HIV, Syphilis and Sexually Transmitted and Blood-Borne Infections (STBBI) Awareness and Perceptions Survey

Final Report

Prepared for:  Health Canada

Supplier:  The Strategic Counsel
Contract number:  CW2334131
Contract value:  $149,999.31
Contract award date: 2023-10-16
Delivery date:  2024-03-06

Registration number:  POR-23-23 / POR-067-23

Aussi disponible en français sous le titre Enquête sur la sensibilisation et la perception du VIH, de la syphilis et des infections transmissibles sexuellement et par le sang (ITSS)

This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from Health Canada. For more information on this report, please contact Health Canada at hc.cpab.por-rop.dgcap.sc@canada.ca or at:

Health Canada, CPAB
200 Eglantine Driveway, Tunney’s Pasture
Jeanne Mance Building, AL 1915C
Ottawa, Ontario K1A 0K9

Catalogue Number:
HP40-361/2024E-PDF

International Standard Book Number (ISBN):
978-0-660-71163-8

Related Publication (Registration Number: POR-067-23

Catalogue Number: HP40-361/2024F-PDF (Final Report, French)
International Standard Book Number (ISBN): 978-0-660-71164-5

© His Majesty the King in Right of Canada, as represented by the Minister of Health, 2024.

Table of Contents

Section A: Executive Summary

• A. Background
• B. Research Objectives
  • 1. Purpose
  • 2. How the Research Will Be Used
  • 3. Objectives
• C. Methodology in Brief
• D. Total Contract Value
• E. Note to readers
• F. Key Findings
• G. Conclusions and Recommendations

Section B: Detailed Findings – General STBBI Issues

• B1. General Public
  • A. Concerns about STBBI Relative to Other Health Issues
  • B. General Knowledge of STBBI
  • C. Experience with STBBI: Perception of Risk, Testing and Diagnosis
  • D. Stigma and Barriers Associated with Diagnosis and Treatment of STBBI
  • E. Awareness of U=U Concept and Information Preferences
  • F. Focused Analysis of Key Audiences
• B2. Health Care Practitioners
  • A. Concerns about STBBI Relative to Other Health Issues
  • B. General Knowledge of STBBI
  • C. General Barriers to Diagnosis and Treatment of STBBI
  • D. Awareness of U=U Concept and Information Preferences

Section C: Detailed Findings – HIV/AIDS

• C1. General Public
  • A. General Knowledge of HIV
  • B. Connections to People Living with HIV and Perceived Personal Risk
  • C. Groups Viewed as Most at Risk of HIV
  • D. HIV/AIDS – Knowledge Index
  • E. Perceived Effectiveness of Treatments
  • F. Stigma Associated with HIV/AIDS
  • G. Focused Analysis of Key Audiences
• C2. Health Care Practitioners
  • A. Concerns about HIV Relative to Other Health Issues
  • B. General Knowledge of HIV
  • C. Groups Viewed as Most at Risk of HIV
  • D. HIV/AIDS – Knowledge Index
  • E. Perceived Effectiveness of Treatments
  • F. Stigma Associated with HIV/AIDS
  • G. Perceived Barriers for Patients Seeking Testing and Treatment for HIV

Section D: Detailed Findings – Syphilis

• D1. General Public
  • A. General Knowledge of Syphilis
  • B. Connections to People Having Contracted Syphilis and Perceived Personal Risk
  • C. Groups Viewed as Most at Risk of Getting Syphilis
  • D. Syphilis – Knowledge Index
  • E. Stigma Associated with Syphilis
  • F. Focused Analysis of Key Audiences
• D2. Health Care Practitioners
  • A. Concerns about Syphilis Relative to Other Public Health Issues
  • B. General Knowledge of Syphilis
  • C. Groups Viewed as Most at Risk of Getting Syphilis
  • D. Syphilis – Knowledge Index
  • E. Stigma Associated with Syphilis
  • F. Perceived Barriers for Patients Seeking Testing and Treatment for Syphilis

Section E: Methodology

• A. Sample Design
• B. Questionnaire Design
• C. Pre-test
• D. Fieldwork and Length of Survey
• E. Final Dispositions
• F. Study Limitations

Section F: Appendice

• A. General Population Questionnaire
• B. Health Care Practitioner Questionnaire

List of Tables

• TABLE 1. LEVELS OF CONCERN ABOUT VARIOUS PUBLIC HEALTH ISSUES – COMPARISON BETWEEN GENERAL PUBLIC AND HEALTH CARE PRACTITIONERS
• TABLE 2. LEVELS OF CONCERN ABOUT VARIOUS HEALTH ISSUES – GENERAL PUBLIC
• TABLE 3. LEVELS OF CONCERN ABOUT VARIOUS HEALTH ISSUES: OTHER DEMOGRAPHIC HIGHLIGHTS
• TABLE 4. GENERAL ATTITUDES TOWARD STBBI – GENERAL PUBLIC
• TABLE 5. GENERAL KNOWLEDGE OF STBBI – GENERAL PUBLIC
• TABLE 6. THOSE MORE LIKELY TO SAY THEY ARE KNOWLEDGEABLE (VERY/SOMEWHAT) ABOUT HIV, SYPHILIS AND OTHER STBBI
• TABLE 7. KNOWLEDGE OF PREVENTION, TESTING AND TREATMENT OF STBBI – GENERAL PUBLIC
• TABLE 8. PERCEPTION OF RISK RELATED TO CONTRACTING STBBI – GENERAL PUBLIC
• TABLE 9. PERSONAL TESTING FOR STBBI – GENERAL PUBLIC
• TABLE 10. PERSONAL DIAGNOSES OF STBBI – GENERAL PUBLIC
• TABLE 11. COMFORT SPEAKING WITH HEALTH PROFESSIONALS ABOUT STBBI – GENERAL PUBLIC
• TABLE 12. BARRIERS RELATED TO TESTING AND TREATMENT FOR STBBI – GENERAL PUBLIC
• TABLE 13. BARRIERS RELATED TO TESTING AND TREATMENT FOR STBBI: DEMOGRAPHIC HIGHLIGHTS BY AGE, MARITAL STATUS AND PAST EXPERIENCE WITH HOMELESSNESS
• TABLE 14. INTEREST IN KNOWING MORE ABOUT RISKS, TESTING OPTIONS, TREATMENTS FOR STBBI – GENERAL PUBLIC
• TABLE 15. PREFERENCE FOR RECEIVING INFORMATION ABOUT STBBI (MULTI-MENTION) – GENERAL PUBLIC
• TABLE 16. AWARENESS OF ‘U=U’ – GENERAL PUBLIC
• TABLE 17. PERCEIVED MEANING OF ‘U=U’ (OPEN-END) – GENERAL PUBLIC
• ABLE 18. LEVELS OF CONCERN ABOUT VARIOUS PUBLIC HEALTH ISSUES – HEALTH CARE PRACTITIONERS
• TABLE 19. ADDITIONAL PUBLIC HEALTH ISSUES (OPEN-END) – HEALTH CARE PRACTITIONERS
• TABLE 20. GENERAL ATTITUDES TOWARD STBBI – HEALTH CARE PRACTITIONERS
• TABLE 21. GENERAL KNOWLEDGE OF STBBI – HEALTH CARE PRACTITIONERS
• TABLE 22. KNOWLEDGE OF PREVENTION, TESTING AND TREATMENT OF STBBI – HEALTH CARE PRACTITIONERS
• TABLE 23. COMFORTABILITY ENGAGING IN CONVERSATIONS ABOUT STBBI – HEALTH CARE PRACTITIONERS
• TABLE 24. INTEREST IN KNOWING MORE ABOUT RISKS, TESTING OPTIONS, TREATMENTS FOR STBBI – HEALTH CARE PRACTITIONERS
• TABLE 25. PREFERENCE FOR RECEIVING INFORMATION ABOUT STBBI (MULTI-MENTION) – HEALTH CARE PRACTITIONERS
• TABLE 26. AWARENESS OF ‘U=U’ – HEALTH CARE PRACTITIONERS
• TABLE 27. PERCEIVED MEANING OF ‘U=U’ (OPEN-END) – HEALTH CARE PRACTITIONERS
• TABLE 28. IMPORTANCE OF COMMUNICATING THE ‘U=U’ MESSAGE TO PATIENTS LIVING WITH HIV – HEALTH CARE PRACTITIONERS
• TABLE 29. FREQUENCY WITH WHICH HEALTH CARE PROFESSIONALS COMMUNICATE ‘U=U’ TO THEIR PATIENTS WITH HIV (AMONG THOSE HAVING HEARD OF THE CONCEPT) – HEALTH CARE PRACTITIONERS
• TABLE 30. GENERAL KNOWLEDGE OF HIV – GENERAL POPULATION
• TABLE 31. VARIATIONS IN SELF-REPORTED KNOWLEDGE – HIV
• TABLE 32. KNOWLEDGE OF PREVENTION, TESTING AND TREATMENT OF HIV – GENERAL POPULATION
• TABLE 33. KNOWLEDGE OF PREVENTION, TESTING AND TREATMENT OF HIV – GROUPS CLAIMING TO BE MORE KNOWLEDGEABLE
• TABLE 34. KNOWLEDGE OF PREVENTION, TESTING AND TREATMENT OF HIV – GROUPS CLAIMING TO BE LESS KNOWLEDGEABLE
• TABLE 35. PERSONAL CONNECTION TO INDIVIDUALS LIVING WITH HIV
• TABLE 36. PERCEPTION OF RISK RELATED TO CONTRACTING HIV
• TABLE 37. PERSONAL TESTING FOR HIV – GENERAL PUBLIC
• TABLE 38. GROUPS VIEWED AS MOST AT RISK OF HIV (MULTI-MENTION) – GENERAL PUBLIC
• TABLE 39. TRUE/FALSE STATEMENTS RELATED TO HIV – GENERAL PUBLIC
• TABLE 40. KNOWLEDGE INDEX: HIV/AIDS – GENERAL PUBLIC
• TABLE 41. CAN HIV BE CURED? – GENERAL PUBLIC
• TABLE 42. EFFECTIVENESS OF HIV TREATMENTS – GENERAL PUBLIC
• TABLE 43. ATTITUDES TOWARDS PEOPLE LIVING WITH HIV – GENERAL PUBLIC
• TABLE 44. ATTITUDES TOWARDS PEOPLE LIVING WITH HIV – DEMOGRAPHIC GROUPS MORE LIKELY TO AGREE
• TABLE 45. COMFORT IN PROXIMITY TO HIV/AIDS – GENERAL PUBLIC
• TABLE 46. GENERAL KNOWLEDGE OF HIV – HEALTH CARE PRACTITIONERS
• TABLE 47. KNOWLEDGE OF PREVENTION, TESTING AND TREATMENT OF HIV – HEALTH CARE PRACTITIONERS
• TABLE 48. GROUPS MOST AFFECTED BY HIV IN CANADA (MULTI-MENTION) – HEALTH CARE PRACTITIONERS
• TABLE 49. TRUE/FALSE STATEMENTS RELATED TO HIV – HEALTH CARE PRACTITIONERS
• TABLE 50. HIV/AIDS KNOWLEDGE INDEX – HEALTH CARE PRACTITIONERS
• TABLE 51. CAN HIV BE CURED? – HEALTH CARE PRACTITIONERS
• TABLE 52. PERCEIVED EFFECTIVENESS OF HIV TREATMENTS – HEALTH CARE PRACTITIONERS
• TABLE 53. AGREE-DISAGREE STATEMENTS: VIEWS ON PEOPLE LIVING WITH HIV – HEALTH CARE PRACTITIONERS
• TABLE 54. COMFORT INTERACTING WITH PEOPLE LIVING WITH HIV – HEALTH CARE PRACTITIONERS
• TABLE 55. RESOURCES WHICH WOULD ENHANCE COMFORT CARING FOR PATIENTS WITH HIV – HEALTH CARE PRACTITIONERS
• TABLE 56. BARRIERS TO SUPPORTS AND SERVICES RELATED TO TESTING AND TREATMENT FOR HIV – HEALTH CARE PRACTITIONERS
• TABLE 57. ARE THERE ANY OTHER BARRIERS, NOT ALREADY MENTIONED? – HEALTH CARE PRACTITIONERS
• TABLE 58. GENERAL KNOWLEDGE OF SYPHILIS – GENERAL PUBLIC
• TABLE 59. VARIATIONS IN SELF-REPORTED KNOWLEDGE – SYPHILIS
• TABLE 60. KNOWLEDGE OF PREVENTION, TESTING AND TREATMENT OF SYPHILIS – GENERAL PUBLIC
• TABLE 61. KNOWLEDGE OF PREVENTION, TESTING AND TREATMENT OF SYPHILIS – GROUPS CLAIMING TO BE MORE KNOWLEDGEABLE
• TABLE 62. KNOWLEDGE OF PREVENTION, TESTING AND TREATMENT OF SYPHILIS – GROUPS CLAIMING TO BE LESS KNOWLEDGEABLE
• TABLE 63. PERSONAL CONNECTION TO INDIVIDUALS WHO HAVE BEEN DIAGNOSED WITH SYPHILIS - GENERAL PUBLIC
• TABLE 64. PERCEPTION OF RISK RELATED TO CONTRACTING SYPHILIS – GENERAL PUBLIC
• TABLE 65. PERSONAL TESTING FOR SYPHILIS – GENERAL PUBLIC
• TABLE 66. GROUPS VIEWED AS MOST AT RISK OF SYPHILIS (MULTI-MENTION) – GENERAL PUBLIC
• TABLE 67. TRUE/FALSE STATEMENTS RELATED TO SYPHILIS – GENERAL PUBLIC
• TABLE 68. KNOWLEDGE INDEX: SYPHILIS – GENERAL PUBLIC
• TABLE 69. INTERACTIONS WITH SOMEONE WHO HAS SYPHILIS – GENERAL PUBLIC
• TABLE 70. GENERAL KNOWLEDGE OF SYPHILIS – HEALTH CARE PRACTITIONERS
• TABLE 71. KNOWLEDGE OF PREVENTION, TESTING AND TREATMENT OF SYPHILIS – HEALTH CARE PRACTITIONERS
• TABLE 72. GROUPS MOST AFFECTED BY SYPHILIS IN CANADA (MULTI-MENTION) – HEALTH CARE PRACTITIONERS
• TABLE 73. TRUE/FALSE STATEMENTS RELATED TO SYPHILIS – HEALTH CARE PRACTITIONERS
• TABLE 74. SYPHILIS KNOWLEDGE INDEX – HEALTH CARE PRACTITIONERS
• TABLE 75. COMFORTABILITY PROVIDING CARE TO A PATIENT WITH SYPHILIS – HEALTH CARE PRACTITIONERS
• TABLE 76. RESOURCES WHICH WOULD ENHANCE COMFORT CARING FOR PATIENTS WITH SYPHILIS – HEALTH CARE PRACTITIONERS
• TABLE 77. BARRIERS TO CARE FOR SYPHILIS – HEALTH CARE PRACTITIONERS
• TABLE 78. OTHER BARRIERS TO CARE FOR SYPHILIS – HEALTH CARE PRACTITIONERS
• TABLE 79. WEIGHTING SCHEME OF GENERAL PUBLIC AUDIENCE BY REGION
• TABLE 80. WEIGHTING SCHEME OF GENERAL PUBLIC AUDIENCE BY AGE
• TABLE 81. QUOTAS BY PRIORITY GROUP
• TABLE 82. ONLINE DISPOSITIONS – GENERAL PUBLIC
• TABLE 83. ONLINE DISPOSITIONS – HEALTH CARE PROFESSIONALS

List of Figures

• FIGURE 1. LEVELS OF CONCERN ABOUT VARIOUS HEALTH ISSUES: WOMEN VS. MEN
• FIGURE 2. LEVELS OF CONCERN ABOUT VARIOUS HEALTH ISSUES BY AGE
• FIGURE 3. LEVELS OF CONCERN ABOUT VARIOUS HEALTH ISSUES: ENGLISH VS. FRENCH
• FIGURE 4. PERCEPTION OF RISK RELATED TO CONTRACTING STBBI – BY AGE
• FIGURE 5. PERCEPTION OF RISK RELATED TO CONTRACTING STBBI – BY MARITAL STATUS
• FIGURE 6. PERCEPTION OF RISK RELATED TO CONTRACTING STBBI – BY HOUSEHOLD INCOME
• FIGURE 7. PERCEPTION OF RISK RELATED TO CONTRACTING STBBI – HOMELESSNESS
• FIGURE 8. PERCEPTION OF RISK RELATED TO CONTRACTING STBBI – BLACK AND 2SLGBTQI+ COMMUNITIES
• FIGURE 9. PERSONAL TESTING FOR STBBI – MEMBERS OF 2SLGBTQI+ COMMUNITY
• FIGURE 10. PERSONAL TESTING FOR STBBI – MEMBERS OF INDIGENOUS COMMUNITY
• FIGURE 11. PERSONAL TESTING FOR STBBI – MEMBERS OF BLACK COMMUNITY
• FIGURE 12. KNOWLEDGE OF PREVENTION, TESTING AND TREATMENT OF HIV – MEMBERS OF BLACK AND 2SLGBTQI+ COMMUNITIES
• FIGURE 13. STATEMENTS RELATED TO HIV - % CORRECT AND % DON’T KNOW*
• FIGURE 14. STATEMENTS RELATED TO SYPHILIS - % CORRECT AND % DON’T KNOW*

Section A: Executive Summary

A. Background

A core principle of the Public Health Agency of Canada’s (PHAC) is to protect people in Canada from infectious diseases by predicting, detecting, assessing and responding to outbreaks and new threats. Additionally, PHAC contributes to the prevention, control and reduction of the spread of infectious disease among the public. 

