HIV/AIDS

HIV/AIDS
What is HIV/AIDS?

HIV – the Human Immunodeficiency Virus – is a virus that attacks the immune system, resulting in a chronic, progressive illness that leaves people vulnerable to opportunistic infections and cancers. When the body can no longer fight infection, the disease is known as AIDS, which stands for Acquired Immunodeficiency Syndrome. On average, it takes more than 10 years to progress from initial HIV infection to AIDS.

The State of the HIV/AIDS Epidemic in Canada

The first reports of HIV/AIDS related illnesses in Canada appeared in March of 1982. Since then, HIV/AIDS has become a national epidemic, with more than 60,000 positive HIV tests and 20,000 AIDS diagnoses having been reported in Canada. But many people with HIV/AIDS have never been diagnosed. New estimates indicate that roughly 58,000 people are currently living with HIV in Canada. About a quarter of these people are unaware of their infections.

Over the last 10 years, treatments for HIV/AIDS have continually been developed, and people are now living longer with HIV infection. This increased survival contributes to the rising number of Canadians living with HIV.

Canada’s epidemic has grown in complexity and now affects many vulnerable populations. Currently in Canada, the groups most at-risk are men who have sex with men and people who inject drugs. However, the number of heterosexual men and women infected through unsafe sex is also rising. More women are being diagnosed with HIV and AIDS than in the past and now represent an estimated 20 per cent of all Canadians infected with HIV. Aboriginal people are also over-represented in the epidemic and are almost three times more likely to be infected by HIV than other Canadians. Other vulnerable groups include prisoners, at-risk youth, and people from countries where HIV is endemic.

Since the beginning of the epidemic in Canada, much progress has been made. Canada’s blood system now screens for HIV and other blood-borne infections, and mother-to-child transmission of HIV has been nearly eliminated. Public health interventions have helped prevent new infections, and policies and programs are more strategically focused on vulnerable populations. Steps have also been taken to increase public awareness of HIV/AIDS and tackle stigma and discrimination around the disease.

As part of Canada’s program to prevent new infections, Canada has supported a number of evidence-based initiatives aimed at reducing the high rates of HIV/AIDS infection among people who inject drugs. Since 2002, the percentage of new HIV infections attributable to people who inject drugs has declined from 19 per cent of the total to14 per cent. While this is good news, and provides evidence of the success of these evidence-based initiatives, the number of new infections among people who inject drugs remains unacceptably high at an estimated 350 to 650 during 2005.

Through the Federal Initiative to Address HIV/AIDS in Canada—launched in 2005—the Government is developing specific approaches for populations vulnerable to HIV/AIDS. These approaches are intended to increase awareness and promote the prevention of HIV/AIDS in people that have been identified as at-risk. New programs will also be developed to provide support and to aid in the treatment of people living with HIV/AIDS.

Over the past 20 years, Canada has made significant progress towards fighting HIV/AIDS. We have succeeded in improving awareness and decreasing the rate of new infection among some vulnerable groups. However, Canada still has a way to go before the threat of HIV/AIDS is eliminated. Groups that have seen a decrease in infection rates are still considered at-risk and progress to date cannot be taken for granted. The Government of Canada remains committed to the fight against HIV and AIDS, and we will continue to work towards awareness and prevention of these diseases.

At the end of 2005, an estimated 58,000 people in Canada were living with HIV infection (including AIDS). This represents an increase of about 16% from the 2002 estimate of 50,000 (Table 1). The individuals most affected by the epidemic have been grouped by their HIV exposure category. These include: men who have sex with men (MSM); injecting drug users (IDU); individuals having heterosexual contact with a person who is either HIV-infected or at risk for HIV, or having heterosexual activity as the only identified risk for HIV (Heterosexual/non-endemic); individuals with an origin in a country where HIV is endemic (mainly sub-Saharan Africa and the Caribbean) and not identified as MSM or IDU (Heterosexual/endemic); and recipients of blood transfusion or clotting factor, perinatal and occupational transmission (Other).

Table 1: Estimated number of individuals living with HIV infection in Canada and associated ranges of uncertainty at the end of 2005 and 2002 (point estimates and ranges are rounded).

