Updated: Dec 12, 2020
By Lauren Tailor
What is HIV?
Human Immunodeficiency Virus (HIV) is an RNA autoimmune virus that can lead to acquired immunodeficiency syndrome (AIDS) if inadequately treated.1,2, 3 While there is no cure for HIV, effective antiretroviral (ARV) therapy suppresses viral loads such that HIV patients now live much longer than was previously possible.2 HIV is a bloodborne infection transmitted through sexual contact, from mother to infant in childbirth (perinatally), or through shared use of contaminated equipment (e.g. injectable drugs). 2 Therefore, factors that increase risk of HIV include unprotected sex, multiple sexual partners, comorbidities, unknown maternal infection, or unsafe injections or blood transfusions.4 HIV patients may be asymptomatic or present with non-specific symptoms.2 HIV and AIDS are notifiable diseases, but legislation surrounding reporting varies provincially.2 HIV remains a public health issue with around 37 million people living with HIV globally in 2017.3 More at-risk groups include Indigenous Canadians, gay/bisexual/men who have sex with men (gbMSM), and people who use injectable drugs (PWID).4
General Trends in HIV in Canada
There have been 88,881 HIV diagnoses in Canada from 1985 to December 31, 2018.4 Since 2014, the prevalence and incidence of HIV have been on the rise.4 The estimated prevalence of HIV in 2018 (167 per 100,000 population) was a 3% increase from 2016.5,6 This increase might be due to improved treatment, which has reduced HIV-related mortality.6 The diagnosis rate of HIV in Canada in 2018 was 6.9 per 100,000 population, representing an increase of 8.2% from the previous year.4 Causes of this increase include improved testing initiatives (e.g., “Know Your Status”) and/or increased transmission.4,6 It is important to note that Saskatchewan consistently has the highest diagnosis rate (14.9 per 100,000 population in 2018), which is more than twice Canada’s national average. 4,6 Data from 2011 suggest that 71.4% of HIV patients in Saskatchewan were also PWID, often from First Nations reserves.5
The gbMSM exposure category continues to account for the highest incidence of HIV, with varying proportions among different age groups.4 However, the proportion of new infections has decreased (e.g., from 48.8% of reported adult cases in 2014 to 41.4% in 2018). 4,6,7 This downward trend might be reflective of effective public health interventions and increased use of provincially funded pre- (PrEP) and post-exposure prophylaxis (PEP).8 While the use of PrEP has increased in Ontario by 713% from 2015 to 2018, PrEP usage is still below recommended guidelines, meaning that more targeted public health educational tools may be beneficial.8
PWID are also at increased risk of HIV infection due to contamination of equipment.4 The rise in PWID cases may be due to the opioid crisis and decreased access to substance use disorder treatment secondary to socioeconomic status.2 The majority of cases attributed to PWID were reported as Indigenous in 2017 (68.1%), highlighting a group in need of focused public health education.9 While Indigenous people made up only 4.9% of the Canadian population in 2016, they represented 11.3% of the incidence rate, and the prevalence rate of HIV in Indigenous people was twice as high than that of the general population (362 per 100,000 population). 5,6,9 Factors that increase the risk of HIV among Indigenous people include the impact of racism and colonialism on health, socioeconomic factors, education, housing, and incarceration rates.10
Campaigns aimed at minimizing risk factors and targeting at-risk groups may help to decrease HIV rates in Canada.10 These targeted public health campaigns should be adapted for different groups, cultures, languages, and literacy levels to exemplify cultural competence. HIV stigma also continues throughout Canada. 11 HIV patients who face stigma are often less likely to access services and social supports (e.g. testing) that could improve their health and minimize future transmission.6,11 Therefore, public health campaigns that promote cultures of inclusivity and reduce stigma may improve surveillance and long-term prevention.
1. German Advisory Committee Blood (Arbeitskreis Blut), Subgroup ‘Assessment of Pathogens Transmissible by Blood’. Human Immunodeficiency Virus (HIV). Transfus Med Hemother. 2016;43(3):203-222. doi:10.1159/000445852
2. Canada.ca. HIV And AIDS: For Health Professionals - Canada.Ca. [online] Canada.ca. Available at: <https://www.canada.ca/en/public-health/services/diseases/hiv-aids/health-professionals.html> [Accessed 21 October 2020].
3. The Joint United Nations Programmed on HIV/AIDS. UNAIDS Data 2018. UNAIDS: 2018. https://www.unaids.org/en/resources/documents/2018/unaids-data-2018
4. Haddad N, Robert A, Weeks A, Popovic N, Siu W, Archibald C. HIV in Canada—Surveillance Report, 2018. Can Commun Dis Rep 2019;45(12):304–12. https://doi.org/10.14745/ccdr.v45i12a01; https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2019-45/issue-12-december-5-2019/article-1-2018-hiv-survellance-report.html
5. Catie.ca. 2020. The Epidemiology of HIV In Canada. Accessed 21 October 2020. Available at: <https://www.catie.ca/en/fact-sheets/epidemiology/epidemiology-hiv-canada>
6. Public Health Agency of Canada. Estimates of HIV incidence, prevalence and Canada’s progress on meeting the 90-90-90 HIV targets - Canada.ca. [online] Canada.ca. Accessed November 25, 2020.Available at: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/summary-estimates-hiv-incidence-prevalence-canadas-progress-90-90-90.html. Published 2020.
7. Tarasuk J, Zhang J, Lemyre A, Cholette F, Bryson M, Paquette D. National findings from the Tracks survey of people who inject drugs in Canada, Phase 4, 2017–2019. Can Commun Dis Rep 2020;46(5):138–48. https://doi.org/10.14745/ccdr.v46i05a07
8. Haddad N, Li JS, Totten S, McGuire M. HIV in Canada–Surveillance Report, 2017. Can Commun Dis Rep. 2018;44(12):324-32. https://doi.org/10.14745/ccdr.v44i12a03
9. Lee H, Colyer S, et al. Trends in HIV diagnoses by age and ethnicity among men who have sex with men (MSM) in British Columbia, Ontario, and Quebec: 2006-2015. Presentation presented at the: CAHR Conference 2018. https://www.engage-men.ca/wp-content/uploads/2019/04/Engage-CAHR-2018-Hwan-Lee.pdf
10. Sexual behaviours, condom use and other contraceptive methods among 15- to 24-year-olds in Canada. Statistics Canada. Published 2020. Accessed November 27, 2020. https://www150.statcan.gc.ca/n1/pub/82-003-x/2020009/article/00001-eng.htm.
11. Ontario Advisory Committee on HIV/AIDS. Changing the course of the HIV prevention, engagement and care cascade in Ontario HIV/AIDS strategy to 2026. Health.gov.on.ca. Published 2020. Accessed November 26, 2020. http://www.health.gov.on.ca/en/pro/programs/hivaids/docs/oach_strategy_2026.pdf