Were Dr. Julio Montaner to have his way, HIV testing would be as routine as getting your blood pressure taken. The director of the B.C. Centre for Excellence in HIV/AIDS says widespread screening is just one of the elements missing in the fight against the disease.

“When I go to the doctor, they check my blood pressure and my blood sugar,” Montaner says in an interview at his office in St. Paul’s hospital. “Why look for hypertension and diabetes and not HIV? My teenage children come to me and say, ‘Why don’t we have access to tests? We have friends who need it.’ And we’re not talking about prototypical high-risk individuals. Too many people are never offered a test.…When’s the last time you were offered an HIV test?

“One-third of Canadians who are infected with HIV don’t know,” he adds.

Montaner, who spends half his time with patients and the other half doing research, came to Vancouver from Buenos Aires in 1981. At the time, he specialized in respiratory medicine. Six years later, he began investigating acquired immune-deficiency syndrome at St. Paul’s and UBC hospitals. This past August, he was named president-elect of the International AIDS Society, an independent organization of health professionals in the field of HIV/AIDS.

Montaner is recognized around the globe as a leading expert on highly active anti­retroviral therapy, which was developed by the B.C. Centre for Excellence in HIV/AIDS in the mid ’90s and has become a standard treatment for AIDS patients. The drug regimen known as HAART brings patients’ viral loads to nearly undetectable levels.

When HIV and AIDS emerged, “We didn’t know what hit us,” says Montaner, who is profiled in the December 1 issue of the British medical journal the Lancet as part of its World AIDS Day coverage. “Younger men were falling quite sick quite quickly and dying. There were social challenges in dealing with the disease that a lot of people found difficult.…To be perfectly candid, St. Paul’s stepped up to the plate while a lot of people stepped back.…I’m proud of having been instrumental in developing treatment.

“We got it right; we were lucky,” he says of HAART, the discovery of which he admits happened somewhat by chance. “I believe providential things happen.”

According to a study Montaner copublished in the August 5, 2006, issue of the Lancet, HAART has substantially reduced AIDS–related hospital admissions and death rates in developed and developing countries. In the last decade, the study states, the medical regime has become less toxic, better tolerated by patients, and more cost-effective.

The success of HAART, however, has led to concerns that people will abandon the use of condoms and other safe-sex practices. Such fears don’t shake Montaner’s belief in the therapy, which he stresses isn’t meant to replace prevention efforts but rather to complement them.

“We can’t avoid doing the right thing because of the potential risk that people’s behaviour is going to change,” he says. “It would be negligent on our part not to implement programs that are successful. We need to be taking appropriate steps to ensure that changing behaviour doesn’t materialize.”

In fact, Montaner hopes that HAART will soon be available around the world—for free.

“If we treat more people appropriately, there will be further decreases in new infections,” he says. “Put on a global scale, there is potential for great diminishing of the devastation that HIV has caused.”

Montaner says that World AIDS Day, which is tomorrow (December 1), is a time to reflect on the successes and failures related to the disease and on new directions for treatment. Much of the recent work of the B.C. Centre for Excellence in HIV/AIDS has focused on the role that supervised injection sites can play in reducing the spread of HIV and AIDS. Montaner co­authored a study published in the November 21 issue of the Canadian Medical Association Journal that pointed to the health and community benefits associated with Vancouver’s pilot medically supervised “safer-injecting facility”.

“The federal government sees me as a pro-drug something-or-other,” Montaner says. “They don’t get it. We’re trying to make a bad thing better. Our work with safer-injection sites is not promoting drug addiction. It’s about reducing harm. We believe heavily entrenched drug addiction should be treated as a medical condition.

“[The governments of] B.C. and Vancouver continue to be supportive [of the supervised-injection site],” Montaner adds. “But I’m very concerned that at the federal level, the message has been lost.”

It’s not just the federal Conservative government’s stance on supervised-injection sites that riles Montaner. There’s also the bigger picture.

“It’s a total shame we have not yet made it a national priority to eradicate HIV from Canada,” Montaner says. “It’s a disgrace we have failed to provide international leadership.…There is a vacuum at the political-leadership level.…We have a huge problem. We’re trying to control an epidemic, and we’re constrained by rules and regulations.”

While the B.C. Centre for Excellence in HIV/AIDS receives government funding as well as money from private donors, Montaner has also received grants from drug companies like Pfizer, GlaxoSmithKline, and Merck Frosst.

“We’ll do what we have to do to get the job done,” he says. “We take money from everybody. There’s honesty and transparency; our track record speaks volumes. I continue to lobby the provincial and federal governments so we can run this operation. I would love to have 100-percent funding from the government, but it ain’t going to happen.”