Division of AIDS
The HIV/AIDS Program at St. Paul’s Hospital (SPH) was established in the early 1980s and has had a longstanding and extensive collaboration with the Division of Infectious Diseases and the BC Centre for Excellence in HIV/AIDS (BC-CfE). In 1997, SPH established the AIDS Ward at the peak of the AIDS epidemic in BC. This coincided with the emergence of Highly Active Antiretroviral Therapy (HAART) as the new standard of care for HIV/AIDS, in part due to research pioneered at the BC-CfE. With the support of the provincial Ministry of Health, the BC-CfE widely implemented HAART programs in BC at no cost to eligible BC residents living with HIV, with a dramatic subsequent reduction in HIV/AIDS related morbidity and mortality. As a result, the AIDS Ward, under the leadership of Dr. Peter Phillips, was reprofiled in 2014 to support Urban Health Infectious Diseases.
Since 1996 we have known that HAART stops HIV replication, and as a result it restores health and prevents progression to AIDS and premature death. At the same time, BC-CfE research showed that HAART drives HIV to undetectable levels in biological fluids, which in turn renders HIV untransmissible and therefore stops HIV transmission. In 2006 in a landmark Lancet article the BC-CfE was the first to formally propose expanding HAART access to all HIV infected individuals, under the Treatment as Prevention® (TasP®) banner, to control HIV/AIDS morbidity, mortality and transmission globally.
In 2014, working together with the United Nations joint AIDS Program (UNAIDS) we, the BC-CfE, developed the TasP® inspired 90-90-90 Target, designed to “End AIDS as a Pandemic by 2030”, defined as decreasing AIDS-related mortality and HIV new infections globally, each by 90%, using 2010 as the baseline. The proposed Target postulated that at least 90% of people living with HIV (PLHIV) should be diagnosed, at least 90% of those diagnosed should be on HAART, and at least 90% of those on HAART should have undetectable HIV levels by the end of 2020. In 2015, the Target was formally adopted by the United Nations, and Canada, and became known as the UN 90-90-90 Target.
On December 1st, 2020, BC surpassed the 90-90-90 Target, with 92% of PLHIV diagnosed, 91% of them on HAART, and 95% virally suppressed. As a result, BC saw a decrease in AIDS related morbidity and mortality of over 90% and a decrease in new HIV infections by over 85%. These findings provided irrefutable confirmation that TasP® works as originally postulated.
As outlined in the original plan, the UN 90-90-90 Target became the UN 95-95-95 Target at the end of 2020. By achieving the new UN 95-95-95 Target, the number of people newly infected with HIV will be expected to fall from 1.7 million in 2019 to 370,000 by 2025, and the number of people dying from AIDS-related illnesses would be expected to decrease from 690,000 in 2019 to 250,000 in 2025.
Earlier in 2021, the United Nations General Assembly convened a High-Level Meeting on AIDS. Ending AIDS as a public health threat by 2030 remains possible. On June 8th, under the leadership of UN Secretary General, António Guterres, UN Members States, including Canada, endorsed the UN 95-95-95 Target, as originally proposed by the BC-CfE.