JULIO MONTANER: doctor led harm reduction in global HIV/AIDS fight

December 1, 2014 

Julio Montaner. Official photo, B.C. Centre for Excellence in HIV/AIIDS

Julio Montaner. Official photo, B.C. Centre for Excellence in HIV/AIIDS

Though still not widely known outside his home Canadian province of British Columbia, Julio Montaner has arguably done more than any medical doctor in the world to save lives in the ongoing struggle to combat the ravages of AIDS.

From his small, cluttered office in Vancouver’s elderly St. Paul’s Hospital, it was Dr. Montaner who first championed the powerful anti-retroviral drug cocktail therapy that has turned HIV/AIDS into a manageable, chronic disease.

And it was Dr. Montaner who then went on to develop the groundbreaking Treatment as Prevention strategy, as he realized that these anti-retroviral drugs reduced the viral load of HIV patients to such minimal levels the danger of passing the virus on to others was eliminated. Hence, if enough patients were treated, transmission could be stopped in its tracks.

In B.C., aggressive employment of Treatment as Prevention, seeking out those on the margins of society, has slashed the number of new infections by more than 70 per cent. This in a province whose drug-riddled, impoverished Downtown Eastside area in Vancouver once had the highest HIV infection rate in the developed world.

Dr. Montaner’s once controversial strategy has now been adopted by the World Health Organization and is being pursued in a growing number of countries, including China and Brazil. Thanks to these advances, the dream of a world without AIDS is no longer just fantasy. This year, UNAIDS set 2030 as a target date for the end of a disease that has killed untold millions around the globe.

“Of course, there is no end to AIDS,” Dr. Montaner explained in an interview. “We are talking about the end of the pandemic as we knew it, and recognizing that people with HIV will not necessarily progress to AIDS, leading normal lives into their 70’s.”

Yet, on World AIDS Day, despite achievements that have won him multiple honours and these tantalizing glimpses of an AIDS-free world, the Argentinian-born Dr. Montanter, at 58, remains restless. There is still so much to be done.

His active mind is beginning to branch towards other infectious diseases. If Treatment as Prevention works to ease the spread of AIDS, why not apply it, say, to Hepatitis B and C, and then, even further to lessen such socially contagious afflictions as smoking, obesity and addiction, itself?

Employ the same principle of aggressively treating those afflicted and engaging with struggling individuals at risk, he proposes.

That message is occupying increasing amounts of Dr. Montaner’s seemingly boundless time and energy. Spend money now for better health later on and, in the long run, costs to the beleaguered health care system are substantially reduced.

“I would never have dreamed that we would have been able to rise this wave of success after success, innovation after innovation, and be able to use our [AIDS/HIV] program to influence the world the way we have,” Dr. Montaner said. “We have demonstrated there is a different way of doing business, to take a pro-active approach, and it is a money-saving strategy.”

In May, Vancouver's St. Paul's hospital closed its dedicated ward for AIDS -- due to lack of patients.  Stigma and despair overshadowed the limited medical interventions that could be provided. Opened in 1997, the ward saw an average of one AIDS-related death every day during its darkest days.   But today, in a historic symbolic move, St. Paul’s Hospital in Vancouver announced that Ward 10C has outlived its role as the place where life ended. Julio Montaner at a news conference announcing the success of treatment. Photo from B.C. government

Julio Montaner, above, at a news conference in May 2014. Vancouver’s St. Paul’s hospital announced closure of ward 10C, opened in 1997 and dedicated to AIDS patients, because of the success of treatments. B.C. government photo.

At the same time, however, Dr. Montaner has hardly forgotten the cause that has consumed him for the past 25 years. Even as he involves himself in and welcomes the ambitious new UNAIDS program, he continues to be angry and frustrated by the failure of the rest of his own country, Canada, to buy into Treatment as Prevention.

While the strategy produces dramatic results in B.C., where it is strongly supported by the provincial government, infection rates are on the rise in Alberta, Saskatchewan and Manitoba, and the federal government sits on the sidelines.

“When you think about it, this life-saving treatment, the role model we have created in British Columbia for dealing with HIV/AIDS is probably one of the biggest public health successes in the history of Canada,” he said. “Yet people are still sitting around and looking the other way. I can’t shake the feeling. That’s wrong. That’s deeply, deeply wrong.”

I have interviewed Dr. Montaner many times. Each conversation is always the same. I sit back and let his passion roll on over what he and his colleagues are doing in their long, long battle against HIV/AIDS roll on. I barely have to say a word. He is driven by the fight.

Only when I suggest that he must be incredibly satisfied by having such an impact on the lives of so many people does the perpetually loquacious doctor become tongue-tied. “I honestly…I’m humbled, honoured….” He stopped, searching for the right words. “I try to adopt a graceful attitude to this incredible opportunity to be able to help people come up with something….

“My goal back in Argentina was to develop better public health. I managed to do that from here, and I can only be grateful for that. I feel myself incredibly blessed that I had this opportunity.”And the world has been blessed, too.

 Copyright Rod Mickleburgh 2014

References and further reading:

United Nations — UNAIDS, press release for World Aids Day 2014
British Columbia Centre for Excellence in HIV/AIDS
, directed by Julio Montaner 
Wikipedia page for Julio Montaner 
Julio Montaner 2010 award by the Albert Einstein World Award of Science, by the World Cultural Council 


UNAIDS statistics on HIV/AIDS:

  • In 2013, there were 35 million [33.2 million–37.2 million] people living with HIV. Since the start of the epidemic, around 78 million [71 million–87 million] people have become infected with HIV and 39 million [35 million–43 million] people have died of AIDS-related illnesses.
  • Worldwide, 2.1 million [1.9 million–2.4 million] people became newly infected with HIV in 2013.
  • Worldwide, 240 000 [210 000–280 000] children became newly infected with HIV in 2013.
  • In 2013, 1.5 million [1.4 million–1.7 million] people died from AIDS-related illnesses worldwide.
  • In 2013, around 12.9 million people living with HIV had access to antiretroviral therapy.
  • This represents 37% [35–39%] of all people living with HIV, yet only 24% [22–26%] of all children living with HIV are receiving the life-saving medicines.
  • Tuberculosis remains the leading cause of death among people living with HIV, with an estimated 320 000 [300 000–340 000] deaths in 2012.
  • HIV is the leading cause of death among women of reproductive age.
  • In 2013, 54% of pregnant women in low- and middle-income countries did not receive an HIV test.
  • In 2013, almost 60% of all new HIV infections among young people aged 15–24 occurred among adolescent girls and young women.
  • AIDS-related illnesses are the leading cause of death among adolescents aged 10–19 years in Africa.
  • Globally, gay men and other men who have sex with men are 19 times more likely to be living with HIV than the general population.
  • HIV prevalence among sex workers is 12 times greater than among the general population.
  • Transgender women are 49 times more likely to acquire HIV than all adults of reproductive age.
  • HIV prevalence is estimated to be up to 28 times higher among people who inject drugs than the general population.


Doctors Julio Montaner and Thomas Kerr .Photo by Brent Granby Creative Commons

Doctors Julio Montaner and Thomas Kerr at a 2011 Vancouver news conference, after the Supreme Court of Canada ruled against federal government efforts to close the city’s Insite injection site.  Montaner and his colleagues led the harm reduction strategy in Canada’s westernmost province. Photo by Brent Granby Creative Commons



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