Turning the Tide
A strategic battle against HIV/AIDS
By Roberta Staley
Portrait by Frank Vena
Dr. Bohdan Nosyk, cell phone clasped to one ear, impatiently waits outside the Comox Street entranceway to Vancouver’s St. Paul’s Hospital. After a brief greeting, we pivot through the glass doors into the mustard-grey hallway and stride down the hall to the aged elevator. As a code blue alert crackles robotically over the intercom, the sluggish lift jolts upwards to the sixth floor where Nosyk’s office is located at the B.C. Centre for Excellence in HIV/AIDS (BC-CfE). With its glass walls and blond wood, the centre is an airy and welcome contrast to the grim hospital corridors.
This morning, Nosyk has managed to clear 20 minutes of his day to discuss the $3 million St. Paul’s Hospital CANFAR chair in HIV/AIDS Research that he was awarded earlier this year (SFU and St. Paul’s Hospital Foundation are equal co-funders). “I’m honoured and excited about what we may be able to accomplish in HIV/AIDS in the coming decade,” says Nosyk. The appointment has added to Nosyk’s already extraordinary workload, which includes an associate professorship in SFU’s Faculty of Health Sciences. The hydra heads of media, academia, and research are proving challenging. Add to this an increasingly assertive two-year-old daughter – still mad at Dad for putting her to bed early the night before – and Nosyk is feeling a bit like a Cirque du Soleil juggler.
Nosyk’s office, on the east side of St. Paul’s, is half a city block away through the labyrinth of hallways to Providence building’s 10th floor, where AIDS patients receive treatment. It is the well-being of such individuals that is ever foremost in Nosyk’s mind – their need is the catalyst for his research and work. He doesn’t visit with the patients; as a health economist, Nosyk’s work requires “a degree of separation,” he says.
“The nature of the work calls for dispassionate decisions that really shouldn’t be influenced by personal references or relationships, but should rather reflect the best interests of the population as a whole,” says Nosyk, as square and broad shouldered as an Olympic wrestler, with thick dark brown hair and startling green eyes.
HIV/AIDS has been a global scourge since the early 1980s; the World Health Organization estimates it has killed 36 million people, including 21,000 Canadians. Still, there is reason for optimism and even celebration. At the same time that Nosyk’s chair appointment was announced, it was reported that the dedicated AIDS ward at St. Paul’s was no longer needed. Such a milestone stems from the pioneering work of the BC-CfE. Its researchers developed highly active antiretroviral therapy (HAART), which reduces the virus to undetectable levels and lowers morbidity and mortality as well as transmission rates.
Today, HAART is the gold standard for HIV therapy, not only in Canada but around the world. Countries like China have liaised with the BC-CfE to implement a HAART program to deal with that nation’s HIV/AIDS problem, which afflicts about one million people. In B.C., where HAART has been embraced since the mid-1990s, the province has had the largest decline in the rate of new diagnoses of HIV in the country. In 2012, there were 238 new infections, down from 702 in 1996. By popping just one pill a day, HIV/AIDS patients are able to live virtually normal lives, able to continue working while remaining part of their social network. “That’s a huge victory,” says Nosyk. “I think the tide has turned in the fight against HIV/AIDS.” (Unfortunately, HIV/AIDS is on the rise in Saskatchewan.)
Savouring such victories is a fleeting luxury. Nosyk is focused on implementing the next strategic advance in the battle against HIV/AIDS: identifying those individuals who may not know that they are infected with the virus. In B.C., there are an estimated 1,500 people – many living in Vancouver’s Downtown Eastside (DTES) or in northern communities – who are HIV positive but don’t know it. Chillingly, the BC-CfE estimates these individuals are responsible for 75 percent of new HIV infections.
As Nosyk explains, the challenge is one of implementation. “If we can optimize the health system to ensure people are getting tested, accessing treatment, and keeping with it, we can go a long way to eliminating new infections.”
Nosyk is coordinating this initiative as a pilot project with Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS). Working closely with community health offices in the north as well as the DTES, “enormous amounts of data” will be gathered from a variety of sources, analyzed and tracked in real time, leading to a swift and effective response from health care professionals.
Nosyk’s earlier studies into opioid addiction inform his current approach to infection reduction.
For the HIV/AIDS tide to truly turn, policy makers must amalgamate HIV care into drug and alcohol dependence programs, says Nosyk.
