Since the publication of the Canada Youth and AIDS Study (CYAS) in 1989, there have been no national studies which focus specifically on the sexual health of adolescents. The Canadian Youth, Sexual Health and HIV/AIDS Study (CYSHHAS), coordinated by the Council of Ministers of Education, Canada, (CMEC) and funded by Health Canada under the Canadian Strategy on HIV/AIDS attempts to fill that void by providing a contemporary picture of the sexual behaviour of adolescents. It was designed to determine the factors that influence youth sexual health, with regards to HIV/AIDS prevention and behaviours.

The CYSHHAS surveyed more than 11,000 students from across Canada in grades 7, 9 and 11 in the 2002 school year. The final report of this survey will be released by CMEC in the fall of 2003 and will be made available at www.http://www.cmec.ca/index.en.html .

Some of the preliminary CYSHHAS results include:

The proportion of students engaging in sexual activities is similar to those reported by the 1989 CYAS, in terms of sexual behaviour.
Slightly fewer students, notably boys, indicate that they have had sexual intercourse, compared to the 1989 CYAS.
A decrease in youth's feelings of susceptibility to HIV/AIDS since 1989. Only a few students in this study indicated they were not having sexual intercourse because of potential negative health outcomes such as fear of pregnancy, contracting HIV/AIDS or other Sexually Transmitted Infections (STIs).
One-half of grade 9 students do not know that there is no cure for AIDS.
Responses across all three grades indicate an increase in respect for the basic human rights of those living with HIV/AIDS, compared to the 1989 results.
Almost half of Grade 9 and 11 girls in the study who were sexually active and had been pregnant reported having had four or more sexual partners.
In general, heterosexual youth reported more positive attitudes toward condom use than did homosexual or bisexual students. In particular, only homosexual or bisexual Grade 11 male students indicated less intention to use condoms.
In relation to education, almost half of students across all grades had received either none or only one or two hours of instruction about HIV/AIDS over the last two years.
Almost three-quarters of students and two-thirds of grade 11 girls had used a condom at last intercourse. Over one-quarter of students had used both a condom and the birth control pill at last intercourse.
There is suggestion that peers can be a support system, particularly for girls who largely identified their friends as a first source for advice if they thought they had a STI.

For more information on the report, contact Shane Rhodes, Program Consultant, at Shane_Rhodes@hc-sc.gc.ca . The executive summary of the report is available at www.aidsida.com , and the full report can be viewed on the Council of Ministers of Education, Canada's Web site at www.cmec.ca/index.en.html .

Developing a National Risk Behaviour Surveillance System for Injecting Drug Users

Injection Drug Users (IDU) are at risk of acquiring HIV and other infections through contaminated injecting equipment and unsafe sexual practices. Although several ongoing regional studies in Canada collect risk behaviour data on IDU, and a number of one-time surveys on risk-taking among IDU has been conducted, it is challenging, if not impossible, to compare levels of risk behaviours over time and develop a picture at national level.

A HIV- and hepatitis C (HCV)- associated risk behaviour surveillance system is being established by Health Canada at selected centres across Canada through collaboration with provincial Ministries of Health, regional health authorities, community stakeholders, and researchers. A feasibility study for development of such a surveillance system was undertaken in October/November, 2002, in Regina, Victoria, Sudbury and Toronto; linkages were also made with IDU studies in Quebec and Ottawa. A meeting was held in March, 2003, to discuss the pilot study results and a report is currently under production.

The surveillance survey is planned to be conducted on an annual basis. This surveillance system will track HIV- and hepatitis C (HCV) - associated risk behaviour in IDU populations in various centres across Canada. This will provide critical information for those involved in planning and evaluating the response to HIV/HCV among IDU. Through such a system, national, and to a certain extent, provincial and local trends in injecting and sexual risk behaviours can be assessed. Further, behavioural trend data will enhance existing national surveillance data and national incidence and prevalence estimates in monitoring the course of the HIV and HCV epidemics among IDU. Such data can also be used in combination with other data sources to assess the effects of prevention efforts and policies at the national, provincial, and to a certain extent, the local level. The first phase of the study will be undertaken at selected centres across Canada in Fall, 2003.

HIV and AIDS in Canada: Surveillance Report to December 31, 2002 is now available

Positive HIV Tests

Since HIV testing began in Canada in 1985, there have been 52,640 positive HIV tests reported to Health Canada's Centre for Infectious Disease Prevent and Control (CIDPC). Of these, 2,473 were reported in 2002, a 17% increase from the number of positive tests reported in 2000. There had been almost a 30% decrease in the number of tests reported annually over a 5-year period in the years leading up to 2000. The recent increase could be due to a combination of factors such as increased reporting, increased testing and/or increased HIV infection rates. However, at least part of the increase can be attributed to Citizenship and Immigration Canada's new policy on HIV testing from immigrants and refugees.

Women accounted for 25.4% of the positive reports in 2002, and represented a gradually increasing proportion of reports. The greatest proportion of positive HIV test reports continued to be in the men who have sex with men (MSM) exposure category, at 41.5%, while the heterosexual category accounted for 29.8% of the positive reports among adults in 2002. The heterosexual category includes those individuals from countries where HIV is endemic, those having heterosexual contact with a person at risk, and those for whom heterosexual contact was the only identified risk. They represented 6.6%, 13.3% and 9.9% of the 2002 total respectively. The proportion of positive reports attributed to injecting drug use (IDU) was 23.6% in 2002. It is important to be cautious when interpreting exposure category data because of underreporting, missing data and the potential for misclassification due to insufficient information.

Perinatal HIV Surveillance Data

The number of HIV-exposed infants reported per birth-year increased steadily from 54 infants in 1990 to 158 in 2002. However, the proportion of infants confirmed to be HIV infected decreased from 50% (27/54) in 1991 to 2% (3/148) in 2002.

Reported AIDS Cases

Since the beginning of the epidemic in the early 1980's, there have been 18,469 AIDS cases reported to CIDPC. In 2002, women accounted for 18.2% of these, and overall represented a slowly increasing proportion of reported AIDS cases.

The proportion of reported adult AIDS cases in the MSM exposure category was 39.2%, representing the largest category. The proportion of cases in the combined heterosexual category was 35.3% in 2002 (54 out of 171 cases among adults). The majority of these cases (28 out of 54) were in people from countries where HIV is endemic. IDU represented 22.2% of reported AIDS cases in 2002.

Mortality Among Reported AIDS Cases

Between 1979 and December 2002, CIDPC received notification of 12,674 deaths among reported AIDS cases. The annual number of deaths increased from the beginning of record keeping to 1994, when the number of deaths reported was 1,481. There has been a dramatic decrease in deaths since that time – 158 deaths among reported AIDS cases were reported in 2001, and 61 cases were reported in 2002.

Notes:
Reported AIDS cases and positive HIV test reports are assigned to a single exposure category according to a hierarchy of HIV-related risk factors reported by the patient in consultation with their physician. The number of reported AIDS cases or positive HIV test reports in an exposure category is based on the risk information provided.

National level HIV and AIDS surveillance is possible as a result of all provinces and territories participating in, and setting directions for, HIV and AIDS surveillance. CIDPC acknowledges the provincial/territorial HIV/AIDS coordinators, laboratories, health care providers and reporting physicians for sharing non-nominal, confidential data for national surveillance.