MSM

MSM-IDU

IDU

Heterosexual/
Non-endemic

Heterosexual/
Endemic

Other

Total*

2005

29,600
(24,000-35,000)

2,250
(1,500-3,000)

9,860
(7,800-12,000)

8,620
(6,600-10,600)

7,050
(5,200-8,800)

400
(300-500)

58,000
(48,000-68,000)

2002

26,200
(21,000-31,000)

1,900
(1,200-2,600)

8,900
(7,200-10,600)

6,950
(5,200-8,800)

5,680
(4,000-7,300)

350
(250-450)

50,000
(41,000-59,000)

*Totals were rounded to the nearest 1,000. Unrounded totals were 57,780 for 2005 and 49,980 for 2002 which were used to compute percentages.

Estimates of New Infections in 2005

The number of new HIV infections in Canada in 2005 has not decreased and may have increased slightly compared to 2002. An estimated 2,300 to 4,500 new HIV infections occurred in 2005 compared with 2,100 to 4,000 in 2002 (Table 2).
Table 2: Estimated ranges of uncertainty for the number of new HIV infections in Canada in 2005 and 2002 (ranges are rounded).

MSM

MSM-IDU

IDU

Heterosexual:
Non-endemic

Heterosexual:
Endemic

Other

Total

2005

1,100-2,000

70-150

350-650

550-950

400-700

< 20

2,300-4,500

2002

900-1,700

60-120

400-700

450-850

300-600

< 20

2,100-4,000

Persons from HIV-endemic countries continue to be over-represented in Canada’s HIV epidemic. While they comprise only 1.5% of the Canadian population, their estimated infection rate is almost 13 times higher than among other Canadians.

Women

It was estimated that women account for 20% of people living with HIV infection in Canada at the end of 2005. Women were also estimated to account for 27% of all new infections in 2005. Approximately three quarters of the new infections among women were attributed to the heterosexual exposure category (endemic and non-endemic together) and the remainder was attributed to the injecting drug user exposure category.
Aboriginal Canadians

Aboriginal persons continue to be over-represented in the HIV epidemic in Canada. They were estimated to account for 7.5% of persons living with HIV in Canada at the end of 2005 and 9% of all new HIV infections in 2005. This shows an estimated overall infection rate in Aboriginal persons that is nearly 3 times higher than among non-Aboriginals.

At 53%, injecting drug users accounted for a majority of new infections among Aboriginal persons. The heterosexual exposure category accounted for 33% and the men who have sex with men category for 10%. This distribution is quite different from that seen in the wider group of all newly HIV infected Canadians in 2005 (see Figure 2).
Undiagnosed

At the end of 2005, an estimated 27% of the 58,000 individuals living with HIV were unaware of their infection. That makes this group “hidden” to the health care and disease monitoring systems, and so they cannot take advantage of available treatment strategies or appropriate counselling to prevent the further spread of HIV.
Comment

The number of Canadians living with HIV infection will likely continue to increase in the years to come as new infections continue and survival rates improve. This will mean increased future care requirements.

Aboriginal people and persons from HIV-endemic countries continue to be over-represented in Canada’s HIV epidemic, highlighting the need for specific measures to address the unique aspects of certain groups. Injecting drug users is the main HIV exposure category among Aboriginal persons while heterosexual activity is the main risk for women and persons from HIV-endemic countries.

There continues to be a sizeable number of people unaware of their HIV infection. Until these individuals are tested and diagnosed, they cannot take advantage of appropriate care and treatment services, nor can they receive counselling to prevent further spread of HIV.

To successfully control the HIV epidemic in Canada, more effective strategies are needed to prevent new infections and provide services for all of the vulnerable populations identified in the Federal Initiative to Address HIV/AIDS in Canada.

Reference

Boulos D, Yan P, Schanzer D, Remis RS and Archibald CP. Estimates of HIV prevalence and incidence in Canada, 2005. Canada Communicable Disease Report 2006; 32(15) (in press). Will be available at the following website on August 8, 2006:

http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/06vol32/dr3215e.html

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