Dr. Julio Montaner has spent decades in the fight against HIV but says he feels years of progress slipping away.
“I am very worried about what’s coming our way,” said Montaner, executive director and physician-in-chief at the B.C. Centre for Excellence in HIV/AIDS in Vancouver, the largest HIV/AIDS research and treatment facility in Canada.
He says new cases of the virus are popping up in British Columbia every week — a reality reflected in health data from across the country, sparking calls from advocates and health experts for Canada to address the growing issue.
New modelling data from the Public Health Agency of Canada shows there was a 22.8 per cent increase in new HIV infections between 2022 and 2024.
In 2024, an estimated 2,517 new infections occurred compared with the 2,050 infections recorded two years earlier.
In 2019, B.C. declared an end to the HIV epidemic after new AIDS cases had declined by 90 per cent and new infections were at a record low. But since then, Montaner says infection numbers have been moving in the other direction.
In May, Manitoba’s public health minister declared HIV a public health emergency after HIV rates rose sharply, becoming 3.5 times higher than the national rate. Earlier this year, Saskatchewan reported infection rates just under Manitoba’s, making theirs the second-highest rates in Canada.
“What we’re seeing is a resurgence of HIV, both new infections and AIDS, which was until two or three years ago, persistently declining — because the strategy was working,” Montaner said.
Canada below key HIV targets
Montaner’s research into highly active antiretroviral therapy in the mid ’90s helped prove HIV infection could be effectively managed by using a combination of drugs. The world renowned physician and professor went on to be the lead architect behind the strategy “treatment as prevention,” introduced in 2006 at the International AIDS Conference in Toronto.
The approach was adopted by the United Nations in 2014 in an effort to end the AIDS pandemic by 2030. A majority of UN member states, including Canada, endorsed and committed to the strategy in 2016, and reaffirmed those commitments this past June.
The strategy asks countries to aim for three targets: 95 per cent of people with HIV to be diagnosed, 95 per cent to be on treatment and 95 per cent to have a suppressed viral load.
But Canada has so far only reached one of the three goals.
“The most important number, at the end of the day, is the number of people that are virologically suppressed because you don’t get sick, your disease doesn’t progress, you lead a normal life — and you don’t transmit HIV,” Montaner said.
Other countries have succeeded.
A new report from UNAIDS, the UN body that leads the global effort against the spread of AIDS, says 11 countries — seven of which are in eastern and southern Africa — have reached the threshold required to eliminate AIDS as a public health threat.
Globally, new HIV infections and deaths from the disease are at the lowest levels in 30 years, the report says.
According to UNAIDS, since 2010, the estimated number of new HIV infections fell by 42 per cent globally while deaths decreased by 57 per cent. In 2025, there were 1.2 million new infections and 570,000 deaths.
However, the same report says 21 countries have seen a rise in infections.
Cuts, slow tracking undermine future progress
This week, global health leaders at the International AIDS conference in Rio de Janeiro warned that major foreign aid cuts, mostly from the United States and other high-income countries — including Canada — could unravel years of progress.
UNAIDS says, in 2025, international funding for HIV testing and treatment initiatives in low- and middle-income nations plummeted by 18 per cent.
Montaner says Canada should restore its funding of global initiatives but says the resurgence of HIV cases at home also needs attention and investment from Ottawa.
“We are reporting every two years and we’re reporting four years behind,” Montaner said. “We cannot adequately take steps to alleviate what’s in front of us if we keep on looking backward.”
He says he’s been asking the federal government to report on national HIV infections quarterly, not every two years, and to make sure treatment is accessible.
Antiretroviral drugs have come a long way, Montaner says, with lower costs and many that are a single daily pill. There’s also oral and injectable medications such as pre-exposure prophylaxis, known as PrEP, and post-exposure prophylaxis, known as PEP, that significantly lower the risk of getting HIV.
Montaner says not everyone can afford deductibles and co-payments, and these medications should be free through Canada’s national pharmacare program.
The changing face of HIV
Jody Jollimore, an executive director for the Canadian AIDS Treatment Information Exchange (CATIE), agrees that more can be done.
Jollimore says despite Canada’s commitment in 2016 to eliminate HIV, investment in the HIV and Hepatitis C Community Action Fund that supports programs, like CATIE, has mostly been stagnant.
Public Health Agency of Canada says funding through the HIV and Hepatitis C Community Action Fund and the Harm Reduction Fund amounts to $33.4 million annually and is “tailored to reach key populations and the regions of the country most affected by HIV, hepatitis C” and other sexually transmitted and blood-borne infections.
“A dollar does not go as far as it used to,” Jollimore said.
Jollimore says the face of HIV is changing in Canada. He says when the AIDS crisis began in the 1980s it was centered in big cities, mostly affecting gay men, but today, it is showing up in rural and remote communities without adequate health infrastructure and resources. He says more investment is needed to reach those people.
“These communities have little infrastructure,” Jollimore said. “They almost certainly do not have an HIV organization supporting the work. And in fact, many don’t even have a clinic or a health-care provider available to them.”
The Public Health Agency of Canada estimates 70,900 people are living with HIV in Canada. The agency says over half identify as gay, bisexual and other men who have sex with men. More than a quarter are female and about 12.6 per cent are people who have injected drugs.
“It tends to thrive in pockets where there’s the least connection to care,” Jollimore said. “In those communities where stigma or discrimination or racism may prevent someone from coming forth to get tested or treated.”
Reconnecting to care
Those are just some of the barriers Darryl Jordan is working to address.
His father died from AIDS in 1994. Then in 2010, Jordan himself was diagnosed with HIV. Today, he works as a harm-reduction navigator in Saskatoon for a local Indigenous organization called Persons Living with AIDS Network.
Its program helps people get tested and connected to HIV treatment, but Jordan says that work has been affected by provincial funding cuts to harm reduction initiatives.
He says stigma around HIV is one of the many reasons people may not want to get tested. But there are other challenges, like substance use, mental health and poverty that have created barriers to getting people help.
“A lot of people have lost connection with their care,” Jordan said. “They’re not taking their medication. I mean, in order to take care of yourself, you got to have a roof over your head.”
Jordan says rapid HIV oral tests have made it easier for people to find out their status.
“Once you’re tested, you can be treated, and once you’re treated, you’re going to live a normal life.”
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