Recent outbreaks of syphilis are a major public health concern, particularly among key populations with higher vulnerability to acquiring sexually transmitted and blood-borne infections (STBBI), including Indigenous communities, gay, bisexual and other men who have sex with men (gbMSM), youth and young adults across Canada, due to compounding issues such as a higher likelihood of exposure, systemic barriers, and higher-risk behaviours. The Government of Canada is committed to accelerating prevention, diagnosis and treatment to reduce the health impacts of STBBI, including syphilis, in Canada by 2030 as highlighted in the Government of Canada Five-Year Action Plan on STBBI. Key priorities included in the Action Plan are to: 

• Reduce the health impacts of STBBI among key populations;
• Address stigma and discrimination; and
• Reach the undiagnosed by increasing access to STBBI testing.

As part of its commitment to the global goal of ending HIV and AIDS as a public health concern by 2030, the Government of Canada is committed to meeting global 95-95-95 targets by 2025 – 95% of all people living with HIV know their status, 95% of those undiagnosed receive antiretroviral treatment and 95% of those on treatment achieve viral suppression. At the end of 2020, an estimated 62,790 people were living with HIV in Canada. Among those living with HIV, an estimated 90% were diagnosed. Of those diagnosed, 87% were estimated to be on treatment and 95% of persons on treatment were estimated to have a suppressed viral load. In other words, 16,690 individuals did not attain viral suppression and were still at risk of transmitting HIV due to a lack of access and uptake of effective HIV prevention, testing and treatment options. In the same year, an estimated 1,520 new HIV infections occurred in Canada.

Despite ongoing efforts, several key populations continue to face systemic barriers when trying to access health services, including: lack of awareness and knowledge surrounding HIV, limited access to cultural and linguistically appropriate services, and fear and stigma surrounding HIV. Additionally, widespread misconceptions about HIV transmission and what it means to live with HIV today, along with a lack of information and awareness around HIV and old beliefs continue to create fear, negative ideas and stereotypes around people who are affected by, and vulnerable to HIV. Stigma and discrimination can increase vulnerability to HIV by affecting self-esteem, social support networks and mental health as highlighted in both the Government of Canada Five-Year Action Plan on STBBI and the Chief Public Health Officer’s 2019 and 2021 Reports. 

Concerns about discrimination by health care providers and negative experiences with the health care system are also barriers to accessing health services generally, as well as for HIV testing and treatment. Fear of disclosure and rejection, feelings of shame, isolation, and despair related to internalized stigma can also keep people from getting tested and treated for HIV. This stigma also extends beyond healthcare as people may worry about disclosing their infections to their family or community out of fear of rejection or exclusion. 

Across Canada, syphilis remains a public health threat with rates of infectious syphilis rapidly increasing over the last several years (109% from 2018 to 2022). These increases have also caused the re-emergence of congenital syphilis due to untreated syphilis among pregnant people. In 2022, 117 cases were reported compared to 17 in 2018, representing an increase of 599%. Several factors impact the rates of syphilis in Canada, including poverty, housing instability, risk behaviours (such as unprotected sex and substance use), racism, stigma and discrimination within health systems, and challenges with access to care. Additionally, some reported risk factors associated with maternal or congenital syphilis, include having inadequate or no prenatal care. Overall syphilis cases are preventable with increased awareness, access to appropriate early interventions, testing and treatment. In supporting the global goal of ending syphilis as a public health concern by 2030, the Government of Canada is committed to working with partners and stakeholders across the country to address the rising rates of syphilis.

B. Research Objectives

1. Purpose

The primary objective of this research is to establish a baseline level of awareness and identify barriers to access among people in Canada aged 16 and over, and those at the highest risk of contracting STBBI. 

2. How the Research Will Be Used

The research findings will be used to measure baseline levels of awareness which will subsequently inform the need for and the type of continued awareness raising efforts, as well as identify gaps in knowledge, barriers to care, and areas where engagement with various stakeholders can be strengthened to advance government priorities related to STBBI. 

Additionally, the research findings will help guide future communications, advertising, and marketing activities for STBBI to ensure that they reach and resonate with at-risk and priority populations.

3. Objectives

Specific objectives for this research study were to:

• Determine levels of awareness, perceptions and attitudes towards HIV/AIDS and syphilis in Canada;
• Assess levels of stigma (both self-stigma and external sources of stigma) associated with a positive HIV/AIDS or syphilis diagnosis;
• Measure the current level of knowledge among Canadians about HIV/AIDS and syphilis;
• Identify the barriers to accessing care for HIV/AIDS and syphilis among key populations;
• Measure awareness and impact of existing messaging strategies for HIV/AIDS and syphilis; and
• Identify opportunities for improving knowledge about risk factors for STBBI, improving knowledge about HIV/AIDS and syphilis, and reducing associated stigmas.

C. Methodology in Brief

An online methodology was undertaken to complete this research study, utilizing an online panel of the Canadian public, aged 16+, as well as an online panel of medical professionals.  

A 15-minute online survey was administered to 3,100 Canadians, aged 16 and older and 250 health care professionals. 

The sample for this study was segmented into two: general public and health care professionals. 

• The general public sample consisted of people in Canada, aged 16+ with quotas set for region and age. Within this audience, oversamples for three priority groups were obtained – Indigenous Peoples, those from at-risk ethnic minority communities (including African, Black, and Caribbean), and members of the 2SLGBTQI+ community. 
• The health care professionals sample consisted of nurses, family physicians, obstetrician-gynecologists (OBGYNs), dentists and pharmacists. No additional quotas were set. 

Monitoring was undertaken while the survey was in field in order to ensure quotas were met. For the general public, a disproportionate sampling plan was employed, including oversampling in Atlantic Canada and the Prairies to ensure sufficiently robust samples in these areas to be able to analyze the results within and between regions. Additional quotas were set by age to ensure good representation from younger people in Canada. A weighting scheme was applied in order to bring the final sample back into line with the distribution of the population in Canada, by region^{Footnote 1}. For health care professionals, no weighting was applied to the sample.  

Given the reliance on a commercial online panel as the primary methodology, the study utilized a non-probability approach to sampling. As such, a margin of error cannot be applied to the final sample and no inferences can be made to the broader target population. The fieldwork was conducted between November 3^rd and November 23^rd, 2023.

D. Total Contract Value

The total value of the contract to undertake this study, including HST was $149,999.31.

E. Note to readers

The design of the general public survey included oversampling of specific communities (e.g., Black, Indigenous, and 2SLGBTQI+ communities). As relevant, notable findings for these target audiences are also presented below as relevant and contrasted with the results for the general public as a whole. A more focused analysis of these target audiences is also included at the end of each section following the detailed results applicable to the general public sample. All differences highlighted are statistically significant at the 95% confidence level. It should also be noted that where cell sizes for analysis were quite small (i.e., fewer than 50 respondents), further demographic and regional analysis was not undertaken.

Analysis of findings from the survey of health care practitioners was also undertaken focusing on key differences across professions and by professional setting based on statistically significant differences at the 95% confidence level. However, given the small sample size overall, and thus even smaller numbers at the sub-cell level, these findings should be considered more directional in nature. For the most part, where cell sizes fell below n=30, any differences by profession, professional setting, region or across demographic sub-groups (e.g., gender and age of practitioner) are not reported.  

As relevant, comparative data from the general public and health care practitioners’ surveys are discussed. However, some caution should be taken in interpreting these results given the relatively small sample of health care practitioners. 

In some cases, results may not add up to 100% due to rounding. Results have been rounded based on the tenth decimal point (e.g., 24.51% has been rounded up to 25% whereas 24.49% has been rounded down to 24%).

F. Key Findings

Overarching themes and highlights from this study are outlined below for each of the two main audiences who were surveyed: the general public and health care practitioners. Given that both audiences responded to a set of core questions related to concerns, experiences, and perceived stigma and barriers regarding sexually transmitted and blood-borne infections, results are examined among and across the two audiences to allow for a comparative analysis of responses. 

Concern about STBBI Relative to Other Public Health Issues

General Public

• Respondents express relatively high overall levels of concern (from 71% to 85% who say they are somewhat/very concerned) on a range of public health issues, including mental illness and suicide among adults and youth, the opioid crisis, e-cigarette use/vaping and obesity (see Section B.B1.A for detailed findings, including demographic variations). In comparison to levels of concern for these issues, respondents are far less concerned about rates of HIV/AIDS (48%) and syphilis infection (42%) – a variance of about 30 to 40 points. 
• In general, concern regarding HIV/AIDS and syphilis tends to be higher among the younger demographic (under 35 years of age), those who are single, unemployed, in lower income households, or who have experienced homelessness within the last 5 years. It is also higher among Anglophones as compared to Francophones.  
• At the same time, many respondents (47%) disagree that STBBI are a very minor health concern. Only 7% agree.  
• Notably, a modest proportion of the general public is somewhat/very concerned about contracting HIV (25%), syphilis (22%) or other types of STBBI (concern ranges from a high of 30% for Hepatitis B or C to a low of 21% for Trichomoniasis). Among the target audiences – members of the Black community and those who identify as 2SLGBTQI+  – a much higher proportion report being concerned about their personal risk of contracting a wide range of STBBI, including HIV and syphilis.

Health Care Practitioners

• Across the board, levels of concern for the wide range of health issues assessed are much higher among health care practitioners, ranging from 98% who are very/somewhat concerned about obesity to 89% who express concern for e-cigarette use and vaping (see Section B.B2.A for detailed findings including significant variations by profession, etc.). As with the general public, health care practitioners also express lower levels of concern regarding rates of HIV/AIDS (74%) and syphilis infection (73%), although practitioners’ overall level of concern for each of these issues is much higher by comparison. Female practitioners are more concerned about rates of syphilis, while older practitioners (aged 55+) are more likely to be concerned about rates of HIV/AIDS as compared to those who are under age 45. 
• Fully 75% of health care practitioners also disagreed with the statement that STBBI are a very minor health concern. This represents a much higher percentage than was found in the survey of the general public (47%).

The table below shows a side-by-side comparison between health care practitioners and the general public regarding their concern for various public health issues. It is notable that overall levels of concern, and specifically those saying they are very concerned, are much higher among  health care practitioners in all cases with one exception – the proportion of health care practitioners who say they are very concerned about HIV/AIDS is just 6-points higher than that reported by the general public (as shown in the column highlighting the difference in ratings between the two audiences).  

Knowledge of and Interest in Information about STBBI (General), HIV/AIDS and Syphilis

General Public

• Respondents claim to be reasonably knowledgeable about HIV (64% say they are very/somewhat knowledgeable), a higher proportion as compared to those who indicate being knowledgeable about syphilis (46%) and other STBBI (52%). A significant proportion of the general public lacks knowledge of syphilis (see Section D.D1.A for detailed results). Just over half (51%) are not that/not at all knowledgeable. By comparison, about one-third (34%) are not that/not at all knowledgeable about HIV (see Section C.C1.A for detailed results). While 17% are not at all knowledgeable about syphilis, this contrasts with just 8% who say the same in regard to HIV. 
• When asked more explicit questions to assess levels of knowledge related to the prevention, testing and treatment of HIV, syphilis and other STBBI, respondents’ self-reported understanding varies considerably. Results show that while many claim to be knowledgeable about preventing HIV (69%), syphilis (52%) and other STBBI (59%), this drops off in regard to knowledge of other areas such as testing for STBBI (HIV (47%); syphilis (33%); other STBBI (44%)), and treatments (HIV (40%); syphilis (33%); other STBBI (37%)).
• Two thirds (66%) of the general public do not believe that HIV can be cured. Among the other third, 13% are of the opinion that there is a cure for HIV and another 20% are unsure. Regardless, many (80%) feel that HIV treatments can effectively help people with HIV lead full and healthy lives. 
• Knowledge levels are more variable in regard to other more specific aspects of HIV/AIDS and syphilis. Overall the proportion of respondents classified as having a high level of knowledge based on their responses across question was consistent between HIV/AIDs (28%) and syphilis (25%), however there were notable differences in the type of information recalled. See Sections C.C1.Dand D.D1.D for further details.
  • For example, with respect to HIV/AIDS, relatively few among the general public understand that pregnant individuals living with HIV can have children without passing on the virus, that condoms and dental dams are not the only way to prevent HIV transmission during sex, that HIV is not transmissible through sex if the patient is being treated and the amount of HIV in their blood is very low, and that HIV testing for HIV is not always included in regular screening for sexually transmitted infections (19%-34% correctly responded in each case). 
  • With respect to the general public’s knowledge of syphilis, there is considerable confusion in a number of areas – that asymptomatic people should get tested for syphilis, that most of those with syphilis may not display any symptoms, that syphilis is a public health priority in Canada, and that testing for syphilis is not undertaken coincident with pap tests nor as a part of regular screening for sexually transmitted infections (16%-38% gave the correct response). 
• Over half (57%) are interested in knowing more about the risks, testing options and treatments for STBBI (16% are very interested; 41% are somewhat interested). The preferred approaches for receiving this type of information include the family doctor or primary care provider (50%) and government websites (47%), although there are notable differences in preferences across sub-groups of the population. Social media, video sites, and the stories of people and/or social media influencers with lived experience are more popular among the younger demographic (under age 35) and members of Black and 2SLGBTQI+ communities. Indigenous Peoples are also more likely to want to hear from people with lived experience with STBBI. By contrast, a higher proportion of older people (aged 55+) prefer this type of information to be delivered by their family doctor or via news stories (see Section B.B1.E). 

Health Care Practitioners

• A large share of practitioners say they are knowledgeable about HIV (86%) and other STBBI (87%), with somewhat fewer reporting being knowledgeable about syphilis (75%).
• Practitioners’ self-assessed knowledge of prevention, testing and treatment of STBBI is also fairly high, although highest when it comes to preventing HIV (94%) and other STBBI (94%). The proportion claiming to be knowledgeable about preventing syphilis is lower by 10 points at 84%.  While over four in five practitioners claim to be knowledgeable about testing for HIV (82%), as well as testing and treatment for other STBBI (85% and 86%, respectively), knowledge levels drop off when it comes to testing and treatments for syphilis (75% and 72%, respectively) and, in particular, regarding treatments for HIV (68%). 
• Perhaps not surprisingly, compared to the general public, a much higher proportion of health care practitioners understand that HIV is incurable (82%), although 14% do feel there is a cure (slightly higher among physicians, although not a statistically significant difference), and another 4% are unsure. Almost unanimously (99%), this group feels that HIV patients can nevertheless lead fulfilled and healthy lives.
• Health care practitioners score highly in terms of their overall knowledge of both HIV/AIDS and syphilis – 87% and 84% have a high knowledge level HIV/AIDS and syphilis, respectively while 13% and 16% are classified as moderately knowledgeable in each area (see Sections C.C2.D and D.D2.D). Nevertheless, there are several areas of opportunity for additional education or information related to both syphilis and HIV/AIDS, including practitioners’ understanding that syphilis is a public health issue in Canada (66% responded correctly that this was a true statement), and that syphilis testing is always included in regular screening for STIs (just 40% correctly responded that this is false). 
• Almost all practitioners (94%) are interested in knowing more about STBBI and favour receiving this type of information via e-learning courses (64%) or through webinars, seminars and/or conferences (57%). Many also cite professional organizations (45%). See Section B.B2.D for more detailed analysis on this topic. Preferences for the way in which information is delivered vary greatly across professions and professional settings as well as by gender and the age of the practitioner. While government websites are mentioned by just over one quarter of all practitioners (27%), nurses identify them more frequently as a preferred information channel (33%) compared to physicians (18%). Female practitioners and those who are younger (under age 45) generally favour receiving information about STBBI via the stories of those with lived experiences.

