Montreal slammed by community organizations over 'inaction' on HIV/AIDS

Organizations dedicated to fighting HIV/AIDS are slamming the city of Montreal and cutting ties with the Montréal sans sida initiative over its "increasing disengagement" and failure to sign the latest Paris Declaration on HIV.

In 2017, Montreal Mayor Valérie Plante signed onto the declaration, which had three targets to eliminate HIV/AIDS transmission by 2030. The Montréal sans sida alliance was formed the following year to tackle an action plan in tandem with public health.

The alliance is also part of the Fast-Track Cities initiative to deliver on the commitments laid out by the Paris Declaration, which is linked to UNAIDS (Joint United Nations Programme on HIV/AIDS).

The 30 member organizations of the local initiative, the Table des organismes communautaires montréalais de lutte contre le sida (TOMS), say they have been waiting almost three years for elected officials to commit to the action plan and to UNAIDS's intermediate targets.

Olivier Gauvin, a co-ordinator with TOMS, says the alliance was only able to successfully launch an educational campaign. He says community organizations can't get as much work done as they would like if the city doesn't commit to helping..

The Paris Declaration required in 2017 that 90 per cent of people know their status regarding HIV, that 90 per cent of those living with HIV undergo treatment, and that 90 per cent of those have an undetectable viral load, meaning they can't transmit the virus.

A 2021 amendment made the new target for those goals 95 per cent, but Montreal didn't sign on to renew its commitment. The amended version also created new targets for 2025 and tackled questions of social status and equity in relation to HIV transmission.

The city's public health authority says it already surpassed the 95-95-95 target. But advocates say the targets aren't limited to health-care like testing and things like pre-exposure prophylaxis (PrEP). They say policing and social policy also have a role to play.

Without signing on to the latest declaration, Montreal loses its commitment and is no longer part of the movement to combat HIV in cities, said Gauvin.

Social policy and HIV

Gauvin says after Montreal committed to the Paris goals in 2017, there was a sense of purpose and commitment at the community level. But that started to dissipate when the city "did not implement the actions they signed off on," he said.

"We can't ask people who are from marginalized communities who are already being repressed in their daily lives to come on board and work with a city that does not commit to their well-being," said Gauvin

TOMS pulled out of the Montréal sans sida alliance saying it's "no longer viable."

Gauvin says cities are limited in their ability to manage health care but says the fight against HIV goes well beyond a doctor's visit. Safe injection sites, the decriminalization of drug use and of sex work and less policing of homeless people are all ways a city can fight HIV, he said.

"We need an elected official to be behind this initiative and say to the rest of the city, of the departments, to the police that they need to stop criminalizing people, that we need to change the way we do things in Montreal so we can actually end HIV by 2030," said Gauvin.

The city said it is "surprised" to hear TOMS is leaving the Montréal sans sida initiative "which is a pity considering the significant concerted and collaborative efforts made by the public health authority and the city in recent months."

It said the public health authority met with TOMS at the end of January to discuss the project's progress.

But Gauvin says despite communication with the public health authority, the city has been lacking action.

Montreal public health pushed back, saying it has already taken several concrete actions.

According to the regional public health authorities, 100 per cent of those living with HIV in Montreal are aware of their status. Of those, 97.6 per cent are undergoing antiretroviral treatment,and 96.6 per cent of those in treatment have an undetectable viral load — statistics that exceed the 2030 objectives laid out in the Paris Declaration.

But, it acknowledges that there are on average 200 new HIV cases in the city every year.

"We must improve the offer of prevention, screening and treatment services, in addition to working on the longstanding issues of stigmatization of the populations concerned or at risk," it said in a statement.

"We will therefore continue our collaboration with community partners, the city of Montreal, clinicians, researchers and populations concerned."

The public health authority said it wants to continue distributing prevention materials like free condoms and clean syringes, especially with more marginalized communities. It also wants to work toward decriminalizing sex work and offer more in-clinic and self-tests for HIV while making PReP more accessible.