Beyond pharmaceutical bandaids: universal access to antiretroviral therapy in Canada

Beyond pharmaceutical bandaids: universal access to antiretroviral therapy in CanadaIn their CMAJ commentary, Dr. Montaner and colleagues called for universal access to antiretroviral therapy (ART), funded through federal-provincial col laboration, as a prerequisite for ending HIV as a public health threat in Canada. 1 Their argument rests on the principle of treatment as prevention: sustained access to ART enables people living with HIV to achieve viral suppression, elimin ating the risk of sexual HIV transmission and reducing the incidence of HIV at the population level. 2 The urgency of this pol icy imperative has become increasingly impossible to ignore following Gilead Sciences Canada's decision, effective June 2026, to discontinue copayment assist ance programs for 4 antiretroviral co formulations still in clinical use: Gen voya, Stribild, Odefsey, and Complera (MAX Gilead Support Program: personal communication, 2026).Rather than cre ating a new problem, this decision exposes a longstanding structural weak ness in Canada's HIV response: access to ART depends on fragmented coverage arrangements and discretionary private assistance rather than a universal public guarantee.Despite Canada's commitment to publicly funded health care, prescrip tion drug coverage remains uneven across provinces and territories.Sev eral jurisdictions, including British Columbia, Alberta, and Saskatchewan, fully cover ART through public drug plans.By contrast, in Quebec and Ontario, where most people in Canada who are living with HIV reside, patients