EATG » Canada makes some progress on HIV but much work lies ahead

Canada makes some progress on HIV but much work lies ahead

— New HIV estimates were released by the Public Health Agency of Canada.
— 63% of Canadians living with HIV have achieved an undetectable viral load.
— Canada exceeds some of the 90-90-90 targets in federal prisons, falls behind in First Nations.

Thanks to anti-HIV therapy (ART), researchers expect that if people are diagnosed with HIV soon after infection, start treatment early, stay engaged in care and adhere to their treatment regimen many will have near-normal life expectancy. Also, studies have found that HIV-positive people who achieve and maintain an undetectable viral load do not pass on HIV to their sexual partners.

These twin benefits of ART—on individual health and transmission—are so profound that the Joint United Nations Program on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) have issued a global strategy to help cities, regions and countries improve the health of HIV-positive people and end the epidemic spread of new infections by the year 2030. The strategy can be encapsulated in the phrase 90-90-90 and consists of the following targets for the year 2020:

  • 90% of people with HIV know their infection status
  • 90% of people diagnosed with HIV receive ART
  • 90% of people taking ART have an undetectable viral load

This distribution of people across HIV testing and treatment outcomes is called the cascade of care.

In Canada

Many countries and regions, including Canada and its provinces and territories, are using 90-90-90 to assess how much progress is being made against the HIV pandemic. The Public Health Agency of Canada (PHAC) has recently released a report on the HIV epidemic in Canada based on data analysed to the end of 2016. PHAC estimates that there were 63,110 HIV-positive people at the end of 2016. According to this report, the Canadian estimates for 90-90-90 for that year are as follows:

  • 86% of people with HIV knew their infection status
  • 81% of people diagnosed with HIV were taking ART
  • 91% of people taking ART had an undetectable viral load

These figures show that Canada is moving forward to reach its 90-90-90 goals. According to these estimates, 63% of people living with HIV had achieved an undetectable viral load in 2016, which is up from 58% in 2014. Furthermore, the estimates for Canada are generally within the range seen for other high-income countries, including Australia, Denmark, Germany, the U.K. and United States.

Saskatchewan—Indigenous people living on reserve

Saskatchewan has the highest rate of new infections in Canada and Indigenous peoples are disproportionately affected. In order to better understand the situation for on-reserve communities, PHAC collaborated with public health and Indigenous authorities in Saskatchewan and produced the following estimates:

  • 77% of Indigenous people diagnosed with HIV were taking ART
  • 75% of Indigenous people taking ART had an undetectable viral load

Collecting and analysing this data is a good first step. Indigenous people in Canada have experienced a legacy of colonialism and racism, which has adversely affected their health, increasing their susceptibility to many conditions. More effort is needed to help all Indigenous HIV-positive people (on and off reserve across Canada) access culturally appropriate HIV testing, care and treatment services and ensure they benefit from ART.

Federal prisons

PHAC notes that “all inmates in federal correctional facilities are offered a health assessment on admission, and in 2016, 96% of newly admitted inmates accepted a voluntary HIV test to know their status. Inmates are also referred for, or can request, HIV testing anytime during incarceration.” In April 2017, among the 170 inmates with diagnosed HIV, their distribution across the cascade of care was as follows:

  • 94% of people diagnosed with HIV were taking ART
  • 91% of people taking ART had an undetectable viral load

New infections

PHAC estimates that about 2,165 new HIV infections occurred in 2016 in Canada—a slight increase from 2014. These infections were distributed among the following populations:

  • 56% – gay, bisexual and other men who have sex with men (MSM), including those who inject drugs
  • 14% – people born in a country where HIV is endemic (heterosexual transmission)
  • 14% – people who inject drugs, including gay, bisexual and other MSM
  • 11% – Indigenous people

(These figures do not total 100, due to some overlap in categories.)

Distribution of people living with HIV

PHAC states that the 63,110 people living with HIV in Canada are distributed largely among the following populations:

  • 49% – gay, bisexual and other men who have sex with men
  • 33% – heterosexual people (heterosexual transmission)
  • 15% – people who inject drugs
  • 23% – women
  • 10% – Indigenous people

(These figures do not total 100, due to some overlap in categories.)

Bear in mind

1. PHAC estimates that of the 63,110 people living with HIV in Canada, 14% are not aware that they have this infection.

According to PHAC, “These people are hidden from the health care and disease monitoring systems, and thus cannot take advantage of appropriate prevention, treatment and ongoing care and support services until they are tested and diagnosed…Innovative strategies aimed at reaching the undiagnosed population and increasing the number of people adhering to treatment could help Canada [achieve 90-90-90].”

2. The PHAC report shows that Canada is generally making some progress in reaching the UNAIDS/WHO 90-90-90 goals. However, HIV continues to disproportionally affect some populations, and PHAC states that this “highlights the continued need for evidence-informed programs that are culturally and gender-appropriate to address the unique aspects of these populations and communities.” PHAC also calls for “ongoing, broad-based prevention education” to help other populations, including heterosexual people.

By Sean R. Hosein

REFERENCES:

  1. Public Health Agency of Canada. Summary: Estimates of HIV incidence, prevalence and Canada’s progress on meeting the 90-90-90 HIV targets, 2016. Report. July 2018. Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/summary-estimates-hiv-incidence-prevalence-canadas-progress-90-90-90.html
  2. Centre for Communicable Diseases and Infection Control. A summary of the Pan-Canadian framework on sexually transmitted and blood-borne infections. Canada Communicable Diseases Report. 2018;44(7/8):179-81. Available from: https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2018-44/issue-7-8-july-5-2018/article-5-framework-action-sexually-transmitted-blood-borne-infections.html
  3. Benoit AC, Younger J, Beaver K, et al. Increased mortality among Indigenous persons in a multisite cohort of people living with HIV in Canada. Canadian Journal of Public Health. 2017 Jun 16;108(2):e169–e175.
  4. Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. New England Journal of Medicine. 2016;375:830–839. Available from: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1600693
  5. Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. Journal of the American Medical Association. 2016;316(2):171–181. Available from: http://jama.jamanetwork.com/article.aspx?articleid=2533066
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News categories: AIDS response, HIV care continuum