cost of effective treatments for AIDS has been a steep barrier to preventing the spread of HIV. In 2003 U.S. President George W. Bush rallied a non-partisan religion-free nation-wide response to the previous Bush and Reagan administrations' willful distancing from acknowledging the virus and its snowballing threat as a reproductive disease. The United States came together in a national commitment to fund $15 billion over five years for global solutions. Its effects are felt to this day.

UNAIDS graphic

 From UNAIDS regarding World AIDS Day 2022:

This year’s UNAIDS theme is Equalize, reminding us that HIV thrives where inequities persist. Intersecting epidemics – such as COVID-19, syphilis, and the poisoned drug supply – require intersectional responses. Without strategies to meet these needs, however, we may see a resurgence of HIV that would threaten our public health response to interconnected epidemics.

The inequalities which perpetuate the AIDS pandemic are not inevitable; we can tackle them. This World AIDS Day, December 1, UNAIDS is urging each of us to address the inequalities which are holding back progress in ending AIDS.  

The Equalize slogan is a call to action. It is a prompt for all of us to work for the proven practical actions needed to address inequalities and help end AIDS. These include:  

• • • Increase availability, quality and suitability of services, for HIV treatment, testing and prevention, so that everyone is well-served. 
    • Reform laws, policies and practices to tackle the stigma and exclusion faced by people living with HIV and by key and marginalised populations, so that everyone is shown respect and is welcomed. 
    • Ensure the sharing of technology to enable equal access to the best HIV science, between communities and between the Global South and North. 
    • Communities will be able to make use of and adapt the Equalize message to highlight the particular inequalities they face and to press for the actions needed to address them.  

Data from UNAIDS on the global HIV response reveals that during the last two years of COVID-19 and other global crises, progress against the HIV pandemic has faltered, resources have shrunk, and millions of lives are at risk as a result.

Four decades into the HIV response, inequalities still persist for the most basic services like testing, treatment, and condoms, and even more so for new technologies.

Young women in Africa remain disproportionately affected by HIV, while coverage of dedicated programmes for them remains too low. In 19 high-burden countries in Africa, dedicated combination prevention programmes for adolescent girls and young women are operating in only 40 per cent of the high HIV incidence locations.

Only a third of people in key populations – including gay men and other men who have sex with men, transgender people, people who use drugs, sex workers, and prisoners – have regular prevention access. Key populations face major legal barriers including criminalisation, discrimination and stigma.

We have only eight years left before the 2030 goal of ending AIDS as a global health threat. Economic, social, cultural and legal inequalities must be addressed as a matter of urgency. In a pandemic, inequalities exacerbate the dangers for everyone. Indeed, the end of AIDS can only be achieved if we tackle the inequalities which drive it. World leaders need to act with bold and accountable leadership. And all of us, everywhere, must do all we can to help tackle inequalities too.

The World AIDS Day report was released in late November.

On World AIDS Day on December 1, events will take place across the world. These activities will be led not only by official bodies but also, most importantly, by communities. Through photos and videos shared by groups on social media and aggregated by UNAIDS, people will be able to have a sense of the kaleidoscope of events taking place and be inspired by the determination and hope.

We can end AIDS – if we end the inequalities which perpetuate it.
This World AIDS Day we need everyone to get involved in sharing the message that we will all benefit when we tackle inequalities.
To keep everyone safe, to protect everyone’s health, we need to Equalize.

UNAIDS Executive Director Winnie Byanyima

Canadian AIDS Treatment Information Exchange (CATIE) is a national resource for treatment and prevention information on hepatitis C as well as HIV/AIDS, including HIV testing and diagnosis.

Information about Grey Bruce Public Health's clinics and testing appointments can be found here.

 – by Hub staff
David Galway