‘At Risk’ Groups for HIV and Syphilis

General Public

• Relatively few respondents are concerned about their own personal risk of contracting HIV (25% - 11% very concerned; 14% somewhat concerned) or syphilis (22% - 9% very concerned; 13% somewhat concerned). 
• A majority of respondents pointed to two groups which they believe to be most at risk of contracting HIV and syphilis (see Sections C.C1.C and D.D1.C) – people who have multiple sexual partners (60% identified this group as being most at risk for HIV; 57% for syphilis) and sex workers (57% for HIV; 54% for syphilis). Other groups identified by about half or more respondents as being more likely to contract HIV include people who inject drugs (53%) men who have sex with other men (53%), and people from countries where HIV is more widespread (47%). By contrast fewer than one third identified these same groups as being among those most at risk of getting syphilis (24%, 29%, and 20% respectively). 

Health Care Practitioners

• Similar to those groups mentioned by the general public, health care practitioners also identified the following as being more affected by HIV or syphilis, although with much greater frequency in some cases:  men who have sex with other men (78% for HIV; 50% for syphilis), sex workers (73% for HIV; 82% for syphilis), and people who have multiple sexual partners (71% for HIV; 81% for syphilis). In addition, a larger share of health care practitioners point to people from countries where HIV is more widespread as being disproportionately affected by both types of STBBI (77% for HIV; 64% for syphilis) and to people who have another type of STBBI (54% for HIV; 64% for syphilis). Notably, while people who inject drugs are mentioned as being at greater risk for HIV by over four in five health care professionals (82%), far fewer believe they are among the most vulnerable with respect to being affected by syphilis (40%). See Sections C.C2.C and D.D2.C for more details pertaining to these findings. 

Stigma and Barriers Affecting Access to Services and Supports

General Public

• Relatively few respondents within the general public report having been tested for (33%) or diagnosed with (13%) an STBBI. About one in five (19%) have been tested for HIV, compared to half that who have been tested for syphilis (10%). The proportion who have been tested for other STBBI varies from 4% to 15%. Those who report having been diagnosed with an STBBI ranges from 1% to 5% (1% for each of HIV and syphilis). 
• At the same time, most (77%) say they would be comfortable having conversations with health professionals about STBBI. In fact, two in five (41%) say they would be very comfortable in this situation. Over two thirds (69%) are comfortable asking a health care professional for an STBBI test. Overall comfortability varies by age and socio-economic status (see Section C.C1.D).
• Although most members of the general public (79%) agree that people living with HIV have the same right to health care as others (65% completely agree), the survey data underscores that stigma exists both at a personal level as well as at a broader societal level. Many (64%) believe that people living with HIV are viewed negatively by others. Furthermore, while over two thirds say they are comfortable engaging with  co-workers and shop owners who are living with HIV/AIDS (see Section C.C1.F), there is some concern about people with HIV serving the public (just 36% agree that they should be allowed to be in positions such as dentists, hairdressers and restaurant workers, etc.). 
• Similarly, many say they feel comfortable discussing a friend or family member’s diagnosis with an STBBI (66% for HIV; 60% for syphilis) and inviting someone into their home who is known to have either of these conditions – higher for HIV (64% are comfortable) than for syphilis (55% are comfortable). Levels of comfort are more modest, however, when it comes to having a child attend school where a student is known to have HIV/AIDS (56%) and decline more dramatically in a hypothetical situation where a close friend or family member is dating someone living with HIV (46%).

Health Care Practitioners

• Compared to the general public, a higher proportion of health care practitioners report being comfortable interacting with patients living with HIV or syphilis – over nine in ten are comfortable caring for patients with HIV (93%; 72% are very comfortable) and syphilis (91%; 71% are very comfortable). The small percentage who expressed some level of discomfort shared that additional training related to HIV (83%) or syphilis (82%) would help to increase their level of comfort. About six in ten also indicated that guidance on how to navigate patients’ experiences of stigma and discrimination, handouts on facilitating discussion discussions about HIV, syphilis and other STBBI, as well as resources on relevant local community-based organizations to which they could refer patients would be helpful. See Sections C.C2.Fand D.D2.E for detailed results.
• This group is also less likely to exhibit stigma towards those living with HIV, but more likely to believe that societal stigma exists to a wider degree. With virtual unanimity health care practitioners agree that people living with HIV have the same right to health care as others (97%), 18 points higher than the proportion of the general public (79%) who agree with this statement. Moreover, three quarters (75%) of health care practitioners agree that people with HIV should be allowed to serve the public in positions such as dentists, hairdressers and restaurant workers versus just over one third (36%) of the general public. Additionally, two thirds (67%) of health care practitioners are comfortable having a close friend or family member date someone living with HIV, much higher than the response from the general public (46%). At the same time, fully four in five (82%) health care practitioners surveyed believe that people hold negative assumptions about those living with HIV (a full 20 points higher than the general public (62%)). 
• Nevertheless, just over one in ten (13%) health care practitioners report feeling uncomfortable around people with HIV, slightly lower than was found among the general public (17%).
• Practitioners believe that a range of barriers are preventing patients from accessing supports and services related to testing and treatment for HIV and/or syphilis. Most often mentioned, by almost nine in ten practitioners (87%), is not having a family physician. Other issues cited by 80%-86% of practitioners include (see Sections C.C2.G and D.D2.F):  previous experiences of discrimination, limited access to services and supports, limited knowledge and awareness of STBBI, sexual health and STBBI being taboo topics in the patient’s culture or household, and operational barriers such as long wait times, hours of operation or the location of testing and treatment facilities. Limited access to culturally and/or linguistically appropriate care was also viewed as a significant barrier (mentioned by just under four in five practitioners).

Awareness of the Concept of ‘Undetectable=Untransmittable’

General Public

• Across all regions, most respondents are unaware of the ‘U=U’ concept – 76% have not heard of it and another 6% are unsure. While recall is modest across all sub-groups, it is notably higher among certain sub-groups of the population, including members of the 2SLGBTQI+ and Black communities, as well as younger adults (under age 35) and Anglophones, as compared to those whose primary language is neither English nor French (see Section B.B1.E). 
• The concept is generally interpreted by about one in three respondents as a condition which is asymptomatic, undetectable and not contagious, although the majority (54%) aren’t sure what it means. 

Health Care Practitioners

• Compared to the general public, health care practitioners are more likely to have heard about the ‘U=U’ concept – 54% claim to have heard about it, while 45% have not and a small number (1%) are unsure (see Section B.B2.D). Those working in community settings are most likely to say they have heard of it, as compared to those working in clinical settings. As with the general public, it is the younger cohort, under the age of 45, who are much more likely to be aware of ‘U=U’ compared to their peers aged 55 and older.
• About two thirds or more interpret it in a similar manner as members of the general public, assuming it to mean that STBBI are undetectable and/or not transmissible. One in four (25%) are uncertain as to the meaning of the concept.
• Overwhelmingly, health care practitioners believe it is important to communicate the ‘U=U’ message to patients living with HIV – 80% view this as very important while another 17% say it is somewhat important. However, relatively few do this with any degree of frequency within their practice settings – one in four (26%) never communicate this message, while just under half (44%) do so a few times a year or less frequently.  

G. Conclusions and Recommendations

Based on the findings from this study, there are clear opportunities to raise awareness among the general public about issues related to HIV/AIDS and syphilis. In particular, there is an urgent need to educate people living in Canada about rising rates of HIV and syphilis as well as prevention, testing and treatment. Given that overall knowledge regarding syphilis is much lower, as compared to HIV, a focus on the former should be a priority. Any initiatives should also address various stigma and barriers which could inhibit ‘at risk’ or affected individuals from seeking care. While some of these barriers require a policy response (i.e., lack of access to medical care), others could be tackled via effective communications, education and community outreach to key populations, including 2SLGBTQI+, Indigenous Peoples and the Black community. Development of communications strategies should consider the following:

• Varying levels of knowledge and understanding of HIV and syphilis;
• Stigma, myths and misperceptions about HIV and syphilis; and
• Variable communications preferences across key sub-groups of the population – while strategies should leverage the trusted role of primary care providers, it would also be advantageous to incorporate the faces, stories and voices of those with lived experience.

A segment of health care professionals could also benefit from additional information, tools and resources to both enhance their understanding with ongoing and up to date epidemiological data (especially regarding rates of HIV/syphilis, vulnerable populations, treatments for HIV, and to some extent, testing and treatments for syphilis) and dispel any ongoing misperceptions. Dentists and pharmacists are a priority target audience in this regard, although the generally trusted relationship between general practitioners/nurses and their patients should not be overlooked. Specifically, more education is warranted among health care practitioners on STI screening practices, notably, that screening for syphilis is typically not included in regular screening for STIs. Online approaches (e-learning, webinars) in addition to working with and through professional organizations are preferred. 

Very few among the general public are aware of the ‘U=U’ concept. Awareness could also be enhanced among health care practitioners who are highly supportive of communicating this message but do not necessarily do so themselves on a regular basis. Promoting this message may also contribute to the normalization of HIV/AIDS among a series of other common health care concerns.  

Statement of Political Neutrality

I hereby certify as Senior Officer of The Strategic Counsel that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Policy on Communications and Federal Identity and the Directive on the Management of Communications. 

Specifically, the deliverables do not include information on electoral voting intentions, political party preferences, standings with the electorate or ratings of the performance of a political party or its leaders.

Signed: 
Donna Nixon, Partner
The Strategic Counsel

Section B: Detailed Findings – General STBBI Issues

Detailed Findings – General STBBI Issues

This section outlines respondents’ general knowledge and concern regarding a range of public health issues, including sexually transmitted and blood-borne infections (STBBI). It is broken out into two sections – the first provides the results from the survey of the general public; the second highlights findings from the survey of health care practitioners. For a more in-depth exploration of respondents’ views concerning HIV and syphilis, please refer to Sections C and D, respectively.

Results show that while rates of HIV/AIDS and syphilis are concerning for almost half of the general public and about three-quarters of health care professionals, issues such as mental illness and suicide among adults, youth and children are a much greater concern.

General knowledge of STBBI, including HIV and syphilis, is modest among the general population. Not unexpectedly, knowledge is considerably higher among health professionals, although both audiences report less understanding of syphilis as compared to HIV and other STBBI. Notably, both audiences also report a greater understanding of preventive strategies for syphilis, HIV and for other STBBI relative to their understanding of testing and treatments. Notably, the proportion of health care professionals who report being somewhat or very knowledgeable about testing for syphilis as well as treatments for both syphilis and HIV is relatively modest, and much lower among the general public, suggesting there are opportunities for additional education with both audiences.

While most members of the general public are comfortable approaching a health care professional to discuss or obtain a test for an STBBI, a substantial segment express some level of unease. The barriers to seeking testing or treatment, while not necessarily prohibitive, are rooted in patients’ emotional response (i.e., fear, embarrassment) and in logistical issues (i.e., uncertainty regarding the location of testing facilities, wait times, lack of access, among others). Similarly, although the vast majority of health care professionals are comfortable engaging in conversations about STBBI, about one in ten are not.

There is a high level of interest in knowing more about the risks, testing options and treatments for STBBI among health care professionals. Interest in learning more about this topic, while reasonable among the general public, is much lower. Survey results underscore the need for a multi-channel strategy specific to each audience, and taking into account variable channel preferences by gender, age and language, etc.

Finally, awareness of the ‘Undetectable=Untransmittable’ or ‘U=U’ concept is modest to low – just over half of health care professionals vaguely/definitely recall it compared to about one in five of the general public. Almost unanimously, health care professionals believe it is important to communicate this message to people living with HIV.

B1. General Public

The findings detailed below pertain to the survey of the general public only. Please see Section B.2 for results on a similar set of questions from a survey directed specifically to health care professionals across Canada.

A. Concerns about STBBI Relative to Other Health Issues

Prior to posing more direct questions regarding sexually transmitted and blood-borne infections (STBBI), respondents were asked how concerned they were about various health issues. The findings, as shown in Table 2 below, clearly indicate position mental illness and suicide among children and youth, as well as among adults as being a primary concern – over four in five respondents are concerned (85% for children/youth; and 84% for adults), with over half of respondents saying they are very concerned (57% and 52%, respectively) about these issues.

Considerable numbers (over three quarters of respondents) also express concern about the opioid crisis (78%) and e-cigarette use and vaping among children and youth (77%), although the proportion of those saying they are very concerned about these issues is less than half (48% and 45%, respectively).

Well over half, but less than three quarters, are concerned about obesity (71%), tobacco and alcohol use (65%) and e-cigarette and vaping among adults (59%). However, the percentage of respondents who say they are very concerned about each of these issues (30%, 26%, and 24%, respectively) is much lower relative to the proportion saying the same about mental health, opioids and e-cigarette use among children as noted above.

Concern drops off for STBBI. Less than half of respondents are concerned about rates of HIV/AIDS (48% overall; 17% very concerned) and syphilis infection (42% overall; 14% very concerned).

While there are no significant differences in overall levels of concern by community type (urban/rural), some variations are apparent across the regions. In general, respondents residing in Manitoba and Saskatchewan exhibit higher levels of concern on all public health issues relative to those residing in Quebec – the gap between these regions ranges from 17 points regarding concern about the opioid crisis (85% vs. 68%, respectively) to 6 points for mental illness and suicide among children and youth (90% vs. 84%, respectively)^{Footnote 2}. Those residing in Ontario and Alberta also generally express greater concern relative to Quebec across the range of health issues. The exceptions are with regards to mental illness and suicide among children and youth (among Ontarians) and tobacco and alcohol use (among Albertans). Specific to STBBI, a higher proportion of respondents from Manitoba and Saskatchewan are concerned about rates of HIV/AIDS relative to the rest of Canada (with the exception of those in Alberta).

In keeping with the trends described in the previous paragraph, a higher proportion of Quebec residents exhibit generally lower levels of concern (not that concerned/not at all concerned) for many of the health issues examined, including:

• Rates of syphilis infection – 57% in Quebec relative to Manitoba and Saskatchewan (40%), Ontario (43%), Alberta (45%), British Columbia and the North (47%), and the Atlantic provinces (49%).
• Rates of HIV/AIDS – 51% in Quebec, compared to 34% in Manitoba and Saskatchewan, 41% in Ontario, and 43% each in Alberta and British Columbia/North.
• E-cigarette use and vaping among adults – 47% in Quebec, compared to 31% in Ontario, 34% in Manitoba and Saskatchewan, and 38% in Alberta.
• Obesity – 34% in Quebec relative to Manitoba and Saskatchewan (21%), Alberta (23%), Ontario (25%) and British Columbia/North (25%).
• The opioid crisis – 31% in Quebec relative to Manitoba and Saskatchewan (13%), Alberta (14%), the Atlantic and British Columbia/North (15% each), and Ontario (17%).
• E-cigarette use and vaping among children and youth – 25% in Quebec, compared to 17% in Alberta, 18% in Manitoba and Saskatchewan, and 19% each for Ontario and British Columbia/North.

Demographics

As highlighted in the charts below, concern for these issues varies considerably across demographic sub-groups. Levels of overall concern (those saying they are somewhat/very concerned) are generally higher among women, younger respondents and Anglophones. To some extent, the extent to which concern is expressed is also a factor of socio-economic status (e.g., household income, education, employment, etc.).

By gender, women as compared to men exhibit greater concern about all of these health issues, with the exception of rates of syphilis infections:

Q9. How concerned are you about each of the following issues? Base: Women (n=1299); Men (n=1144)

By age, younger respondents, under the age of 35, express greater concern for issues shown in Figure 2. Note that in some cases the data indicate statistically significant differences between those under age 35 relative to the two older age cohorts (35-54 and 55+), and in others the difference is only with respect to those who are middle-aged (35-54): 

Q9, How concerned are you about each of the following issues? Base: Age <35 (n=1098); Age 35-54 (n=578); Age 55+ (n=789)

There is also some variability in levels of concern based on language, with Anglophones expressing higher levels of concern as compared to Francophones:

Q9. How concerned are you about each of the following issues? Base: English (n=2054); French (n=463)

Other differences across demographic sub-groups are evident, based on a range of socio-economic factors such as household income and employment status. However, we do not see the same degree of consistency in terms of variability across the range of issues as is the case by gender, age and language. Note that the items including an arrow and highlighted in blue indicate those sub-groups expressing a higher level of concern on each issue, relative to other sub-groups listed.

