Canada's Report on HIV/AIDS 2005

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A New Beginning: Launching the Next Phase of Canada's HIV/AIDS Response

HIV/AIDS is a disease that knows no boundaries - geographic, socio-economic, gender, age or otherwise. Although the epidemic is most entrenched and virulent among target populations in the developing world, it can and does reach into the most privileged groups in western society. Although HIV infection is preventable, the virus continues to spread at an alarming rate. Despite treatment advances, there is no vaccine or cure, and AIDS remains deadly. Fuelled by stigma and discrimination, wherever it strikes, HIV/AIDS leaves a trail of distress and suffering, lost potential and premature death, social strife and upheaval, loss of human rights and economic devastation.

The Global Epidemic Continues to Grow

Global action to combat HIV/AIDS has improved dramatically since the adoption of the UNGASS Declaration of Commitment in June 2001.¹ As a result of strengthened political commitment, HIV/AIDS prevention and treatment efforts are increasing in many countries. Despite encouraging signs of progress, however, the overall global epidemic continues to expand, with dire consequences.

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), the number of people living with HIV has now reached its highest level ever.² Almost 5 million people became newly infected in 2004 alone, bringing the total number of people living with HIV/AIDS worldwide to close to 40 million. The greatest increases in HIV infections are occurring in East Asia, Eastern Europe and Central Asia. Nevertheless, sub-Saharan Africa remains the world's most-affected region, accounting for more than 60 per cent of all people living with HIV, even though it is home to just over 10 per cent of the world's population.

More than 8 000 people die every day from AIDS-related conditions. About 76 per cent of the 3 million people killed by AIDS in 2004 lived in sub-Saharan Africa, and 18 per cent in Asia. In the Caribbean, AIDS has become the leading cause of death among people aged 15 to 44 years. It was the number one cause of death in 2001 for African American women aged 25 to 34. The World Health Organization (WHO) reports that AIDS is among the top conditions causing death in children under five years of age. In some countries, it may account for as many as 50 per cent of deaths in this age group.

Women now account for almost half (47 per cent) of all people living with HIV worldwide and for 57 per cent of infected individuals in sub-Saharan Africa. According to UNAIDS, young women and girls are particularly vulnerable to HIV/AIDS in the global context due to factors such as inadequate knowledge of AIDS, insufficient access to HIV prevention services, inability to negotiate safer sex, and a lack of female-controlled HIV prevention methods. In many parts of the world, women also do not enjoy the same rights and access to employment, property and education as men. Women and girls are more likely to face sexual violence, which can accelerate the spread of HIV.

Adolescents and young adults (aged 15 to 24) also appear to be at particular risk of HIV infection, due in part to their increased likelihood to engage in risky sexual behaviours and injection drug use (IDU). One half of new infections worldwide occur among this age group. Children are also being ravaged by the disease. Globally, an estimated 2.2 million children under 15 years of age are living with HIV, the vast majority of them infants who contracted HIV during gestation or delivery or as a result of breastfeeding. More than half a million HIV/AIDS-related deaths in 2004 were in this age group. Millions more children have lost one or both parents to the epidemic, with no signs of a slowing or reversal of this trend in sight.

The continued growth in HIV infections can be attributed in large part to the lack of basic prevention services in many countries. According to UNAIDS, in 2004 only 20 per cent of people who needed HIV prevention worldwide had access to these services, and only 10 per cent of people living with HIV had been tested for the virus.

HIV/AIDS treatment is also inadequate in many parts of the world. The latest report from UNAIDS and the WHO on the 3 by 5 Initiative indicates that, despite significant progress, the goal of providing antiretroviral drug treatments to 3 million people living with HIV/AIDS in developing countries by the end of 2005 will likely not be met.

"Stop AIDS. Keep the Promise" is the theme of the 2005 World AIDS Campaign. It challenges the world community to fulfill the commitments set out in the UNGASS Declaration of Commitment, including implementing prevention campaigns, reducing stigma, building health systems, providing necessary resources, and ensuring treatment, care and respect for people living with HIV/AIDS. Canada is determined to do its part.

Troubling Trends in the Canadian Epidemic

Although HIV/AIDS has taken root in Canada to a much lesser degree than in many other parts of the world, the domestic epidemic is serious and is growing in magnitude and complexity. A number of troubling trends are emerging.

