A little more than 20 years after Vancouver became known internationally as the city with the “highest HIV-infection rate in the Western World,” the provincial government has said B.C. now “nears the end of the AIDS epidemic”.

On World AIDS Day (December 1), the province announced that 2018 saw a record-low number of new HIV cases in B.C.

"With the success of the Treatment as Prevention strategy (TasP), B.C. is seen as the having the world's gold standard to profoundly reduce HIV transmission and transition the crisis from a serious epidemic to a manageable chronic disease,” B.C. health minister Adrian Dix said quoted in a media release.

It’s noted there that the number of new HIV infections recorded in B.C. has fallen consistently from 437 cases in 2004 to 205 in 2018.

TaSP was pioneered in Vancouver’s West End at the B.C. Centre for Excellence in HIV/AIDS (BCCfE) under the leadership of Dr. Julio Montaner. In 2014, the United Nations adopted its 90-90-90 targets—90 percent of people living with HIV know their status, 90 percent of people diagnosed with HIV receive antiretroviral therapy, and 90 percent of people receiving antiretroviral therapy achieve viral suppression—as the world’s best chance to end the global AIDS epidemic.

"Since the first AIDS patients presented to St. Paul's Hospital in Vancouver—struggling against stigma and marginalization—community, researchers and clinicians worked tirelessly to advance evidence-based research to inform B.C.'s HIV treatment policies," Montaner, BCCfE executive director and physician-in-chief, said quoted in the release. "This included pioneering effective treatment and supporting widespread availability of antiretroviral therapy. We are now reaping the rewards of this province's continued commitment to provide the best possible treatment and care for those living with HIV as we set a standard for the rest of the world."

Progress on HIV/AIDS wasn't always a good-news story for B.C. Vancouver’s ground-breaking work emerged from a crisis.

Through the summer of 1997, a pair of Downtown Eastside activists named Bud Osborn and Ann Livingston attended a series of Vancouver health board meetings to talk about HIV/AIDS. Researchers had just confirmed that their neighbourhood had the highest rate of HIV/AIDS infections outside of Sub-Saharan Africa. The Globe and Mail had just called the Downtown Eastside an “incubator for AIDS”. Osborn and Livingston wanted the health board (later replaced by Vancouver Coastal Health) to do something about it.

“Bud was in a board meeting and somebody was looking at the graphs of AIDS deaths,” Livingston said, interviewed for the 2017 book Fighting for Space. Presenting the numbers, the bureaucrat told the board meeting: “If we don’t do anything, they are going to come down, because we’ll hit a saturation point.”

The suggestion was that government action would soon become unnecessary. Vancouver’s HIV-infection rate would begin to fall because the virus had already killed so many people, it was running out of new bodies to infect.

Livingston recounted Osborn's reaction (he passed away in 2014): “Bud lost his shit,” she said. “He jumps up, the fucking chair falls over, and he starts screaming. ‘Are you fucking serious?!’”

That meeting prompted Osborn to harass the Vancouver health board to declare the city’s HIV/AIDS epidemic a public-health emergency. On September 25, 1997, the board finally did. It marked a turning point in the city’s fight against HIV/AIDS and the start date from which politicians finally took the crisis seriously.

The province’s 2019 World AIDS Day release doesn’t mention them, but Osborn, Livingston, and other activists such as John Turvey (an early pioneer of needle exchange), Liz Evans (a co-founder of North America’s first supervised-injection facility, Insite), Dean Wilson (an influential former president of the Vancouver Area Network of Drug Users), and other Downtown Eastside activists deserve similar credit.

More than fighting for specific policies like unrestricted needle exchange and supervised injection, Downtown Eastside activists’ work went a long way to reduce stigma and convince public-health researchers that a disease that primarily afflicted LGBTQ people and intravenous-drug users was worth their time and worth the public’s money.

In a separate release, B.C. Premier John Horgan doesn’t mention any activist by name but does briefly allude to the role activists play in responding to HIV/AIDS in Vancouver. He notes there that the theme for World AIDS Day 2019 is “communities make the difference”.

"I want to extend my gratitude to all the volunteers, health-care workers, medical practitioners, researchers, friends and family who dedicate their time to helping those living with, or vulnerable to, HIV,” Horgan said. “We must continue to lift each other up and build strong communities to end the AIDS epidemic here and around the world."