Target Audiences

Some variability in concern is noted among specific target audiences when results for these groups are compared with the levels of concern expressed by the general population as a whole. A higher proportion within certain communities report being concerned about each of the following issues:

• Mental illness and suicide among children and youth – higher among Indigenous (91%) and members of the Black community (89%) compared to the average (85%)
• Mental illness and suicide among adults – higher among Indigenous (89%) and 2SLGBTQI+ respondents (88%) versus the average (84%)
• The opioid crisis – higher among those who identify as Indigenous (86%) versus an average of 78%
• Rates of HIV/AIDS – higher among members of the Black (65%) and 2SLGBTQI+ communities (59%) versus the average (48%)
• Rates of syphilis infection – higher among Indigenous Peoples (59%) compared to an average of 42%

To further explore general levels of concern regarding STBBI, respondents were asked to what extent they agreed or disagreed that STBBI are a ‘very minor health concern.’  Just under half (47%) strongly disagreed that this was the case (i.e., responding by indicating a ‘1’ or ‘2’ on a 7-point scale where 1 is completely disagree and 7 is completely agree). About 4 in 10 (39%) neither strongly agreed nor disagreed with the statement (‘3,’4’, or ‘5’ on the same scale) and a small share (7%) completely agreed (‘6’ or ‘7’) that STBBI are a very minor health concern.

Across the regions, respondents residing in Quebec (54%) are more likely to completely disagree with this statement relative to those in Ontario (40%), Manitoba and Saskatchewan (43%), the Atlantic provinces (46%), and British Columbia and the North (46%). Conversely, those in Ontario (11%) are more likely to completely agree that STBBI are a very minor health concern compared to those residing in Quebec (5%), Alberta (6%), the Atlantic provinces (6%), and Manitoba and Saskatchewan (7%).

Demographics

Those more likely to completely disagree (‘1’ or ‘2’) with the statement include:

• Respondents who speak French at home (59%), relative to those who speak English (45%) or another language (46%).
• Those aged 55+ (53%), relative to their younger peers (45% for those aged 35-54; 42% for those younger than 35).

Target Audiences

Members of the Black community (53%) are more likely to completely disagree with the statement.

B. General Knowledge of STBBI

General knowledge of STBBI is quite variable, with about two thirds of respondents (64%) reporting they are somewhat/very knowledgeable about HIV. Just over half (52%) report similar knowledge levels for other sexually transmitted and blood-borne infections, while somewhat fewer (46%) say they are somewhat/very knowledgeable about syphilis.

Results are fairly consistent across the regions with a few exceptions as follows:

• Respondents residing in Ontario (67%) and British Columbia/North (66%) are more likely to report being knowledgeable about HIV compared to Atlantic Canadians (57%) and Quebecers (59%).
• A higher proportion of respondents in Ontario and Quebec (54% in each province) report being knowledgeable about other STBBI relative to respondents in the Atlantic region (46%).
• Atlantic Canadians are more likely to say they are less knowledgeable (not that/not at all knowledgeable) about all STBBI relative to Ontarians:
  • HIV – 41% in Atlantic versus 32% in British Columbia/North and 31% in Ontario.
  • Syphilis – 56% in the Atlantic vs. 49% in Ontario.
  • Other STBBI – 50% in the Atlantic vs. 43% in Ontario.

By community type, a larger share of those residing in urban versus rural areas report being knowledgeable about HIV (64% and 56%, respectively). Similarly, respondents in rural versus urban areas (58% and 52%, respectively) say they are less knowledgeable (not that/not at all knowledgeable) about syphilis.

Demographics

Knowledge levels vary across demographic groups, although generally those with higher levels of educational attainment, people who are employed, those working in the health care sector, and people who have experienced homelessness tend to be more knowledgeable across the board about STBBI. By contrast, single people and to some extent those in the younger demographic (under 35 years of age) report being less knowledgeable, although there are a few exceptions by age. These variations are detailed below. Note that items highlighted in green below with an upward-facing arrow are the sub-groups which reporting a higher level of knowledge, relative to the others listed for each of the demographic variables. Those with no significant differences to the other subgroups have been excluded from the table.

Target Audiences

• Members of the Black community are more likely to report being knowledgeable in all three areas:  HIV (77%), syphilis (58%) and other STBBI (66%), relative to the average (64%, 46%, and 52%, respectively).
• Those who identify as part of the 2SLGBTQI+ community are also more likely to report they are knowledgeable about HIV (73%) and other STBBI (61%), relative to the average (64% and 52%, respectively).
• Those who identify as Indigenous were less likely to report they are knowledgeable about syphilis (40%) than average (46%).

As shown above, while a reasonable proportion of respondents report being knowledgeable of STBBI, the percentage saying they are knowledgeable of syphilis is nevertheless a full 18 points lower as compared to the proportion who are knowledgeable about HIV. When asked in more detail about their specific knowledge levels regarding the prevention, testing and treatment of STBBI, including HIV and syphilis, those reporting they are either somewhat or very knowledgeable declines relative to their more general knowledge scores. These lower scores underscore opportunities to raise the general public’s understanding of STBBI with a more targeted educational and awareness-raising campaign.

A larger share of the general public reports being knowledgeable about prevention of STBBI, while results suggest more modest levels of knowledge related to testing and treatment. Over half of respondents say they are knowledgeable about the prevention of HIV (69%), other STBBI (59%), and syphilis (52%). In terms of testing, somewhat fewer report similar knowledge levels for HIV (47%) and other STBBI (44%), and this drops off quite dramatically in terms of the public’s understanding of testing for syphilis (33% - 14 points lower as compared to knowledge of testing for HIV). Smaller proportions report being knowledgeable about treatments for HIV (40%), other STBBI (37%) and particularly for syphilis (30%).

By region, a few significant differences are noted:

• Respondents residing in Quebec (59%) are less likely to report being knowledgeable about the prevention of HIV, relative to other provinces (67% in the Atlantic, 72% in British Columbia and the North, 73% in Ontario, 75% in Manitoba and Saskatchewan, and 75% in Alberta).
• Those residing in Manitoba and Saskatchewan (57%) and Alberta (57%) are more likely to report being knowledgeable about the prevention of syphilis as compared to Quebec (46%), British Columbia/the North (48%), and the Atlantic region (49%).
• Those in the Atlantic region (41%) are less likely to be knowledgeable about testing for HIV, relative to Ontario (49%), Manitoba and Saskatchewan, Alberta, and British Columbia/the North (51% each).

Results also vary by community type with a higher proportion of urban respondents indicating they are knowledgeable about testing (50%) and treatments (42%) for HIV, relative to those living in rural areas (38% and 36%, respectively).

Demographics

There is considerable variability in knowledge levels reported across key demographic groups.

• Age – With very few exceptions, those who are under the age of 55 are generally more knowledgeable about all aspects, compared to those who are 55 or older. The differences by age are shown in the table below. Note that items highlighted in green with an upward-facing arrow indicate the age cohort reporting a higher level of knowledge, relative to others.

• Household income – Respondents with a household income of $100,000 or more are more likely to say they are knowledgeable about preventing syphilis (56%) compared to those with an income of less than $60,000 per annum (49%).
• Educational attainment – University educated respondents are generally more knowledgeable about all aspects of preventing, testing and treatments for HIV, syphilis and other STBBI compared to those with a high school diploma or less education (ranging from 75% vs. 62% for preventing HIV to 32% vs. 26% for treatments for syphilis).
• Employment status – Employed persons and those who are unemployed and looking for work, compared to those not in the workforce, are more likely to be knowledgeable about testing for other STBBI (52%; 50%; 37%, respectively) and treatments for HIV (45%; 47%; 32%, respectively).  Of note, those working in the health care sector are more likely to say they are very/somewhat knowledgeable about the prevention, testing and treatments of various STBBI, with the exception of HIV prevention (where there is no significant difference).
• Language spoken at home – Those who speak English or a language other than English or French at home are more knowledgeable about the prevention of HIV (72% and 78%, respectively), compared to those who speak French at home (60%). Anglophones are also more likely, as compared to those who speak a language other than French or English, to indicate being knowledgeable about preventing other STBBI (60% vs. 49%). Notably, a greater proportion of those who speak French (49%) or English (44%) at home say they are knowledgeable about testing for other STBBI, relative to those who speak a language other than English or French (32%).
• Marital status – A larger proportion of people who are divorced, separated or widowed (58%) and respondents who are married or living common-law (53%) say they are knowledgeable about preventing syphilis, relative to those who are single (48%).
• Shelter – People who have experienced homelessness in the past 5 years, relative to those who have not, tend to report being more knowledgeable about all aspects of prevention, testing and treatment for STBBI, including HIV and syphilis (ranging from 85% vs. 69% for preventing HIV to 51% vs. 29% for treatments for syphilis).

Target Audiences

With greater frequency, members of the Black community report being knowledgeable about all aspects of preventing, testing and treatments for HIV, syphilis and other STBBI, relative to the average:

• Preventing HIV (79% vs. 69%), syphilis (63% vs. 52%), and other STBBI (71% vs. 59%).
• Testing for HIV (68% vs. 47%), syphilis (49% vs. 33%), and other STBBI (63% vs. 44%).
• Treatments for HIV (54% vs. 40%), syphilis (44% vs. 30%), and other STBBI (53% vs. 37%).

Similarly, relative to the average, a higher proportion of those who identify as 2SLGBTQI+ say they are knowledgeable (very/somewhat) about most aspects of prevention, testing and treatments. However, with respect to syphilis, the proportion of those who say they are very/somewhat knowledgeable about the prevention and treatments for syphilis is in line with the average:

• Preventing HIV (76% vs. 69%) and preventing other STBBI (64% vs. 59%).
• Testing for HIV (59% vs. 47%), syphilis (38% vs. 33%), and other STBBI (54% vs. 44%).
• Treatments for HIV (53% vs. 40%) and other STBBI (47% vs. 37%).

C. Experience with STBBI: Perception of Risk, Testing and Diagnosis

Respondents report modest levels of concern regarding their personal risk of contracting various STBBI. Just under one in three (29%-30%) say they are very/somewhat concerned about contracting hepatitis A, B or C. By comparison, a quarter or slightly more are concerned about contracting human papillomavirus (28%), genital herpes (26%), HIV (25%), and genital warts (25%). A smaller but still significant proportion of respondents are concerned about contracting chlamydia (24%), gonorrhea (22%), syphilis (22%), and trichomoniasis (21%).

Respondents residing in the Atlantic region are less likely to express concern about their personal risk of contracting each STBBI (ranging from 18% for trichomoniasis to 24% for human papillomavirus (HPV)) compared to those in Ontario (ranging from 28% for syphilis and trichomoniasis to 36% for hepatitis B, C and HPV), Alberta (ranging from 25% for trichomoniasis to 36% for hepatitis B), and British Columbia and the North (ranging from 28% for trichomoniasis to 37% for hepatitis A, B, and C). Additionally, those in Ontario and British Columbia and the North are more likely to report being concerned about their personal risk for each STBBI relative to those in Quebec (with the exception of HPV for those in British Columbia and the North).

By community type, respondents living in an urban setting are more likely to be concerned about contracting all STBBI, relative to those in rural areas. The variability in concern ranges from a high of 10 points for HIV (30% urban vs. 20% rural) and dropping to a 6-point difference for syphilis (26% urban vs. 20% rural).

Demographics

In general, respondents under the age of 35, single people, those in lower income households and those who have experienced homelessness in the last 5 years are most concerned about being at risk of contracting an STBBI, as illustrated in the charts that follow.

• By age, respondents under the age of 35 are most concerned (very/somewhat) about their personal risk of contracting many of the STBBI, when compared to those who are 35-54 and those 55+.

Q12. How concerned are you about your personal risk of contracting each of the following? Base: Age <35 (n=1098); Age 35-54 (n=578); Age 55+ (n=789)

• By marital status, those who are single are more likely to say they are concerned (very/somewhat) about their personal risk of contracting all of the above mentioned STBBI, relative to those who are married or living common-law.

Q12. How concerned are you about your personal risk of contracting each of the following? Base: Single (n=921); Married/Common-Law (n=1283);

• On many of the STBBI, respondents with a household income of less than $60K are more likely to report concern (very/somewhat) about their personal risk when compared to those with a household income of $60K to less than $100K and those with a household income of more than $100K.

Q12. How concerned are you about your personal risk of contracting each of the following? Base: <$60K (n=1056); $60K-<$100K (n=650); $100k+ (n=589)

• Those who have experienced homelessness within the past five years are more likely to express concern (very/somewhat) about their personal risk of contracting all STBBI above, when compared to those who have not.

Q12. How concerned are you about your personal risk of contracting each of the following? Base: Homelessness in last 5 years (n=198); No experience with homelessness (n=2256);

Target Audiences

Relative to the average, members of the Black and 2SLGBTQI+ communities are also among those who are more likely to express concern (very/somewhat) about their personal risk of contracting an STBBI as illustrated in the figure below. Where there were no significant differences against the average, results have been excluded from the chart below.

Q12. How concerned are you about your personal risk of contracting each of the following? Base: Black (n=346); 2SLGBTQ+ (n=499); Average/Total (n=2500)

Over half (53%) of respondents say they have not been tested for any STBBI (see TABLE 9), while another 14% are unsure if they have ever been tested. 

Over one in ten, but less than one in five have been tested for the following STBBI – 19% for HIV, 15% for hepatitis B, 15% for chlamydia, 14% for hepatitis C and for hepatitis A, and 13% for gonorrhea. One in ten or fewer say they have been tested for HPV (10%), syphilis (10%), genital herpes (8%), genital warts (6%), or trichomoniasis (4%).

Regionally, respondents from the Atlantic region (61%), Ontario (58%) and Manitoba and Saskatchewan (55%), are more likely to indicate they have never been tested for any of the STBBI, relative to those in Quebec (46%), Alberta (47%), and British Columbia/the North (47%).

Rates of testing vary across the provinces and regions, but are generally somewhat higher among those in Quebec, Alberta and British Columbia/North (ranging anywhere from 6% for trichomoniasis to 24-25% for HIV) compared to the incidence of those saying they have been tested in the Atlantic or Ontario (ranging from 2%-3% for trichomoniasis to 10%-14% for HIV). Additionally, respondents in Manitoba and Saskatchewan are more likely to say they have been tested for gonorrhea (14%) and syphilis (11%) as compared to those in the Atlantic (8% and 7%, respectively) and Ontario (9% and 6%, respectively).

Significant differences were not noted by community type.

Demographics

Testing rates vary primarily by age, and to some extent are also a factor of educational attainment and gender. Homeless status has some impact as well, with respondents who have not experienced homelessness in the past 5 years more likely to say they have not been tested, relative to those who have (54% vs. 39%).

• Respondents, aged 55 and older, are less likely to say they have been tested for many of the STBBI queried relative to their younger counterparts.
  • HIV (12% 55+; 26% 35-54; 21% under 35)
  • Hepatitis B (9% 55+; 20% 35-54; 17% under 35)
  • Chlamydia (5% 55+; 21% 35-54; 21% under 35)
  • Hepatitis C (10% 55+; 19% 35-54; 15% under 35)
  • Hepatitis A (9% 55+; 18% 35-54; 14% under 35)
  • Gonorrhea (7% 55+; 18% 35-54; 17% under 35)
• Compared to those with a high school education or less, a greater proportion of those with a university level education say they have been tested for the following STBBI:
  • HIV (23% vs. 15%)
  • Hepatitis B (17% vs. 11%)
  • Hepatitis A (15% vs. 11%)
• Respondents with a college level education or trades certification are also more likely to say they have been tested for Hepatitis B, relative to those with a high school diploma (15% vs. 11%).
• Women, more so than men, report having been tested for chlamydia (17% vs. 12%) and HPV (14% vs. 6%).

Target Audiences

Rates of testing for many of the STBBI are generally much higher across the three target audiences, relative to the average for the general population, as shown below.

• For many of the STBBI queried, respondents who identify as a member of the 2SLGBTQI+ community are more likely to report having been tested, relative to the average (see the figure below).

Q15.  Have you ever been tested for any of the following types of sexually transmitted and blood-borne infections (STBBI)?
Base: 2SLGBTQ+ (n=499); Average/Total (n=2500)

• Indigenous respondents are more likely to report, relative to the average, having been tested for the following STBBI:

Q15.  Have you ever been tested for any of the following types of sexually transmitted and blood-borne infections (STBBI)?
Base: Indigenous (n=345); Average/Total (n=2500)

• Members of the Black community are more likely, relative to the average, to report having been tested for:

Q15.  Have you ever been tested for any of the following types of sexually transmitted and blood-borne infections (STBBI)?
Base: Black (n=346); Average/Total (n=2500)

Most respondents (86%) report they have not been diagnosed with any of the STBBI listed in the table below. Very few, 5% or less, indicate having received a diagnosis of any of the listed STBBI.