Updated surveillance data released by the Public Health Agency of Canada (PHAC) in April 2005 reveal that a total of 57,674 positive HIV tests were reported to PHAC between November 1985, when reporting began in Canada, and December 31, 2004.³ The number of positive HIV test reports has increased by 20 per cent over the past five years, from 2,111 in 2000 to 2,529 in 2004. (This increase may be partly attributed to changes in immigration policies, including the introduction in 2002 of HIV screening of immigrants). The new surveillance data also reveal that a total of 19,828 AIDS diagnoses in Canada had been reported to the end of 2004 (however, data were not available from Quebec for 2004).

Although surveillance data provide a snapshot of persons who have been diagnosed with HIV and AIDS in Canada, they understate the magnitude of the HIV epidemic since they do not tell us about persons who have not been tested and diagnosed. In fact, PHAC estimates that 56 000 people in Canada were living with HIV infection at the end of 2002 (the latest year for which estimates are available) - a 12 per cent increase from estimates in 1999. PHAC further estimates that 17 000 (or 30 per cent) of these individuals were unaware of their infection (commonly referred to as the "hidden" epidemic).

Men who have sex with men (MSM) continue to be the group most affected in Canada, accounting for an estimated 58 per cent of all HIV infections, followed by injection drug users at 20 per cent.⁴ Aboriginal persons account for a disproportionately high number of HIV infections in Canada. As well, the epidemic is growing among women of all age groups. Disproportionate rates of infection have also been noted among persons in Canada who were born in a country where HIV is endemic (mainly countries of sub-Saharan Africa and the Caribbean).

A New Era in Canada 's HIV/AIDS Response

Canada has made important progress in addressing the domestic epidemic. Nevertheless, significant challenges remain, and efforts must be enhanced to reduce stigma and discrimination, achieve better health outcomes for Canadians, save lives and mitigate the long-term impact of HIV/AIDS.

As our understanding of the causes and impacts of the epidemic improves, Canada's response to HIV/AIDS continues to evolve. Over the past year, a new, more strategic approach has taken shape through two distinct but interconnected initiatives.

Following widespread consultation with people across the country, Canada's HIV/AIDS community has issued a call for action on HIV/AIDS. Leading Together: Canada Takes Action on HIV/AIDS 2005-2010 sets out an ambitious, coordinated nation-wide approach to tackling HIV/AIDS and the underlying health and social issues that contribute to the epidemic, so that "By 2010, the end of the epidemic is in sight." ⁵

Developed with the support of PHAC, Leading Together lays out the "optimal, ideal response" to HIV/AIDS in Canada. It promises to continue and strengthen the broad, multi-sectoral model of action on HIV/AIDS that has evolved in Canada over the past two decades. To that end, a "championing group" is being formed as a mechanism for encouraging its use in Canada.

Leading Together points to a new beginning for Canada's HIV/AIDS response, with federal leadership as a cornerstone of the way forward. To fulfill this leadership role and ensure a greater federal contribution to the pan-Canadian approach envisioned in Leading Together, the Government of Canada has renewed its own framework for dealing with the epidemic and has increased federal funding for HIV/AIDS (to $84.4 million annually by 2008-2009 from $42.2 million in 2003-2004).

This renewed framework - the Federal Initiative to Address HIV/AIDS in Canada - was announced by the Minister of Health on January 13, 2005. The Federal Initiative is an evolution from the Canadian Strategy on HIV/AIDS (CSHA). It builds on recommendations from the Standing Committee on Health, lessons learned from past federal HIV/AIDS strategies, and consultations with stakeholders, provinces and territories, all of which pointed the way to needed shifts in the federal response.

The Federal Initiative is distinct from but will contribute to the broader comprehensive and integrated response called for in Leading Together. Through the Federal Initiative, which is described in further detail in the next section of this report, the Government of Canada will continue to lead efforts to fight HIV/AIDS in Canada and around the world.

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1. The Declaration of Commitment was adopted by member states at the United Nations General Assembly Special Session (UNGASS) in New York from June 25 to 27, 2001 - the first time the United Nations General Assembly had convened a special session on a health issue.
2. Global Facts and Figures Fact Sheet, 22/7/2005, UNAIDS (www.unaids.org).
3. Prior to the creation of PHAC in September 2004, positive HIV test results and AIDS diagnoses were reported to Health Canada. Unless otherwise noted, all domestic epidemiological and surveillance data presented in this report have been provided by PHAC.
4. For the purposes of surveillance, terms such as MSM, injection drug useIDU and heterosexual contact are used to characterize exposure categories, or the most likely way a person became infected with HIV.
5. For the full text of Leading Together: Canada Takes Action on HIV/AIDS 2005-2010, visit www.leadingtogether.ca.