The changing face of HIV in Canada

The number of reported HIV cases in Canada is at the same level as when the epidemic was emerging in the early 1980s, but the lifestyle and profile of many of these new patients is evolving, the Public Health Agency of Canada indicated in a report released this week.

When HIV monitoring and reporting began in 1985, the virus was cutting a swath through the gay community, with men who had sex with men representing more than 80 per cent of all cases.

Although that same community remains a significant risk group, the profile of a "typical" HIV patient is shifting.

The newest report found that gay and bisexual men represented less than half – 41.8 per cent – of all cases in 2009.

"They’re still over-represented," said Andrew Brett, a spokesman with the AIDS Community of Toronto. "The proportion might be decreasing, but gay and bisexual men are still the group most affected by HIV and AIDS."

But other groups – such as women, aboriginals, injection-drug users and people over 40 years old – are representing increasingly larger chunks of overall cases in Canada.

Women accounted for a negligible number of newly reported HIV cases in 1985. Their representation peaked in 2006 when it reached 28 per cent. It has dipped slightly since, and in 2009, 26 per cent of the 2,417 HIV cases reported were among females.

"One of the major reasons we see the incidence increasing among certain populations isn’t just lack of access to education, but also a lack of access to tools to reduce harm," Brett said.

"HIV reduction is not just about telling people to use a condom. We need to look beyond that."

At the end of 2008, there were approximately 65,000 people living with HIV and AIDS in Canada, the report said.

The evolving profile of Canadian HIV patients means the county’s response must continue to shift as well, said Sean Hosein, the science and medicine editor at Canadian AIDS Treatment Information Exchange.

"The response has changed somewhat, but I think it needs to change more in certain regions," he said. "We need more targeted focus in the Prairies, with high aboriginal populations. If we don’t, I fear the number of people who have HIV will be much higher, much more expensive and cost the system a lot more."

Overall, 25.4 per cent of all reported HIV cases involved people who identified themselves as aboriginal, the report said, noting that not all reported cases included the patient’s ethnicity.

When it came to new cases in 2009: 44 per cent involved white patients; 33 per cent involved Aboriginal Peoples; 11.5 per cent of reported HIV sufferers were black.

The remaining cases involved Latin American, Arab, East, South and West Asian, and other ethnicities.

The rate of HIV infection in Canada was decreasing steadily from 1995 to 2000. But that trend was reversed in 2001, and has since remained relatively stable, with an estimated 3,300 new infections reported each year.

The actual number of reported cases "understates the magnitude" of the HIV epidemic, the authors wrote, since approximately 26 per cent of people who become infected each year are unaware of their status.

"Surveillance data can only tell us about persons who have been tested and diagnosed with HIV or AIDS and not those who remain untested and undiagnosed," the report says.

That is troubling, Hosein said, since those individuals don’t take steps to care of themselves and they don’t know they can pass on the infection.