Small base sizes preclude any further sub-cell analysis.

D. Stigma and Barriers Associated with Diagnosis and Treatment of STBBI

Respondents to the survey were asked several questions which aimed to assess the degree to which stigma and barriers are present that may inhibit them or others from having conversations with health professionals and seeking out testing or treatment for an STBBI. Note that in this section of the report we examine stigma and barriers related to STBBI in general. Issues specific to HIV and syphilis are explored more fully in later sections (see Sections C and D).

Over three quarters (77%) of respondents feel comfortable (41% very comfortable; 36% somewhat comfortable) speaking to a health professional about STBBI. And just over two thirds (69%) report being comfortable asking for an STBBI test, although somewhat fewer feel fully at ease making this request (36% very comfortable; 33% somewhat comfortable).

A larger share of respondents in Alberta (82%) and Quebec (80%) say they would be comfortable discussing STBBI with health professionals relative to those in British Columbia/North and Manitoba/Saskatchewan (74% in each region), Ontario (73%) and Atlantic Canada (67%). Those in Quebec (74%) are also more inclined to say they are comfortable asking for an STBBI test compared to respondents who reside in Ontario (66%), Manitoba/Saskatchewan (64%), and the Atlantic region (59%).

There are no significant differences based on the type of community in which respondents reside.

Demographics

On both items, comfort levels vary based on socio-economic status and by language spoken. Age and marital status also factor into one’s overall feelings of comfort in approaching health professionals for advice or assistance. These groups are highlighted below:

There are no significant variations across the target audiences.

When asked what might prevent them from getting tested or treated if they thought that had an STBBI, most respondents (51%) did not identify any particular challenges or barriers, perceived or otherwise.

Across the regions, residents of Quebec (52%), Manitoba/Saskatchewan and Atlantic Canada (50% in each of these two regions) are less likely overall to say they face any barriers (e.g., a higher proportion respond that nothing would prevent them from getting tested or seeking treatment). The reverse is true in Ontario (43%).

Those living in rural areas are also less likely to have identified any specific barriers to testing or treatment for an STBBI, with over half (56%) saying they face no impediments in this regard, relative to those living in urban areas (46%).

Demographics

The extent to which specific barriers are mentioned varies across demographic sub-groups, although women, younger people, those who are single, and respondents who have experienced homelessness within the last 5 years are more inclined to cite a wider range of impediments to testing and treatment for STBBI. 

• Women are more likely than men to have mentioned long wait times (18% vs. 14%) and previous experiences of stigma or discrimination from healthcare providers (9% vs. 5%).
• Across the board, respondents under age 35 are more likely than those 55 and older to have mentioned the wider range of barriers. While 66% of the latter group indicate there is nothing that would prevent them from getting tested or seeking treatment for an STBBI, just 35% of the former group say the same. The most striking differences between younger and older respondents are summarized in the table below.
• Respondents who speak a language other than English or French at home are more likely to be unaware of where to go to get tested (26%) as are Anglophones (19%), relative to Francophones (14%). Compared to others, those whose first language is neither English nor French are also more likely to mention concerns about anonymity and confidentiality (22%) – 13% among Anglophones and 9% among Francophones.

Target Audiences

• Members of the Black community are more likely, as compared to the average, to cite the following as barriers to getting tested or seeking treatment for STBBI:   previous experiences of stigma and/or discrimination in the health care system (18%), concerns about anonymity and confidentiality of personal information (17%), inconvenient location of testing and treatment facilities (15%), fear of disclosing information related to sexual orientation, gender identity, etc. (12%), lack of culturally appropriate care (11%) and lack of time due to competing medical priorities (10%).
• Members of the 2SLGBTQI+ community share some of the same concerns as mentioned by Black Canadians, in addition to several others:  feelings of shame or embarrassment (28%), fear that they might test positive (22%), not being sure where to get tested (22%), fear or discomfort regarding testing procedures (19%), fear of having to disclose certain behaviours (19%), as well as having to disclose sexual orientation, gender identity or gender-affirming surgery (13%), and lack of time as a result of other medical priorities (10%).

E. Awareness of U=U Concept and Information Preferences

A slim majority of the general public are interested (57%) in knowing more about the risks, testing options, and treatments for STBBI – 16% are very interested while 41% are somewhat interested. A significant proportion (almost four in ten), however, are not interested (38%) – saying they are either not that interested (27%) or not interested at all (11%).  A few indicate some uncertainty in their response to this question (5%). 

There are no significant differences across regions or by community type. 

Demographics

• Overall, men (41%) are less interested in knowing more about STBBI compared to women (35%) and this is primarily a factor of a higher proportion of men as compared to women saying they are not that interested (30% vs. 24%). While a small subgroup, gender minorities (79%) were much more interested in knowing more about STBBIs compared to both men (55%) and women (58%).
• Younger people under the age of 35 (67%) express a higher level of interest overall (e.g., somewhat/very interested) compared to those aged 35 to 54 (60%) and those 55 years of age or older (47%).
• In line with the above finding for younger people, single people (65%) also express a higher level of interest compared to those who are married or living in a common-law relationship (55%) as well as those who are divorced, separated or widowed (48%) in knowing more about the risks, testing options and treatments for STBBI. 

Target Audiences

• Much higher overall interest in information about STBBI is evident among each of the three target audiences, including the Black community (78%), people who identify as 2SLGBTQI+ (74%) and Indigenous Peoples (63%), relative to the average (57%).

Based on respondents’ stated preferences for information channels, there are extensive opportunities to connect with those who are interested in receiving more information about STBBI. That said, about half would prefer to get this type of information from their family doctor/primary care provider (50%) or via government websites (47%). One quarter to just under one third state a preference for information by e-mail (30%), through stories of people with lived experiences (27%), video sites such as YouTube (26%), and news stories (26%). Social media (23%), television (21%) and social media influencers with expertise on the topic or with lived experience (20%) are preferred by one fifth to just under one quarter respondents. Fewer than one in five prefer to receive information via websites operated by charities or non-profit organizations (16%), podcasts (15%) or radio (9%). Less than 1% mention printed materials, Google or healthcare/medica websites.

There are relatively few variations across the regions or by community type, although Albertans (54%) are more likely to prefer receiving information about STBBI from their family doctor or primary care provider, as compared to those in Ontario (45%). 

Demographics

• By gender:
  • Men are more likely than women to state a preference for receiving information by e-mail (34% vs. 28%, respectively). 
  • Women, on the other hand, are more likely than men to prefer the following channels:  stories of people with lived experiences (30% vs. 22%, respectively), social media (26% vs. 19%), social media influencers (25% vs. 14%).
• Across age groups:
  • Those 55 and older are more likely as compared to both those aged 35-54 and those under age 35 to prefer the following:  their family doctor or primary care provider (61%; 47%; 43%, respectively), and news stories (34%; 26%; 17%). 
  • The two older age cohorts – those aged 55+ and those 35-54 – are more likely relative to those under age 35 to prefer government websites (55%; 50%; 35%, respectively) and e-mail (35%; 32%; 25%).
  • The younger demographic, those between the ages of 16 and 34, as week as those 35-54, are more likely compared to people who are 55 or older to state a preference for social media (37%; 22%; 8%); social media influencers with expertise or lived experiences (35%; 16%; 9%, respectively), video sites such as YouTube (32%; 28%; 18%), and podcasts (20%; 17%; 9%). Those under age 35 are also more likely to prefer the stories of people with lived experience with STBBI, compared to those aged 55 and older (30% vs. 26%, respectively). 
• By relationship status:
  • Single people are more likely as compared to those who are married or in a common-law relationship, as well as those who are divorced/separated/widowed to prefer the following:  video sites (32%; 23%; 22%, respectively), and social media influencers with expertise or lived experience (26%; 18%; 12%). They are also more likely to indicate a preference for social media, compared to those who are married or in a common-law relationship (29% vs. 22%) and podcasts, compared to those who are divorced/separated/widowed (17% vs. 10%).
  • Government websites are cited more frequently by those who are divorced, separated or widowed, compared to those who are single (56% vs. 42%).
• Respondents whose primary language is neither English nor French are more likely to prefer each of the following ways of receiving information, compared to Anglophones and Francophones:  video sites (52%; 26%; 26%, respectively), the websites of charitable or non-profit organizations (38%; 15%; 23%), and social media influencers (34%; 22%; 13%).

Target Audiences

• Members of the Black community are more likely to prefer information via social media (36%), video sites (34%), television (31%), social media influencers with expertise or lived experience (31%), podcasts (21%), and radio (14%).
• Relative to the average a higher proportion of Indigenous Peoples prefer to hear from people with lived experience with STBBI (33%).  
• The 2SLBTQI+ community is more likely to indicate a preference for:  stories of those with lived experiences with STBBI (37%), social media (35%), video sites (34%), social media influencers (30%), and websites operated by charitable or non-profit organizations (25%).

In 2018, Canada became the first country to endorse the ‘U=U’ (‘Undetectable is Untransmittable’) campaign, led by the Prevention Access Campaign. U=U introduced the concept of Treatment as Prevention (TasP) and promotes the fact that HIV is not passed on through sex when a person living with HIV is on treatment and the level of HIV in their blood remains very low (e.g., viral suppression). The campaign aims to change the conversation around HIV, address misinformation, and reduce stigma by improving public awareness of the importance of culturally safe HIV testing and treatment. Knowledge of U=U has been proven to increase uptake in HIV testing, treatment and achieving viral suppression, all of which support the global goal of ending HIV and AIDS as a public health concern by 2030.

These survey results show that, among the general public, awareness of ‘Undetectable=Untransmittable’ or the ‘U=U’ concept is relatively modest at 19%, with just 6% saying they have definitely heard about it and another 13% saying they have vaguely heard about it. The vast majority (76%) are unaware of this concept while another 6% are unsure.

There are no variations by region – two thirds or more in each region say they have not heard of this concept. Similarly, awareness does not vary by type of community.

Demographics

Claimed awareness of the ‘U=U’ concept is higher among the following groups:

• Those under age 35 (28%) relative to those aged 35-54 (21%) and those 55+ (10%). It should be noted, however, that the higher level of awareness among the younger age cohort is primarily driven by the proportion saying they are vaguely aware (19%);
• Single persons (24%) compared to those who are married or living common-law (17%) and those who are divorced, separated or widowed (14%); and
• Anglophones (20%) relative to those whose primary language is neither English nor French (13%).

Target Audiences

• Members of the 2SLGBTQI+ (40%) and Black communities (38%) are more likely to claim awareness of the ‘U=U’ concept. Notably, a significantly higher proportion in these two groups say they have definitely heard of the concept – 17% among those identifying as 2SLGBTQI+ and 10% among the Black community – as compared to the average of 6%, and relative to proportion of Indigenous Peoples who say the same (5%).

For just over a third of respondents, the ‘U=U’ concept means that STBBI are undetectable/asymptomatic (36%) and/or that the condition is not contagious and can’t be transmitted (32%).

There are no significant differences with regards to interpretation of the ‘U=U’ concept across the regions or by community type.

Demographics

• Women are more likely than men to interpret ‘U=U’ as meaning that STBBI are not detectable (39% vs. 33%, respectively) and as non-contagious (35% vs. 29%).
• Single people (36%) are more inclined to interpret ‘U=U’ as meaning that STBBI cannot be transmitted, compared to people who are married or living in a common-law relationship (30%). By contrast, those who are divorced, separated or widowed (43%) are more inclined to interpret the concept as meaning STBBI are not detectable and/or do not have any associated symptoms that are apparent, much higher than the proportion saying the same among those who are married or residing in a common-law partnership (34%).

Target Audiences

• A much higher proportion of 2SLGBTQI+ believe that the concept means STBBI are not detectable (45%) relative to the average (36%) and to Indigenous Peoples (38%) and that they are not contagious (43%; 32%; 30%, respectively).

F. Focused Analysis of Key Audiences

In a number of areas, the views of the Black, Indigenous and 2SLGBTQI+ communities as they relate to general knowledge, attitudes and experiences with STBBI differs from those of the general public.

Members of the Black (65%) and 2SLGBTQI+ (59%) communities express higher overall levels of concern regarding rates of HIV/AIDS, compared to the average (48% saying they are somewhat/very concerned). In line with this, Black respondents are among those who are more likely to refute the premise that STBBI are a relatively minor health concern (53% disagree with a statement to this effect vs. 47% on average). Similarly, concern about rates of syphilis infection is much higher among Black respondents (59%) relative to the average (42%).

A higher proportion of Black and 2SLGBTQI+ respondents also report being concerned about their personal risk of contracting HIV (48% and 35%, respectively) and syphilis (45% and 30%, respectively). In fact, these two audiences are generally more likely to express concern about their personal risk of contracting the wider range of STBBI.

Notably, those in the 2SLGBTQI+ and Indigenous communities are generally more likely to report having been tested for a wider range of STBBI compared to the average. And the percentage of respondents in all three of these groups who have been tested for HIV or syphilis is much higher relative to the average:

• Have been tested for HIV – 35% among 2SLGBTQI+; 27% among Indigenous Peoples; 32% among the Black community compared to 19% on average.
• Have been tested for syphilis – 21% among 2SLGBTQI+; 17% among Indigenous Peoples and the Black community compared to 10% on average.

The Black and 2SLGBTQI+ communities in particular face a number of barriers to testing and treatment for STBBI some of which are identified with greater frequency relative to the general population. 2SLGBTQI+ respondents are more likely to cite feelings of shame and embarrassment (28%), fears of testing positive (22%), not being sure of where to get tested (22%), and fear regarding testing procedures or having to disclose certain behaviours (19% for each) compared to the average. Other barriers are also cited, but to a lesser degree. For the Black community, issues such as previous experience with stigma and discrimination within the health care system (18%) and concerns about anonymity and confidentiality of their personal information (17%) are mentioned by just under one in five.

Given higher levels of personal concern about and the incidence of testing for STBBI within the Black and 2SLGBTQI+ communities, it may not be entirely surprising that these respondents are also more likely to say they are both generally knowledgeable about STBBI and more specifically about preventing, testing and treatment for HIV, syphilis and other STBBI. Relative to the average, respondents within these communities who say they are somewhat or very knowledgeable is anywhere from 5 to 21 points higher than the average. The differential is higher for members of the Black community and specifically in relation to self-reported knowledge about testing for HIV (78% are very/somewhat knowledge vs. 64% on average), other STBBI (66% vs. 52%) and for syphilis (58% vs. 46%).

Interest in knowing more about the risks, testing options and treatments for STBBI is greater among all three of these target audiences:  78% of Black respondents are somewhat/very interested; 74% of 2SLGBTQI+ and 63% of Indigenous Peoples relative to an average of 57%. Preferences for how information is shared and received does vary although common to both the Black and 2SLGBTQI+ communities is the higher proportion who favour social media (36% and 35%, respectively), video sites (34% for each), and social media influencers with expertise or lived experience (31% and 30%). Indigenous Peoples are more likely to state a preference to hear from people with lived experience of STBBI (33%) but are not significantly more likely to identify any other means of sharing information to a greater or lesser degree relative to the average.

With respect to awareness of the ‘U=U’ concept, members of the 2SLGBTQI+ (40%) and Black (38%) communities are more likely to say they have heard about it compared to the average for the general population (19%). Moreover, those identifying as 2SLGBTQI+ are also more likely to interpret this to mean that STBBI are not detectable (45%) and not contagious (43%) compared to others.  

B2. Health Care Practitioners

Health care practitioners were asked to respond to a similar series of questions as the general public in regard to their views regarding and knowledge of STBBI.

A. Concerns about STBBI Relative to Other Health Issues

Practitioners express high levels of concern (and much higher than the general public) about a wide range of public health issues. Over 9 in 10 are very/somewhat concerned about each of the following:

• Obesity (98%; 68% very concerned);
• Mental illness and suicide among adults (98%; 78% very concerned);
• Mental illness and suicide among youth (97%; 75% very concerned);
• The opioid crisis (96%; 75% very concerned);
• E-cigarette use and vaping among children and youth (96%; 72% very concerned); and
• Tobacco and alcohol use (94%; 48% very concerned).

Just under 9 in 10 (89%) also say they are very/somewhat concerned about e-cigarette use and vaping among adults (45% very concerned).

In relative terms, smaller numbers of health care practitioners report being very/somewhat concerned about HIV/AIDs (74%; 23% very concerned) or syphilis (73%; 30% very concerned).

While there are no significant differences in overall levels of concern across professions or by professional setting, key differences are more apparent when looking only at the proportion who say they are very concerned about each of these issues. A general pattern emerges of nurses exhibiting among the highest levels of concern for a range of public health issues, particularly as compared to dentists/pharmacists but also in some cases relative to physicians.

