In a recently released study by the British Columbia Centre for Excellence in HIV-AIDS, an alarming forty per cent of the people who died of HIV-AIDS in British Columbia never sought life-saving treatment even though it was free. The study examined more than 1,400 HIV-related deaths in British Columba between 1997 and 2005 and found that 567 people died without ever receiving antiretroviral treatment. In a statement by Dr. Julio Montaner, director of the centre, he notes that: "We have a problem. The treatments are available for free but something is wrong because the people that most need the treatment, they're not always accessing the treatment."

Low income is one of the most prominent factors associated with high AIDS mortality with residence in a poor neighbourhood being linked with reduced access to treatment. Other factors include lack of housing or transportation, mental illness, illegal activity and language barriers that play a role in an individual's ability to access treatment.

An estimated twenty-five per cent of those infected with HIV in Canada are not aware of their infection, according to the centre. While the centre distributes free antiretroviral medications to all eligible British Columbians through the provincewide Drug Treatment Program, funded by Pharmacare, ensuring access to treatment for all HIV patients remains an elusive goal.

"We have found that over the last several years there is a persistent number of people dying with HIV in our midst, where treatment and health care is supposed to be readily available," Montaner said.

He described typical examples including single mothers without access to child care resources and homeless, mentally ill drug addicts who are unaware of their HIV status.

Montaner further adds that the problem is that same across all of Canada and the percentage could even be worse in smaller communities where fewer resources are available.

Ken Buchanan, of the British Columbia Persons with AIDS Society, commented on the study by saying that the long-term solution is to bring some stability to the lives of HIV-AIDS sufferers. "For a person who is homeless, taking medications, even free medications, is pretty low in their priorities," he said.

He further warned that access to medication isn't enough since a person who begins treatment and doesn't maintain the proper dose regime will build up a resistance to the drugs and end up more likely to die.

While the centre currently has a proposal before the provincial government to form outreach teams that would take rapid-response testing to the most vulnerable and offer treatment, the presence of free health care may not be enough to address this problem,

"We need to bring the treatments to the people and we need to create the programs that are going to help these individuals to take the treatment. It is not only the ethical and human thing to do, he said, it's also better for society at large because it reduces HIV-related illnesses that drain the health care system. By treating these people we're doing what is right for them, we're doing what is right for the system and we're also going to decrease HIV transmission," Montaner said.

Previous research by the centre and by researchers in Taiwan showed a 50 per cent reduction in new HIV cases that due to access to antiretroviral therapy. The current treatment regimen of three or more antiretroviral drugs on a daily basis for life requires a very high level of adherence in order to be fully effective.