Health Committee on April 11th, 2019

[Dr. Mark Gilbert]

That's the million-dollar question, right? It's hard to say one thing that would really address it, but I do think it needs to deal with factors at the individual level, such as around access to testing and access to treatment. We know that there are treatment gaps across the province—that's a clear one—in getting us to the third part of 90-90-90. We're focused so much on the “treatment as prevention” biomedical model, but I think we really do have to think about the underlying determinants as well, and about how we deal with those. It continues to create the problem if we're not actually dealing with such underlying determinants as stigma and health care access as well.

[Don Davies, NDP, Vancouver Kingsway, BC]

With regard to determinants, are you seeing a connection between, say, socio-economic status, intersectionality, race, indigenous, character—everything? Are those playing a role?

[Dr. Mark Gilbert]

Definitely, when it comes to looking at this—I know the B.C. epidemic quite well, but I think it probably applies across Canada—we do see that the folks who are at those intersections or margins and who are falling through the cracks are also the people who have probably the greatest difficulty accessing appropriate health care or having it made available to them. I do think those intersections are quite important. Even for one of the key populations—gay, bisexual and other men who have sex with men—we know that intersections within that population are also associated with disparities in access to care and treatment.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Moore, I'll give the last word to you. Do you have any advice for the committee on achieving zero new infection rates?

[Dr. David Moore]

Really, the federal government does have a role to play in trying to engage the provincial governments that have not been as active or engaged in the process. We're quite fortunate in B.C., where the provincial government understood the net benefit to the province of appropriately engaging on HIV early on.

One thing would be to look at policies about things like copayments for publicly funded medications. Those are really deterrents to people getting effective treatment. The other thing would be provincial policies on testing and access to testing. Again, we have this kind of promotion that everybody should know their HIV status in British Columbia. It's not that testing a whole bunch of low-risk heterosexual people is necessarily a direct way to end the epidemic, but we're hopeful that it will remove the stigma around offering an HIV test. It's part of why some people may not get tested or engage in care and that kind of thing.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Bill Casey]

That winds it up. Thank you.

We think maybe the bells are ringing, so we'll have to end the meeting.

On behalf of the committee, I want to thank you all. This is a most interesting subject. We appreciate your frankness and realistic answers. They will be of great help to us. I think we will have a very interesting report when we're finished because of the quality of the testimony we've gotten everywhere. I think everybody realizes how important and unique this is.

[Gerry Croteau]

Thank you.

[The Chair, Liberal, Bill Casey]

The meeting is adjourned.