The 2017 Wainberg Lecture was given by Dr. Julie Bruneau, an addiction physician and researcher from the Université de Montréal.
The CAHR Conference organizing committee awards the Mark Wainberg lecture to both honour Dr. Wainberg’s ongoing contributions to research and to recognize the efforts of others in the research community who exemplify the same traits of excellence, perseverance, and commitment to the cause of finding innovative and ground breaking ways to address the HIV/AIDS epidemic. Dr. Bruneau’s presentation “From SEP to PrEP: The end of the HIV and HCV “problem” for persons who inject drugs?” will discuss the individual-centered and systemic strategies needed to bridge HIV/HCV prevention, treatment, and addiction services.
As an addiction physician in the mid 80’s, Dr. Bruneau was thrust into the midst of the HIV crisis. Looking retrospectively at a bank of sera from persons who injected drugs seen at the clinic, she uncovered the presence of HIV in this population. From this effort has come a long-standing cohort study of HIV transmission, individual factors, and contexts that are associated with HIV infection.
Since this realization, she has seen improvements in the way addiction is perceived and how HIV and HCV transmission is reduced in the IDU community. “Because of the HIV threat, there was a whole shift in the paradigm of how we see people who inject drugs—health workers had to see drug use and drug use trajectories as something to adapt to, instead of a contraindication for any care until abstinence was achieved.”
In the 90’s, Dr. Bruneau participated in the implementation of the first needle exchange program and the expansion of opiate substitution programs in Montreal. “We went from reluctantly thinking maybe we should give out clean syringes to an accepted and documented protective harm reduction strategy implemented in many countries.” she says. “In the past 10 years we’ve started to apply a continuum of care for HIV at-risk and infected persons— we prevent harm, we test, we treat, we consider treatment as prevention and as a way to help people deal with multiple comorbidities including addiction.”
Despite these advances, there are still gaps in the system that Dr. Bruneau will address in her talk. “We’re still a little disconnected between the mainstream healthcare system and the addiction system,” she explains. “The next step is to ensure that drug users have the best healthcare given their condition and it’s integrated within the mainstream system. We need to get vulnerable people access to the care they need efficiently, while preventing or treating their HCV and HIV and other conditions, and helping them stay safe and clean afterwards.”