• More nurses (86%) say they are very concerned about the opioid crisis, relative to physicians (71%) and dentists/pharmacists (57%). Nurses are also more inclined to say they are very concerned about mental illness and suicide among children and youth (82%), relative to dentists/pharmacists (63%).
• Nurses along with physicians are also more likely to be very concerned relative to dentists/pharmacists about each of the following issues:
  • Mental illness and suicide among adults (82%; 82%; 65%, respectively);
  • E-cigarette use and vaping among children and youth (82%; 72%; 53%, respectively) and among adults (56%; 43%; 25%, respectively);
  • Rates of syphilis infections (37%; 32%; 15%, respectively); and
  • HIV/AIDS (29%; 23%; 10%, respectively).
• By contrast, a larger proportion of physicians (83%) are very concerned about obesity, relative to nurses (66%) and dentists/pharmacists (58%).

Demographics

Although rates of concern for various health issues are high across all sub-groups, women and older health professionals exhibit higher levels of concern in specific areas: 

• By gender, women health care practitioners are more likely as compared to their male counterparts to say they are very/somewhat concerned about rates of syphilis infection (79% vs. 63%, respectively).
• Older health care practitioners (aged 55+) are more likely relative to those under age 45 to express concern about tobacco and alcohol use (100% vs. 90%, respectively) and rates of HIV/AIDS (85% vs. 65%, respectively).

Region and Community Type

• Keeping in mind that the number of practitioners from Manitoba and Saskatchewan who completed the survey is quite small (n=16), all of them (100%) say they are very/somewhat concerned about HIV/AIDS. Levels of concern, comparatively speaking, are lower among practitioners based in Ontario (80%), British Columbia/North (74%), Atlantic Canada (67%), Quebec (64%), and Alberta (59%). This pattern is also evident with respect to levels of concern regarding rates of syphilis infection:  Manitoba/Saskatchewan (100%), Ontario (75%), British Columbia/North (74%), Alberta (74%), Quebec (67%), and Atlantic Canada (50%).

As a follow-up to this question, respondents were asked if there were any other public health issues with which they were concerned as a health professional. The plurality (40%) did not raise any other issues. Small proportions did, however, identify several additional issues of concern, including:  poverty/ability of people to meet their basic needs (11%), challenges related to access health care and the ability to access a family doctor (10%), immunization (9%), substance use (8%), mental health issues (6%), rates of infection from sexually transmitted diseases (6%), ongoing concerns related to COVID-19 (4%), discrimination, bias and racism in society (4%), diabetes (3%) and social media use (3%). A range of other issues were mentioned by fewer than 3% of respondents (e.g., contraception/unwanted pregnancies (2%), effects of climate change (2%), antibiotic resistance (2%), domestic abuse/family violence (1%), hepatitis (1%), tuberculosis (1%), heart disease (1%), aging population (1%), gender issues/dysphoria (1%) and lack of physical activity (1%), among others).

Overall, physicians are more likely to have raised a series of other public health issues, compared to nurses and pharmacists/dentists – while 48% of pharmacists/dentists and 41% of nurses did not flag any other issues of concern other than those addressed in the previous question, just one third (31%) of physicians did the same. In particular, a higher proportion of physicians (17%) cite immunization as an additional public health concern compared to nurses (6%) and pharmacists/dentists (5%).

Demographics

• Compared to female health care practitioners, male practitioners are more likely to have cited immunization (14% vs. 6%) as an additional public health concern. By contrast, women are somewhat more likely to have flagged issues related to mental health (8% vs. 2%) and STI rates (8% vs. 2%).

There are no other differences of note across regions or by community type.

To further gauge general levels of concern regarding STBBI, practitioners were asked to what extent they agreed or disagreed with the statement that STBBI are a very minor health concern. Three quarters (75%) strongly disagreed that this was the case (e.g., responding either ‘1’ or ‘2’ on a 7-point scale where 1 is completely disagree, 7 is completely agree and the mid-point 4 is neither agree nor disagree).

While there are no statistically significant variations in responses to this question across professions, those in a clinic setting (81%) are more likely to disagree with this statement relative to those in a hospital setting (67%).

Demographics

• Health care practitioners who are aged 55+ are more inclined to disagree with this statement (85%) compared to their counterparts under age 45 (70%).

There are no other differences of note across regions or by community type.

B. General Knowledge of STBBI

A high proportion of practitioners report being knowledgeable about STBBI. Over four in five claim to be somewhat/very knowledgeable about HIV (86%) and other sexually transmitted and blood-borne infections (87%), while fewer report similar knowledge levels about syphilis (75%).

Across professions, a higher percentage of nurses claim to be somewhat/very knowledgeable about HIV (90%) compared to dentists/pharmacists (77%). Physicians and nurses alike (98% and 90%, respectively) report being reasonably knowledgeable about other STBBI, significantly higher than do dentists/ pharmacists (68%). With respect to syphilis, a larger proportion of physicians claim to be knowledgeable as compared to nurses (94% vs. 76%, respectively), and both these groups are more likely to say they are somewhat/very knowledgeable about this issue relative to dentists/pharmacists (52%).

There are a few variations of note by professional setting:

• Those in a hospital setting (94%) are more likely to report being knowledgeable about HIV compared to those in a community setting (82%).
• In terms of other STBBI, practitioners in a clinic setting (91%) are more likely to report being knowledgeable relative to those in a community setting (82%).

Demographics

• Female practitioners are more likely to cite being knowledgeable about syphilis compared to their male counterparts (79% vs. 68%, respectively).

Region and Community Type

• As noted earlier, the total number of respondents by region is quite small in some cases. Nevertheless, practitioners in Atlantic Canada are more likely to report being knowledgeable about HIV (100%) compared to those in Ontario (92%), British Columbia/North (89%), Alberta (78%), and Quebec (78%). There is no statistically significant difference from respondents in Manitoba/Saskatchewan (81%).
• This is also true in terms of knowledge levels reported for other STBBI where Atlantic Canadian-based practitioners are more likely to report being knowledgeable (100%) compared to those in Ontario (92%), British Columbia/North (89%), Quebec (80%) and Alberta (74%). Again, there is no difference when compared to respondents in Manitoba/Saskatchewan (94%).
• Across community types, practitioners in smaller urban areas with populations of 100,000 to under a million as compared to those practicing in communities of under 100,000 people are more likely to report being knowledgeable of both HIV (92% vs. 79%, respectively) and syphilis (79% vs. 62%, respectively).

As shown above, with the exception of syphilis where about one quarter claim to be not that knowledgeable (22%) or not at all knowledgeable (4%), practitioners’ self-reported general knowledge of STBBI is reasonably good. Responses to additional probing questions exploring practitioners’ understanding specific to prevention, testing and treatment of STBBI underscore an opportunity to better educate and inform health care professionals not only regarding prevention, testing and treatment for syphilis but also testing and treatment for HIV.

Overall, a high percentage of practitioners claim to be knowledgeable about preventing HIV (94% are very/somewhat knowledgeable) and other STBBI (95%), while the proportion saying the same with respect to their knowledge regarding the prevention of syphilis is 10-points lower (84%). In terms of testing for STBBI, over four in five claim to be knowledgeable about HIV (82%) and other STBBI (85%), while the proportion who say they are knowledgeable about testing for syphilis is considerably lower (75%). With respect to treatments, far fewer practitioners report being knowledgeable about treatments for syphilis (72%) and for HIV (68%) than they are about treatments for other STBBI (86%).

There is some variability in claimed levels of knowledge across professions. In general, a higher proportion of physicians and nurses as compared to dentists/pharmacists report being knowledgeable about:

• Testing for syphilis (99%; 82%; 35%, respectively), other STBBI (97%; 87%; 67%, respectively), and HIV (92%; 88%; 60%, respectively); and
• Preventing syphilis (92%; 89%; 63%, respectively).

Physicians (85%) are also more likely to say they are knowledgeable about treatments for syphilis, compared to nurses (70%) and dentists/pharmacists (62%). A higher proportion of physicians (94%) also claim to be knowledgeable about treatments for other STBBI as compared to nurses (82%).

By contrast, dentists/pharmacists (75%) and nurses (73%) are more likely to report being knowledgeable about treatments for HIV relative to physicians (54%).

Results on this question vary, to some extent, across professional settings, with reported levels of knowledge generally lower among those working in a community setting.

• Those practicing in a hospital or clinic setting are more likely, relative to those in a community setting, to say they are very/somewhat knowledgeable about testing for HIV (88%; 89%; and 74%, respectively), syphilis (88%; 82%; 63%, respectively), and other STBBI (90%; 92%; and 77%, respectively).
• Practitioners working in a clinic setting, compared to those in a community setting, are also more likely to say they are knowledgeable about preventing syphilis (90% vs. 79%, respectively) and other STBBI (99% vs. 93%, respectively).

Demographics

• With respect to the age of practitioners, a higher proportion of those 55 and older relative to those under age 45 say they are knowledgeable about the prevention of syphilis (92% vs. 79%, respectively) and testing for syphilis (85% vs. 68%, respectively). 
• By contrast, younger practitioners (under 45 years of age) are more likely to report being knowledgeable about treatments for HIV (75%) compared to those aged 45-54 years of age (60%).

Region and Community Type

• From a regional perspective, there are few variations of note with one exception. A higher percentage of practitioners in Atlantic Canada (100%) say they are knowledgeable about testing for syphilis compared to those in Ontario (86%), British Columbia/North (77%), Manitoba/Saskatchewan (69%), Alberta (63%) and Quebec (59%). Again, some caution should be taken when examining regional differences. Although they are statistically significant, the base sizes are small in some regions.

C. General Barriers to Diagnosis and Treatment of STBBI

Health care professionals responded to a series of questions aimed at better understanding the degree to which stigma or barriers exist which would affect patient access to and usage of STBBI prevention, treatment and support services. The results highlighted in the table below suggest that most health care practitioners are quite comfortable having conversations with patients about sexual health and sexually transmitted and blood-borne infections (89% overall; 65% who are very comfortable). While just one in ten practitioners report being uncomfortable (11%), when combined with those who say they are somewhat comfortable (24%), over one third of practitioners express some degree of hesitation or discomfort in this situation.

Physicians (95%) and nurses (92%) express a greater level of comfort engaging in these types of conversations relative to dentists/pharmacists (77%). The difference is more striking in terms of those indicating a high level of comfort – many more physicians (83%) report being very comfortable, as compared to nurses (67%) and dentists/pharmacists (40%). By contrast, over one in five dentists/pharmacists say they are uncomfortable (23%), a much higher proportion relative to nurses (8%) and physicians (5%).

There are no significant differences on this question across practice settings.  

There are no variations of note across demographic sub-groups or by region and community type.

D. Awareness of U=U Concept and Information Preferences

There is considerable interest (94%) among health care professionals in knowing more about the risks, testing options, and treatments for STBBI. Almost half (47%) are very interested and about the same number are at least somewhat interested (48%).

Few variations by profession or across practice settings are evident, although nurses (52%) are much more likely to say they are very interested in knowing more about STBBI relative to dentists/pharmacists (35%).

There are no statistically significant variations across demographic sub-groups, regions or by community type.

Health care professionals were asked how they would prefer to receive information or learn more about STBBI. Over half favoured obtaining information via e-learning courses (64%) as well as webinars, seminars and/or conferences (57%). Over one-quarter to just under half indicated a preference for information which they would receive through a professional organization (45%), print material such as brochures and pamphlets (38%), academic journals (38%), e-mails (29%), podcasts (29%), government websites (27%) and via stories of those with lived experience (25%). One in five (or fewer) cited videos through channels such as YouTube (20%), classroom or other traditional training venues (20%), social media (16%), websites of charitable or non-governmental organizations (10%), news stories (10%), and traditional media such as television (9%) and radio (5%).

Nurses, as compared to dentists/pharmacists and physicians, are more likely to cite a preference for academic journals (46%; 30%; 28%, respectively). They are also more likely than physicians to favour government websites (33% vs. 18%, respectively).

Across professional settings, those working in a clinic or community setting (50% and 48%, respectively) are more likely to state a preference for professional organizations, compared to those in a hospital setting (36%).

By contrast, those in a hospital setting are more likely to favour each of the following modes for receiving information:

• Academic journals – 48% vs. 31% among those in a community setting
• Podcasts – 37% vs. 26% among those in a clinic setting
• Stories of those with lived experience – 36% vs. 24% among those working in a community setting and 22% among those in a clinical setting
• Video sites such as YouTube – 32% vs. 21% among those in a community setting and 17% among those in a clinical setting
• Social media – 23% vs. 12% for those in a clinic setting and 11% for those in a community setting

Demographics

• By gender, women practitioners (34%) are more likely to cite a preference for receiving information about STBBI via the stories of those with lived experience as compared to men (11%).
• Podcasts are favoured more so by those under age 55 (33%) relative to those aged 55+ (18%), while a higher proportion of practitioners under age 45 (33%) prefer learning about STBBI through the stories of people with lived experience compared to those 45 and older (18%).

Region and Community Type

• Regionally, health care professionals working in Manitoba/Saskatchewan (81%) are more likely to indicate a preference for academic journals compared to those in Ontario (41%), British Columbia/North (34%), Alberta (33%) and Quebec (23%). Similar numbers in Manitoba/Saskatchewan (81%) are also more likely to cite webinars, seminars and/or conferences among their preferred means of receiving information about STBBI, relative to those in British Columbia/North (46%) and Alberta (41%).

Over half (54%) of health care professionals surveyed have heard about the concept of ‘Undetectable=Untransmittable’ or ‘U=U,’ although most describe their recall as vague (36%) rather than definite (18%). Many (45%) do not recall hearing anything about this concept, while several (1%) were unsure.

While there was little difference by profession in terms of the overall recall of ‘U=U,’ a higher proportion of dentists/pharmacists (48%) say they vaguely recall hearing about this concept, compared to nurses (33%) and physicians (29%).

Across professional settings, those working in a community setting (63%) are more likely to have heard about ‘U=U’ relative to those working in a clinical setting (52%).

Demographics

• Although there are no differences based on the gender of health care professionals, the younger cohort, under the age of 45 (62%) are more likely than those aged 55+ (42%) to have heard about ‘U=U.’  The plurality (42%) do however describe their recall as vague.

There are no variations across regions or by community type on this question.

In a subsequent question, all respondents were asked what they felt was meant by the phrase ‘Undetectable=Untransmittable.’  Almost as many health care professionals believe it to mean that STBBI are not detectable (68%) as they believe it to mean that STBBI that are not detectable or contagious (62%). Notably, one quarter (25%) of respondents are unsure of the meaning of this phrase, while small percentages believe the statement to be false (3%) or felt it alluded to the ability to control or cure STBBI (3%), difficulties testing and diagnosing STBBI (1%), the transmissibility of STBBI (1%) or the possibility of having an STBBI without knowing it (1%).

Overall, a higher proportion of physicians, as compared to nurses, correctly interpreted the phrase believing it to mean that an STBBI is not transmissible if it can’t be detected (74% vs. 55%, respectively). By contrast, nurses are more likely than physicians to report being unsure of the meaning (29% vs. 15%, respectively).

There are no significant variations in respondents’ understanding of the meaning of ‘U=U’ across professional settings.

Demographics

• Younger health care professionals, under 45 years of age, are more likely than those 55+ to feel that ‘U=U’ refers to the undetectability/asymptomatic nature of STBBI (74% vs. 58%, respectively). At the same time, this younger cohort is almost equally likely to interpret the phrase as meaning STBBI are not contagious (70%) compared to those aged 45 to 54 (55%).

Region and Community Type

• Respondents working in Quebec (73%) and Ontario (63%) are more likely to interpret ‘U=U’ as meaning the infection is not transmissible, compared to those in British Columbia/North (43%).

Overwhelmingly, those who have heard about ‘U=U’ feel it is important (97%) to communicate this message to people living with HIV (80% say it is very important to do so while another 17% say it is somewhat important). A small number (3%) are unsure.

The extent to which health care professionals see this as important is consistent across professions and professional settings.

Demographics

• Female health care professionals (85%) are more likely to say that communicating this message is very important, compared to their male counterparts (70%).

There are no significant variations on this question by region or community type.

Among those who have heard of ‘U=U,’ the extent to which this message is communicated to patients living with HIV is relatively infrequent. Just over two in five (44%) say they share this message with affected patients a few times a year, but not on a monthly basis (31%) or no more than once a year (13%). Just over one quarter (26%) indicate never speaking with their affected patients about this concept. By contrast, a little less than one quarter (24%) share this information daily (2%), several times a week but not on a daily basis (13%), or several times a month, but not on a weekly basis (9%). A small proportion are unsure (6%).

