VANCOUVER - Forty per cent of the people who died of HIV-AIDS in British Columbia never accessed life-saving treatment even though it was free, according to a new study released Friday.
The study by the B.C. Centre for Excellence in HIV-AIDS looked into more than 1,400 HIV-related deaths in the province between 1997 and 2005.
In that period of time, a total of 567 people died without ever receiving the highly effective antiretroviral treatment.
"We have a problem,'' Montaner said. "The treatments are available for free but something is wrong because the people that most need the treatment, they're not always accessing the treatment.''
Low income was strongly associated with the delay in starting therapy and the ensuing high mortality rate.
Residence in a poor neighbourhood was associated with an increased risk of mortality among HIV patients, Montaner said.
"Factors such as a lack of housing or transportation, mental illness, illegal activity and language barriers play a role in an individual's ability to access treatment,'' he said.
Twenty-five per cent of those infected with HIV in Canada are not aware of their infection, according to the centre.
The centre distributes the cocktail of antiretroviral medications to all eligible British Columbians, free of charge, through the provincewide Drug Treatment Program, funded by Pharmacare.
Yet ensuring access to the treatment remains an elusive goal, he said.
"We have found that over the last several years there is a persistent number of people dying with HIV in our midst, where treatment and health care is supposed to be readily available,'' Montaner said.
Typical examples are single mothers who don't have the resources to get a babysitter or a homeless, mentally ill drug addict who lives on the Downtown Eastside and doesn't even know he's HIV-positive, he said.
And it's not just Vancouver, Montaner said. It's a problem right across the country and the percentage could even be worse in smaller communities where fewer resources are available.
Ann Livingston, spokeswoman for the Vancouver Area Network of Drug Users, called the study shocking.
Four in 10 people in Vancouver's Downtown Eastside live outside and many among them are sick with AIDS, she said.
Some live in substandard hotels that are often infested with cockroaches and unsafe but people stay there because welfare payments don't provide enough money for decent housing for those who are too ill to work, Livingston said.
"And they have no general practitioner. That's another nightmare,'' she said.
Ken Buchanan, of the British Columbia Persons with AIDS Society, said the long-term solution is to bring some stability to the lives of HIV-AIDS sufferers.
"For a person who is homeless, taking medications, even free medications, is pretty low in their priorities,'' he said.
Buchanan warned that access to medication isn't enough. A person who begins treatment and doesn't maintain the proper dose regime will build up a resistance to the drugs and end up more likely to die.
"You can't take them for a few days and then stop for a few days,'' he said. "If your life is chaotic ... you don't have the ability or the need or the desire to take your meds.''
The centre has a proposal before the provincial government to form outreach teams that would take rapid-response testing to the most vulnerable and offer treatment.
But "free health care is not necessarily enough to address this problem,'' he said.
"We need to bring the treatments to the people and we need to create the programs that are going to help these individuals to take the treatment,'' he said.
It is not only the ethical and human thing to do, he said, it's also better for society at large because it reduces HIV-related illnesses that drain the health care system.
"By treating these people we're doing what is right for them, we're doing what is right for the system and we're also going to decrease HIV transmission,'' Montaner said.
"This is the right thing to do both in an ethical sense and also in a business sense.''
Previous research by the centre and by researchers in Taiwan showed a 50 per cent reduction in new HIV cases that they felt was due to access to the highly active antiretroviral therapy.
The treatment consists of three or more antiretroviral drugs on a daily basis for life and it requires a very high level of adherence in order to be fully effective.
It has been the standard of care for the treatment of HIV-AIDS since 1996.