“It is about engineering the health care system to do the best we can to get people on treatment and keep them there,” says Nosyk. From being reactive – treating people who’ve fallen ill – the HIV/AIDS strategy under development is proactive – “treatment as prevention,” says Nosyk. “The ultimate goal is zero new infections.” The challenge, he anticipates, will be keeping people in treatment, a key problem that Nosyk and his fellow researchers will analyze in another randomized trial to improve HIV care in drug treatment facilities.
Zero new infections is a lofty goal, and one that has long been on Nosyk’s radar. Only 34 years of age, Nosyk has a body of peer-reviewed published works that eclipses the oeuvre of many researchers twice his age. Broadly, he looks at the shifting economic landscape of HIV prevention and treatment. Specifically, Nosyk focuses on the quality of medical care given those with HIV/AIDS and undertakes mathematical modelling to determine where and how limited resources can be funnelled to prevent new infections. His research arm stretches beyond North America to as far afield as China and Thailand.
Such exotic locales are a long way from what Nosyk calls “humble beginnings” in Winnipeg. The son of Ukrainian immigrants whose families had fled Europe during the Second World War, Nosyk aspired early to an academic career. His university professors saw the potential in this bright, polite young man, “and inspired me to push myself to achieve my goals.” A plethora of awards and scholarships quickly followed.
Nosyk was interested in health economics but, unlike today, such classes weren’t offered in economics departments. His focus in this area proved prescient, laying the foundation for a career in public health. After finishing his graduate work in Canada, Nosyk became a postdoctoral fellow and scientist at UCLA’s Integrated Substance Abuse Programs, researching opioid drug addiction. It was there that he was touched personally by AIDS. Nosyk’s UCLA supervisor was a survivor from the early days of the pandemic. It was an ongoing battle with the insurance provider for his supervisor to get the drugs he needed to keep him healthy. “A reason to be thankful for what we have here,” Nosyk says.
By 2011, Nosyk was back in Canada, the BC-CfE’s newest senior scientist, his work garnering such accolades as the Michael Smith Foundation for Health Research Career Investigator Award.
“When you can walk into the offices of political leaders and say, ‘We have a very good idea that is not only saving lives, promoting health, and preventing infection but over time will save you money,’ that’s when they truly listen.”
– DR. JULIO MONTANER, director of the BC-CfE
Nosyk’s earlier studies into opioid addiction inform his current approach to infection reduction. For the HIV/AIDS tide to truly turn, policy makers must amalgamate HIV care into drug and alcohol dependence programs, says Nosyk. He estimates that up to 45 percent of those with HIV are or once were injection drug (mainly heroin) users who contracted the virus from sharing needles. The efficacy of coordinated policies is highlighted by vastly increased access to methadone treatment as well as the success of Insite, Vancouver’s supervised injection facility, where users exchange dirty needles for clean ones. Statistically, “it has made a huge impact on the HIV/AIDS epidemic in B.C.,” says Nosyk. In 2012, there were 29 new HIV cases among injection drug users in the DTES, down from 352 in 1996.
Dr. Julio Montaner, the director of the BC-CfE and one of the world’s foremost experts on HIV/AIDS, predicts that Nosyk, in his position as CANFAR chair, will achieve “totally new heights” in research into the impact of HIV. Nosyk’s contributions have been “phenomenal,” says Montaner, citing his young colleague’s “seven days a week dedication, his passion and commitment and spectacular productivity.”
It is Nosyk’s ability to place HIV/AIDS within an economic framework that will prove valuable not only for HIV/AIDS patients but B.C.’s cash-strapped health care system. His approach will also influence those within the corridors of power, Montaner says. “When you can walk into the offices of political leaders and say, ‘We have a very good idea that is not only saving lives, promoting health, and preventing infection but over time will save you money,’ that’s when they truly listen,” Montaner says.
Montaner and Nosyk view their work at reducing HIV/AIDS as being part of a worldwide effort. This past summer’s International AIDS Conference in Melbourne, Australia, presented a new global objective and strategy called 90-90-90. The triptych of 90, set to be achieved by 2020, aims for 90 percent of people with HIV to become aware of their status, 90 percent of those diagnosed to receive antiretroviral therapy, and 90 percent of people undergoing treatment to have lasting viral suppression. The objective is an end to the AIDS epidemic globally by 2030.
It’s another lofty goal, and one that Nosyk conceivably will see in his working lifetime. Moreover, he will have had a significant hand in its achievement. “We are poised to do something profound in HIV, and I want to do everything I can to help make that happen,” he says.