HIV/AIDS Communiqué - Volume 3 Number 1 - Spring 2004

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National HIV Prevalence and Incidence Estimates for 2002

The Centre for Infectious Disease Prevention and Control has produced estimates of HIV prevalence to the end of 2002 and HIV incidence in 2002. These estimates were produced using a combination of methods, incorporating data from a wide variety of sources, including HIV test reports, AIDS case reports, population-based surveys, targeted epidemiological studies and census data. It was estimated that at the end of 2002 there were approximately 56,000 people (with a range of 46,000 to 66,000) in Canada living with HIV (includes those living with AIDS) and 2,800-5,200 newly infected with HIV in 2002. Furthermore, of the 56,000, an estimated 17,000 Canadians or 30% were living with HIV but were unaware that they were infected and are consequently not represented in the HIV surveillance data. Further information on the methodology and results of these estimates can be found in the Canadian Communicable Disease Report, 2003 (Geduld J, Gatali M, Remis RS, Archibald CP. Estimates of HIV prevalence and incidence in Canada, 2002. Canadian Communicable Disease Report, 2003;29:197-206.), or on the following website in May 2004: http://www.phac-aspc.gc.ca/ publicat/epiu-aepi/index-eng.php

Developing a National Enhanced Risk Behaviour Surveillance System for injecting drug users in Canada (I-Track) and men who have sex with men

In response to a need for ongoing monitoring of HIV prevalence and incidence rates as well as risk behaviours among injecting drug user (IDU) populations across the country, an HIV and hepatitis C (HCV)-associated risk behaviour enhanced surveillance system (I-Track) is being established by Health Canada at sentinel centres across Canada through collaboration with provincial, regional and local health authorities, community-based organizations and researchers. A pilot study of the I-Track surveillance system was undertaken between October 2002 and March 2003 in which a total of 794 IDU were surveyed in Victoria, Regina, Sudbury and Toronto; linkages are also being made with the SurvUDI study in Quebec. A report on the findings of the pilot phase is soon to be released. Phase one of the survey was completed at one sentinel centre in fall 2003, and is scheduled in other centres in spring and summer 2004. The establishment of the I-Track Survey will permit the tracking of injecting and sexual risk behaviours over time and will provide important trend data that could be used to inform prevention program design and would help evaluate program effectiveness. Such behavioural data could also be used to interpret changes in HIV prevalence and incidence among IDU and would serve as an early warning system for HIV spread in this population.

Since the mid-1990s, the use of highly active antiretroviral therapies (HAART) has significantly delayed death and serious morbidity from HIV infection. The growing optimism among men who have sex with men (MSM) about HIV treatment, coupled with "prevention fatigue" has been postulated to be associated with a rise in risk behaviour. Recent data suggest that MSM continue to be at risk for HIV infection and other sexually-transmitted infections (STIs) by engaging in risky sexual behaviour, such as unprotected anal intercourse. This hypothesis highlights the need to monitor the HIV- and STI-associated risk behaviour more closely in order to enhance reportable disease surveillance systems and to better guide prevention and care programs.

An HIV-, hepatitis C (HCV)-, and STIs-associated risk behaviour surveillance system is being established by Health Canada at sentinel centres across Canada through collaboration with regional health authorities, community stakeholders, and researchers. This enhanced surveillance system will track risk behaviour among MSM in urban and semi-urban centres and will provide critical information about trends in sexual risk behaviours for those involved in planning and evaluating the response to HIV, HCV and STIs among MSM. Further, behavioural trend data will enhance existing national surveillance data and national incidence and prevalence estimates in monitoring the course of the HIV epidemic among MSM. The data can also be used in combination with other data sources to assess the effects of prevention efforts and policies at the national and provincial levels.

A Health Canada-led working group has developed the draft survey protocol instrument for the surveillance system. Discussions are ongoing with provincial authorities and interested stakeholders to establish pilot sites and further refine methodological details. The pilot phase of the survey is likely to be undertaken in late summer/early fall in 2004 at selected centres.

For more information, please contact Yogesh Choudhri at Yogesh_Choudhri@hc-sc.gc.ca .

Leading Together: An HIV/AIDS Action Plan for All Canada, 2004-2008

Results of consultations on the draft Strategic Plan for HIV/AIDS, entitled "Leading Together: An HIV/AIDS Action Plan for All Canada 2004-2008," are now being compiled. Consultations have been underway since November, 2003, and included face to face multi-stakeholder sessions, focus groups with people living with HIV/AIDS (PHA's), vulnerable populations and specific stakeholder groups, as well as telephone conversations and written solicitations. Health Canada has led consultations with federal, provincial and territorial government officials. Once all input is compiled, the Steering Committee will convene to consider the feedback and develop a final version of the document. (The target for finalization is the end of June, 2004)

The HIV/AIDS Action Plan for All Canada originated at large-scale direction-setting meetings held in Grey Rocks and Montreal. Participants requested that a broad, strategic HIV/AIDS plan, with specific, measurable targets, be developed. Stakeholders have been involved in the development and consultation of the draft. It is hoped that, once final, the plan will serve as a useful tool to guide and align Canada's response to HIV/AIDS.

For further information, contact Fernand Comeau, Policy Analyst, in the HIV/AIDS Policy, Coordination and Programs Division, at fernand_comeau@hc-sc.gc.ca .

The Canadian HIV Vaccines Plan

On December 4 and 5, 2003, Health Canada convened a second round table on a Canadian plan for the development and equitable distribution of HIV vaccines. An expanded expert panel included representation from Health Canada, other Government of Canada departments, HIV/AIDS community organisations, and the scientific research community. Presentations were made by each sector on new developments and potential incentives in the HIV vaccine field. After two days of discussion, the round table accomplished the following:

• modified a draft outline for the Plan
• committed to the complementarity of microbicide planning
• achieved consensus on Plan vision and principles
• established a critical path for the drafting of the Plan.

A Steering Committee with representation from Canadian community organisations, the scientific research community, PHAs, federal -provincial immunization agencies, and international vaccine initiatives has been meeting since January, 2004, and is currently overseeing the drafting of the Plan.

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