Dentists/pharmacists (45%) are more likely to say they never communicate this message, compared to nurses (16%).

There are no differences in the frequency with which health care professionals communicate the ‘U=U’ by region or community type.

C: Detailed Findings – HIV/AIDS

C1. General Public

This section delves more deeply into respondents’ understanding of HIV, including their knowledge of specific aspects of the virus in terms of how it is transmitted, as well as how it can be prevented, treated and managed. It also examines, from the perspectives of both the general public and health care professionals, the extent to which stigma exists around HIV/AIDS and people living with HIV/AIDS which could impact those seeking advice or assistance.

As noted in the Section B, general knowledge of HIV is modest among the general population and considerably higher among health care professionals, although for both audiences relatively few describe themselves as being very knowledgeable (one-quarter among health care professionals and just over one in ten among the general public). Knowledge levels regarding the prevention, testing and treatment of HIV vary greatly – knowledge correlates closely with age and educational attainment, and is generally higher among members of the Black community and those identifying as 2SLGBTQI+. With few exceptions, among health care professionals nurses and physicians exhibit greater knowledge of various aspects of HIV relative to dentists and pharmacists.

Close to one in five among the general public have been tested for HIV – notably the prevalence of reported testing is significantly higher among people who have experienced homelessness within the last 5 years, as well as equity-deserving groups such as 2SLGTBQI+, the Black community and Indigenous Peoples.

The general public and health care professionals alike identify a wide range of groups as being at risk of HIV, although the latter group tends to cite the various groups more frequently compared to the former. Most frequently mentioned by both groups are: people who inject drugs, men who have sex with other men, sex workers and people from countries where HIV is more widespread. By comparison relatively few mention the African, Caribbean and Black (ACB) communities or Indigenous Peoples. Of note, the proportion of Black and Indigenous respondents who indicate their own community as being more at risk for HIV is relatively low, although in some cases higher than the average.

Results highlight that there is some stigma and discomfort around HIV among both target audiences mainly when it comes to interactions at a more personal level – for example, people with HIV serving the public in positions such as dentist, hairdresser or in a restaurant, as well as a family member or close friend dating someone with HIV. While comfort levels are higher among health care professionals, there is a clear need for additional training and resources to enhance their sense of ease in caring for patients living with HIV.

A. General Knowledge of HIV

A majority (64%) of the general public say they are knowledgeable about HIV with just over half (51%) reporting they are somewhat knowledgeable and 13% saying they are very knowledgeable. Conversely, about one third (34%) say they are not knowledgeable with about a quarter (26%) reporting they are not that knowledgeable and a further 8% reporting they are not at all knowledgeable. Only a very small share of respondents (2%) had some difficulty assessing their knowledge about HIV responding that they don’t know.

Those more likely to say they are knowledgeable (very/somewhat) about HIV include:

• Residents of Ontario (67%) and British Columbia/North (66%), relative to those in the Atlantic region (57%) and Quebec (59%); and
• People living in urban areas (64%) when compared to those in rural areas (56%).

Conversely, those who are more likely to say be less knowledgeable (not that/not at all) about HIV are:

• People in Atlantic Canada (41%) and Quebec (39%), relative to those in Ontario (31%) and British Columbia and the North (32%); and
• Those residing in rural communities (43%) versus urban areas (34%). This difference is primarily due to a larger proportion in rural areas (34%) who say they are not that knowledgeable, relative to respondents in urban areas (26%).

Demographics

Knowledge levels vary across key demographics, for example by educational attainment and age. The table below highlights those groups that report higher and lower levels of knowledge about HIV.  

Target Audiences

• Members of the Black and the 2SLGBTQI+ communities are more likely to report being knowledgeable (very/somewhat) about HIV (77% and 73%, respectively), relative to the average (64%).

In Section B.B1 it was reported that a majority of respondents say they are knowledgeable about the prevention of HIV – 69% are very (22%) or somewhat (47%) knowledgeable. However, self-described knowledge declines when asked about testing and treatments for HIV, with less than half who say they are knowledgeable (very/somewhat) about testing (47%) and treatments (40%) for HIV (see Table 28).  

With respect to preventing HIV:

• Respondents residing in Manitoba and Saskatchewan (75%) and Alberta (75%), relative to those in Quebec (59%) and the Atlantic (67%), are more likely to report a higher levels of knowledge(very/somewhat). By contrast, those in Quebec (38%), relative to residents of other provinces (31% in the Atlantic, 26% in British Columbia and the North, 25% in Ontario, 24% in Manitoba/Saskatchewan, and 23% in Alberta) are more likely to say they are less knowledgeable (not that/not at all knowledgeable). The difference primarily stems from a greater proportion in Quebec who say they are not that knowledgeable (26%) when compared to those in the Atlantic (20%), Manitoba and Saskatchewan (18%), Ontario (17%), British Columbia and the North (17%) and Alberta (14%). Respondents residing in the Atlantic (31%) region are also more likely to report not being knowledgeable (not that/not at all knowledgeable), relative to those residing in Ontario (25%), Manitoba and Saskatchewan (24%), and Alberta (23%).

With respect to testing for HIV:

• Respondents residing in Alberta (17%), Quebec, Ontario, and Manitoba and Saskatchewan (15% each) are more likely to report they are very knowledgeable, relative to those residing in the Atlantic (10%), although these numbers reflect relatively small proportions of the overall population, aged 16+, in each region.    
• Respondents residing in the Atlantic region (41%) are less likely to say they are knowledgeable (very/somewhat) about testing for HIV, relative to those in Manitoba and Saskatchewan (51%), British Columbia and the North (51%), Alberta (51%), and Ontario (49%). In line with this, a higher proportion of Atlantic Canadians (56%) are more likely to say they are not knowledgeable (not that/not at all), relative to those in Ontario (47%), Alberta (47%), Manitoba and Saskatchewan (46%), and British Columbia/North (45%).
• Those living in urban communities are more likely to report a higher level of knowledge compared to those residing in rural areas:
  • 50% of respondents in urban areas say they are very/somewhat knowledgeable vs. 38% in rural areas.
  • 59% of respondents residing in rural communities say they are not that/not at all knowledgeable vs. 48% in urban communities.

With respect to treatments for HIV:

• Respondents residing in Alberta (24%) are more likely to say they are not at all knowledgeable relative to those in Ontario (18%) and British Columbia and the North (16%).
• Similar to knowledge levels reported above for the testing of HIV, respondents residing in urban communities (42%) are more likely to say they are knowledgeable (very/somewhat) compared to those in rural areas (36%). Conversely, respondents in rural communities (27%) are more likely to say they are not at all knowledgeable about treatments for HIV, relative to those in urban areas (19%).

Demographics

In general, younger people, those with a university education, people who have experienced homelessness within the last 5 years, as well as those working in the health care sector tend to be more knowledgeable about various aspects of HIV (e.g., prevention, testing and treatment). By contrast, people aged 55 and older as well as those with lower levels of educational attainment report being less knowledgeable in all these areas (see Tables 32 and 33 below).

Target Audiences

Members of the Black community are more likely to say they are knowledgeable (very/somewhat) about prevention, testing and treatment of HIV, relative to the average (see Figure 12). This is also the case for people who identify as 2SLGBTQI+.    

Additionally, members of the Black community report with greater frequency, compared to the average, that they are very knowledgeable about various aspects of HIV:

• Preventing HIV (38% vs. 22%)
• Testing for HIV (27% vs. 13%)
• Treatments for HIV (20% vs. 8%)

B. Connections to People Living with HIV and Perceived Personal Risk

To provide context for respondents’ views on the topic of HIV, they were asked if they know of anyone who is or was living with HIV. In responding to this question, they were also asked to identify the nature of their relationship to this person(s) to better understand the extent of their potential emotional and/or physical proximity to people living with HIV.

The vast majority (80%) of respondents do not know of anyone who has had HIV. About one in ten (9%) identified a friend. Smaller proportions a member of their extended family (4%), a colleague at work (3%), or a neighbour (2%). Others such as an acquaintance, parent, sibling, current/former partner or spouse, celebrity, or the respondent themselves were each mentioned by 1% or fewer respondents.

There are no significant differences by region or community type and the small bases sizes for those who know of someone with HIV precludes further in-depth analysis.

Demographics

Those more likely to be unaware of anyone living with HIV include:

• Those aged 18 to 24 (86%), as compared to people aged 65+ (80%) and those age 45 to 64 (79%);
• People who speak a language other than English or French (87%), compared to Francophones (78%);
• People who are not in the workforce (88%), compared to those who are employed (79%); and
• Those who have not experienced homelessness within the last 5 years (82%), compared to those who have (62%).

Target Audiences

Across the three target audiences, a higher proportion within the Black community (76%) are more likely to say they do not know anyone who has had HIV, relative to Indigenous Peoples and those who identify as 2SLGBTQI+ (69% each). Keeping in mind the small base size for analysis, it is notable that Indigenous Peoples and those identifying as 2SLGBTQI+ are more likely, relative to the average, to cite knowing a friend (19% among 2SLGBTQI+; 16% among Indigenous Peoples; 9% on average) or a partner/spouse (2% among each of these two groups compared to <1% on average) who has HIV or has lived with HIV. Those in the 2SLGBTQI+ community are also slightly more likely to report having HIV themselves (2%) as compared to the average among all respondents (1%).

As previously reported in an earlier section of this report, a modest percentage of respondents express some concern about the possibility of personally contracting HIV with one in four (25%) saying they are either very (11%) or somewhat concerned (14%). Most (73%) respondents are not concerned, with almost half saying they are not at all concerned (48%) and another quarter (25%) who are not that concerned. An additional 2% are uncertain about their personal risk of contracting HIV.

Residents of British Columbia/North (35%), Ontario (32%), Alberta (31%), and Manitoba/Saskatchewan (30%) are more likely to express some degree of concern (very/somewhat) about contracting HIV, as compared to people residing in the Atlantic region (22%) and Quebec (24%). Concern is also higher among those living in urban (30%) versus rural areas (20%) of the country.

A full demographic analysis, including differences across the key target audiences, is included in Section B.B1.C. Experience with STBBI: Perception of Risk, Testing and Diagnosis.

Similar to respondents’ level of concern around contracting HIV, a modest proportion of respondents (19%) have been tested for HIV and very few among the total sample (1%) say they have been diagnosed with HIV.

Regionally, respondents in British Columbia/North (25%) and Quebec (25%) are more likely to say they have been tested for HIV relative to those in the Atlantic (10%), Ontario (14%), and Manitoba/Saskatchewan (19%).

Despite their having higher levels of concern about personally contracting HIV, people living in urban areas are no more likely than rural residents to say they have been tested for HIV.

Detailed demographic and target audience analysis for this question, showing comparative rates for testing and diagnosis across all STBBI, can be found in Section B.B1.C. Variations specific to the testing and diagnosis of HIV are highlighted below.

Demographic Analysis

While the base size for those who have been diagnosed with HIV is too small to undertake further sub-group analysis, the incidence of testing for HIV varies by:

• Age – those 35 to 45 years of age (27%) are more likely to have been tested, compared to both younger and older people (21% for 18-34; 20% for 45-64; 10% aged 65+);
• Educational attainment – people with a university degree (23%) are more likely to have been tested, compared to those whose highest level of educational attainment is high school or less (15%);
• Language – a higher proportion of Francophones (25%) have been tested, relative to Anglophones (18%); and
• Shelter status – those who have experienced homelessness within the last 5 years (29%) are more likely to have been tested compared to others (18%).

Target Group Analysis

Each of the three target audiences is more likely to indicate having been tested for HIV relative to the average (19%) – 35% among those identifying as 2SLGBTQI+, 32% among members of the Black community and 27% among Indigenous Peoples.

C. Groups Viewed as Most at Risk of HIV

There is a general consensus among the public regarding those groups which are most at risk of HIV. They include people who have multiple sexual partners (60%), sex workers (57%), people who inject drugs (53%), men who have sex with other men (53%) and people from countries where HIV is more widespread (47%). A smaller proportion – between one quarter to just under one third – identified other groups, including bisexual people (30%) and people who have another type of sexually transmitted infection such as chlamydia, gonorrhea or syphilis (24%). Relatively few respondents believe that the following groups are at risk: members of African, Caribbean and Black (ACB) communities (18%), hemophiliacs (16%), heterosexual women (16%) or men (15%), women who have sex with other women (15%), or Indigenous Peoples (9%). Just over one in ten (14%) are unsure which, if any, groups are at risk of HIV.

Regionally, there are relatively few differences to note on this question the exception being that residents of Alberta are more likely to identify:

• Sex workers (64% in Alberta), relative to Atlantic Canada (56%), Ontario (56%), and Quebec (47%); and
• People from countries where HIV is more widespread (52% in Alberta), compared to Ontario (44%), Atlantic Canada (43%), and Quebec (41%).

Rural Canadians are more likely than those residing in urban centers to believe that the following groups are at higher risk of contracting HIV: people with multiple sexual partners (65% vs. 58%, respectively), people who inject drugs (58% vs. 50%), those from countries where HIV is more prevalent (52% vs. 44%), and hemophiliacs (22% vs. 15%).

Demographics

Perceptions regarding those sub-groups which are perceived to be most at risk of HIV vary based on gender, age, marital status and language: 

• Men are more likely than women to believe that men who have sex with other men (56% vs. 49%, respectively) and bisexual people (33% vs. 27%) are at higher risk.
• Older respondents, aged 55+ are generally more likely than those under age 35 to identify the wider array of groups as being at greater risk of contracting HIV with a particular focus on people who have multiple sexual partners (69% vs. 52%, respectively), men who have sex with other men (69% vs. 39%), sex workers (61% vs. 54%), people who inject drugs (60% vs. 41%), people from countries where HIV is more prevalent (54% vs. 41%), and bisexual people (42% vs. 17%).
• Those who are separated/widowed/divorced as well as those who are married or living in a common-law relationship are more likely than people who are single to say the following groups are at greater risk of HIV: people who have multiple sexual partners (66%; 63%; 54%, respectively), men who have sex with other men (64%; 55%; 45%), people who inject drugs (60%; 56%; 46%), people from countries where HIV is prevalent (53%; 49%; 41%), bisexual people (36%; 34%, 21%), and ACB communities (27%; 19%; 14%).
• A higher proportion of respondents whose primary language is neither English nor French, as compared to Anglophones or Francophones mentioned the following: people who have multiple sexual partners (75%; 60%; 61%, respectively), sex workers (71%; 60%; 45%), and people from countries where HIV is more widespread (60%; 48%; 41%, respectively). 

Target Audiences

• Black respondents are more likely than the average to believe the following groups are most at risk of HIV: people who have another type of STBBI (31%), women who have sex with other women (21%), heterosexual men (23%), and people who have hemophilia (20%). Notably, this group is less likely to cite people who inject drugs (47%), men who have sex with other men (46%), and the ACB community (13%).
• Indigenous respondents are more likely to identify people who inject drugs (60%) and Indigenous Peoples (17%) as being most at risk.
• Among the 2SLGBTQI+ community there is a greater propensity to cite people who have another type of STBBI (29%), people who have hemophilia (20%), and Indigenous Peoples (15%). They are somewhat less likely to cite bisexual people (23%), compared to the average.

D. HIV/AIDS – Knowledge Index

A series of 14 true/false statements about HIV/AIDS were included in the survey to assess respondents’ knowledge. The table below shows the percentage of respondents answering each statement correctly (indicated by either a T or an F in parentheses at the end of each statement to denote whether the statement was actually true or false).

Overall, the proportion of those responding ‘don’t know’ ranged from just over one in ten to a little under half. That said, over half of all respondents correctly identified (as either true or false) six of the 14 statements. As is shown in the chart below, two thirds or more of respondents are aware that people who inject drugs can get HIV from sharing needles, HIV is a treatable condition and that those with HIV can live a long and healthy life. Another 50% to 60% of respondents know that HIV and AIDS are not the same thing, people with HIV can prevent passing it on to a sexual partner, and that it cannot be contracted by sharing items like cutlery, cups, dishes, towels and toothbrushes. By contrast, there is much more uncertainty with regards to the remaining statements which assessed knowledge related to the prevention, testing and treatment of HIV as well as the vulnerability of some groups to HIV (e.g., women versus men, and the transmission of HIV from mother to fetus, in the absence of intervention).

Knowledge levels vary to some extent across the regions (as shown in TABLE 39 below), with most of the variability being between Quebec relative to other regions. For example, a higher proportion in Quebec correctly claim each of the following statements to be false:

• Women are less likely than men to get HIV – Quebec (56%), compared to those in Alberta (46%), Ontario and Manitoba/Saskatchewan (44% in each), and Atlantic Canada (40%). Of note, a higher percentage of respondents in other regions were unsure (e.g., responded ‘don’t know’) relative to those in Quebec.
• When receiving a blood test for any purpose, you are automatically screened for HIV – Quebec (51%), compared to those in Alberta (43%), British Columbia/North (42%), Manitoba/Saskatchewan (42%), Ontario (40%) and Atlantic Canada (39%).

By contrast, while a majority of Quebec respondents (52%) correctly respond that the statement HIV and AIDS are the same thing is false, this percentage is lower than what was found in other regions – Manitoba/Saskatchewan (68%), Alberta (64%), Atlantic Canada (63%), British Columbia/North (63%), and Ontario (61%). Similarly, a plurality of those in Quebec believe that people with HIV can prevent passing on HIV to a sexual partner (45%), close to one in three (29%) incorrectly say this is false which is higher than the proportion in other regions who responded similarly (ranging from 14% to 18%).

Other variations by region, include the following:

• While under half of all respondents are aware that HIV treatment can be as simple as taking a pill daily, a higher proportion of those in Atlantic Canada are uncertain, responding ‘don’t know’ to this statement (45%) relative to other regions where the percentage saying the same ranges from 35% to 39%.
• The same pattern holds true regarding the statement that condoms and dental dams are the only way to prevent HIV from being passed on during sex. About equal numbers in Atlantic Canada say this is false (33%) which is the correct response, as say it is true (33%) or don’t know (34%). The percentage of respondents who are unsure is lower in all regions, ranging from 24% to 26%, with the exception of Quebec (32%).

There are no variations of note by community type.

For ease of analysis, results for each of the 14 true/false statements were used to create a Knowledge Index. Each respondent was given a score based on the number of statements they correctly attributed as being either true or false – each correct response earned a value of +1, while each incorrect response earned a value of -1. Thus, the total score for a respondent could range from -14 (e.g., responded incorrectly to all statements) up to +14 (e.g., responded correctly to all statements). Respondents are classified as having high, moderate or low levels of knowledge of HIV/AIDs based on their total score as follows:

Based on this analysis, just over one in four respondents (28%) exhibit a high level of knowledge with respect to HIV/AIDS. Nearly two in three (65%) exhibit a moderate level of knowledge, while under one in ten (7%) are classified as having low knowledge levels.    

Knowledge levels are fairly consistent across the regions and by community type. While a higher proportion of those in Ontario exhibit moderate levels of knowledge (69%), relative only to respondents in Manitoba/Saskatchewan (61%) and British Columbia/North (60%), results vary minimally between the provinces and regions. The proportion exhibiting a high level of knowledge ranges from 24% in Atlantic Canada to 32% in British Columbia/North.

Demographics

Overall levels of knowledge about HIV/AIDS vary based on age and socio-economic status:

• By age, a larger proportion of those aged 35 to 54 (36%) are classified as having a high level of knowledge, relative to those under age 35 (26%) and those 55 years of age or older (24%).
• By household income, those in households earning $100,000 or more (33%) are more likely to fall into the high knowledge category, relative to those in households with less than $60,000 annual income (26%).
• Based on educational attainment, a higher proportion of respondents with some post-secondary education are classified as having high knowledge of HIV/AIDS (33% for those with a university degree; 30% for those with a college diploma/some university), compared to those with a high school education (19%).
• Similarly, employed persons (34%) are more likely to have a higher knowledge, compared to those who are unemployed (25%) or not in the workforce (21%).

Target Audiences

While the majority of respondents within each of the three target audiences fall into the moderate knowledge category, findings show that a higher percentage of those identifying as 2SLGBTQI+ (42%), Indigenous Peoples (35%) or as Black (34%) have a high knowledge of HIV/AIDS, relative to the average (28%).   

E. Perceived Effectiveness of Treatments

Two in three respondents (66%) are of the view that HIV cannot be cured, while just 13% say it can and another 20% are unsure. There is in fact no cure for HIV, although it can be managed with HIV treatments.

Across all regions, six to seven in ten respondents understand that HIV is incurable – knowledge of this fact is highest in Manitoba/Saskatchewan (72%) compared to Quebec (66%) and Ontario (62%). Awareness does not vary by community type.

Demographics

The proportion responding in the negative to this question (e.g., correctly of the view that HIV cannot be cured) is higher among the following groups: 

• Those aged 35 to 54 (72%), compared to people aged 55+ (65%) and those under the age of 35 (62%);
• Those residing in households with annual incomes of $100,000 or more (73%), compared to those with lower annual household incomes under $60,000 (63%); and
• Anglophones and Francophones (67% in each of these groups), relative to those who speak another language (50%).

There are no signification differences for the three target audiences on this question.

When asked about the efficacy of HIV treatments, four in five respondents (80%) believe they are effective in helping people with HIV lead full and healthy lives (34% very effective; 46% somewhat effective). Just 6% feel treatments are either not very/not at all effective. Just over one in ten (14%) are unsure.

Results vary minimally across the regions and by community type – in Quebec just one in four respondents (24%) believe that HIV treatments are very effective, compared to about one third or more in other areas of the country.

Demographics

The analysis of demographic variations on this question aligns with findings on the previous question regarding beliefs about the curability of HIV. There are significant differences found in perceptions of the efficacy of HIV treatments by age, household income and education as follows:

• People between the ages of 35 and 54 (83%) and those aged 55+ (80%) are more likely to believe the treatments are effective compared to those under 35 years of age (76%);
• Higher income households of $100,000+ annually (83%) are also more likely to hold this view, relative to those earning under $60,000 annually (78%); and
• University educated respondents (86%) and those with a college or some university education (80%) are more inclined to say that treatments are effective compared to those with a high school education or less (74%).

Target Audiences

With respect to the proportion who believe that treatments for HIV are generally effective, there are no significant variations across the three target audiences, although a higher proportion of those identifying as 2SLGBTQI+ (43%) describe the treatments as very effective, relative to the average (34%).

F. Stigma Associated with HIV/AIDS

To assess the degree to which stigma exists regarding those living with HIV, respondents were presented with several statements and asked about the extent to which they agree or disagree with each. The results are shown in TABLE 43 below, highlighting the proportion who agreed with each statement. While most respondents themselves have no concerns with people living with HIV, the findings indicate that many feel negative attitudes and beliefs do exist at a societal level. Moreover, there is a small but significant segment of respondents who do acknowledge feeling some degree of discomfort engaging with people who are living with HIV and a larger share who, at a minimum, have mixed views as to whether those with HIV should be permitted to work in a service capacity where they may interact regularly with customers and clients within the general population.

The level of agreement on each of these four statements is consistent across the regions and by community type

Demographics

The extent to which stigma exists, to a greater or lesser degree, is generally a factor of gender identity, age, and one’s socio-economic status (education, household income, and to a lesser extent employment status). Marital status, language spoken, and homeless status also drive views, in some cases. The groups which are more likely to agree with each of the statements are highlighted below.

Target Audiences

Relative to the average, those identifying as 2SLGBTQI+ are more likely to agree with two of the four statements, including that people often hold negative impressions about those living with HIV (69% vs. 62% on average) and those living HIV should be able to work in public-facing occupations (58% vs. 36%).

Survey respondents were asked about their level of comfort in terms of interacting with people living with HIV/AIDS under various circumstances as well as discussing the topic with health professionals or others. Two thirds, or more, are generally comfortable (either somewhat or very comfortable) shopping in a neighbourhood store where the owner was known to have HIV/AIDS (69%), working in an office where a colleague has HIV/AIDS (68%), and discussing a friend or family member’s diagnosis of HIV (66%). The proportion saying they are comfortable drops off somewhat for scenarios which involve closer interaction or a greater level of intimacy with an individual or individuals living with HIV/AIDS, including:  inviting a person with HIV/AIDS into one’s home (64%), wearing a sweater (61%) or using a clean drinking glass (58%) previously used by someone living with HIV/AIDS, having a child attend school where other students are known to have HIV/AIDS (56%), and a close friend or family member dating someone living with HIV (46%).

There are no differences by community type in terms of respondents’ overall levels of comfort in various scenarios involving interactions or discussions with someone with HIV/AIDS. Regionally, residents of Quebec are more likely to say they are comfortable (70%) discussing a friend or family member’s diagnosis of HIV with them, relative to those living in other regions where comfortability ranges from 63% in Manitoba/Saskatchewan to 62% in the Atlantic provinces, Alberta and British Columbia/North).

Demographics

Comfort levels vary across demographic groups and are, in some cases, situationally specific. However, with a few exceptions, comfortability generally increases with age, and is higher among women, married people and/or those living in a common-law relationship as compared to singles, and Francophones relative to Anglophones as well as those who speak a language other than English or French. Comfortability with HIV/AIDS is also increases based on socio-economic status and is higher among employed persons, those with higher household incomes and those with a university education, relative to those for whom high school was the highest level of education they attained. In a number of situations, although not all, health care workers also exhibit greater levels of comfort. For each statement (above), those groups expressing higher levels of comfort (somewhat/very comfortable) are highlighted below.

Target Audiences

Those who identify as a member of the 2SLGBTQI+ community are more likely to be comfortable in all of the above-noted situations, relative to the average. The proportion saying they are somewhat/very comfortable ranges from 65% for using a clean restaurant drinking glass previously used by a person living with HIV/AIDS to 78% for shopping a small neighbourhood grocery store owned by a person living with HIV/AIDS. As compared to the average, 2SLGBTQI+ comfort levels are 6-17 points higher, the highest difference being for a close friend or family member dating someone living with HIV (63% vs. 46% on average).

By contrast, there are no variations of note among the Black community or Indigenous Peoples relative to the average.

G. Focused Analysis of Key Audiences

This section highlights key trends found for several key target audiences including Black, Indigenous and 2SLGBTQI+ communities as they relate to their general knowledge, attitudes and experiences with HIV.

In general, members of the Black (65%) and 2SLGBTQI+ (59%) communities express higher levels of concern regarding rates of HIV/AIDS, compared to the average of 48% who are somewhat/very concerned. Moreover, a higher proportion of Black and 2SLGBTQI+ respondents also report being concerned about their personal risk of contracting HIV (48% and 35%, respectively). And, notably, across all three audiences, the proportion who say they have been tested for HIV is higher than the average: 35% among 2SLGBTQI+, 32% among the Black community and 27% among Indigenous Peoples.

When asked which groups are most at risk of HIV, Black respondents are more likely to identify the ACB community (13%). Similarly, Indigenous respondents are likely to cite their own community as being more at risk (17%), although both these groups mention a wide range of other groups with much greater frequency. Across all of these groups, a majority or near majority identify sex workers, people who have multiple sexual partners, people who inject drugs, and men who have sex with other men as being most vulnerable to contracting HIV.

Black respondents and those who identify as 2SLGBTQI+ exhibit higher than average levels of knowledge both about HIV in general and specifically in relation to prevention, testing and treatment for HIV. A higher proportion within each of these three target audiences is classified as having a high level of knowledge of HIV, based on their responses to a series of true/false statements about HIV. Although the majority nevertheless are categorized as having a moderate level of knowledge, significant portions of 2SLGBTQI+ (42%), Indigenous Peoples (35%) and Black respondents (34%) are considered to have a high knowledge of HIV relative to the average (28%) for the general population.

C2. Health Care Practitioners

While an earlier section of this report (B.B2) provided an overview of health care professionals general attitudes and understanding of STBBI, this section delves into more detail on their views and experiences specific to the prevention, diagnosis and treatment of HIV. Note that some items covered in the earlier section are given brief mention here in order to provide additional context and a more complete picture of practitioners’ perspectives with respect to the management of patients with or at risk of contracting HIV.

A. Concerns about HIV Relative to Other Health Issues

As noted in Section B.B2, health care practitioners express high levels of concern about issues such as obesity (98% are very/somewhat concerned), mental illness and suicide among adults and youth (98% and 97%, respectively), the opioid crisis (96%), e-cigarette use or vaping among children/youth and adults (96% and 89%, respectively) and tobacco/alcohol use (94%). By comparison, the overall level of concern about rates of HIV/AIDS among health care professionals is in the range of 15 to 24 points lower (74%). And, while three quarters or more are very concerned about mental illness/suicide among adults and youth as well as the opioid crisis, this compares with just under a quarter (23%) who hold the same view about HIV/AIDS.

B. General Knowledge of HIV

Health care practitioners express reasonably high overall levels of knowledge of HIV (86%), although most say they are somewhat (61%), rather than very knowledgeable (25%). Notably, just over one in ten practitioners (14%) are either not that knowledgeable (13%) or not at all knowledgeable (1%).

As was reported in Section B.B2, a higher proportion of nurses say they are knowledgeable about HIV relative to dentists/pharmacists (90% vs. 77%, respectively) – just under one third of nurses (30%) describe themselves as very knowledgeable, compared to just under one in five dentists/pharmacists (17%). This is also the case for those working in a hospital setting (94%) versus those in a community setting (82%).

There are no notable variations by gender or age. 

Region and Community Type

• While the number of respondents in some regions is quite small, as reported in Section B.B2, practitioners in Atlantic Canada are more likely to report being knowledge about HIV (100%) compared to those in Ontario (92%), British Columbia/North (89%), Alberta (78%), and Quebec (78%). There is no statistically significant difference relative to respondents in Manitoba/Saskatchewan (81%).
• Across community types, practitioners in smaller urban areas (with populations of 100,000 to under a million) are more likely as compared to those practicing in communities of less than 100,000 people to report being knowledgeable of HIV (92% vs. 79%, respectively).

In Section B.B2 it was reported that practitioners’ self-described knowledge of preventing HIV is relatively high – 94% are very (53%) or somewhat knowledgeable (41%). However, reported knowledge levels decline somewhat when it comes to testing for HIV – 82% are very (38%) or somewhat knowledgeable (44%) – and more dramatically in regard to treatments for HIV – 68% are very (15%) or somewhat knowledgeable (53%).  

Nurses are generally more likely to describe themselves as knowledgeable across the board:

• They are more likely to say they are very knowledgeable about preventing HIV (63%), compared to dentists/pharmacists (45%) and physicians (42%).
• Physicians and nurses alike are also more likely to report being knowledgeable about testing for HIV relative to dentists/pharmacists (92%; 88%; 60%, respectively).
• In regard to treating HIV, a higher proportion of dentists/pharmacists and nurses say they are knowledgeable compared to physicians (75%; 73%; 54%, respectively).

Demographics

• Compared to their male counterparts, a larger share of female practitioners report being very knowledgeable about the prevention (62% vs. 39%) and testing of HIV (46% vs. 27%).
• With respect to the age of practitioners, younger practitioners (under 45 years of age) are more likely to report being knowledgeable about treatments for HIV (75%) compared to those aged 45-54 years of age (60%).

Region and Community Type

• Health care practitioners working in Ontario are more likely than those located in Quebec to say they are very knowledgeable both about preventing (58% vs. 42%) and testing for HIV (44% vs. 22%).

C. Groups Viewed as Most at Risk of HIV

Respondents were asked to identify those groups which they feel are disproportionately affected by HIV in Canada. The following are most frequently mentioned by health professionals: people who inject drugs (82%), men who have sex with other men (78%), people from countries where HIV is widespread (77%), sex workers (73%) and people with multiple sexual partners (71%). About one third to just over half also mentioned people who already have another type of STBBI (54%), members of the African, Caribbean and Black (ACB) communities (42%), Indigenous Peoples (36%), and bisexuals (30%). Far fewer cited people with a blood disorder (16%), heterosexual women (13%) or men (10%), women who have sex with other women (8%), anyone (1%), or those having unprotected sex (<1%).

Nurses and physicians (34% each) mention bisexual people as being more at risk to a greater degree relative to pharmacists/dentists (17%). Physicians are more likely, as compared to nurses, to cite people who inject drugs (88% vs. 76%, respectively) and men who have sex with other men (88% vs. 73%, respectively). Relative to pharmacists/dentists, physicians are also more likely to identify people who have other sexually transmitted infections such as chlamydia, gonorrhea or syphilis as being disproportionately affected by HIV (66% vs. 42%).

There are also a few notable differences across professional settings. Those working in ‘other’ settings are more likely to identify:

• People who inject drugs (89%), as compared to health care practitioners working in a hospital setting (78%);
• Men who have sex with other men (89%), as compared to health care practitioners working in a hospital setting (77%);
• People who have another STBBI (79%), compared to health care professionals working in a community (55%), clinic (54%) or hospital (54%) setting; and
• Members of the ACB community (61%), relative to those working in a community setting (42%) or  hospital setting (34%).

Those in a community setting are more likely relative to those working in hospitals to mention Indigenous Peoples (44% vs. 32%, respectively).