HIV and AIDS in Canada

Surveillance Report to December 31, 1999

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Information to the readers of HIV and AIDS in Canada

The Division of HIV/AIDS Surveillance of the Bureau of HIV/AIDS, STD and TB at the Laboratory Centre for Disease Control (LCDC), Health Canada, is pleased to provide you with the HIV and AIDS Surveillance Report to December 31, 1999.

This report reveals two developing trends that we would like to bring to your attention. First, the decline in the annual number of delay-adjusted AIDS cases that started in 1995 is continuing, but the rate of decline has slowed noticeably and the curve in now leveling off. Reasons for this are not yet clear, but may include issues such as the development of resistance to antiretroviral drugs, whether therapy can prevent or only postpone the development of AIDS, and the number of individuals who are diagnosed with AIDS without a prior diagnosis of HIV infection.

The second trend to note is the increase in the proportion of Aboriginal persons among AIDS case, from 3.4% in 1995 to 7.1% in 1997 and to 14.4% in 1999. This trend is worrisome and is further corroborated by HIV testing and prevalence data presented in our April 2000 Epi Update series.

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. Accordingly, the Bureau of HIV/AIDS, STD and TB would like to acknowledge the contributions of all provinces and territories in Canada towards the production of this report. Without their close collaboration and participation in HIV and AIDS surveillance, the report would not have been possible.

The Division of HIV/AIDS Surveillance is continually working towards improving the report to reflect changing HIV disease surveillance requirements. We welcome and appreciate your comments and suggestions.

Yours sincerely,

Dr. Don Sutherland, MD, MComm H, MSc (Epi) Director Bureau of HIV/AIDS, STD and TB

Dr. Ping Yan, BSc, MMath, PhD Chief, Division of HIV/AIDS Surveillance Bureau of HIV/AIDS, STD and TB

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Table of Contents

Commentary on Surveillance of Positive HIV Test Reports and AIDS Diagnoses
TECHNICAL NOTES: Positive HIV Test Reports and AIDS Case Reports in Canada
SECTION I HIV in Canada: Positive HIV Test Reports to December 31, 1999
Table 1.	Number of positive HIV test reports occurring between November 1, 1985, and December 31, 1999, by year of test, Canada, and reported to LCDC up to February 25, 2000
Table 2.	Cumulative number of positive HIV test reports occurring in adults and children between November 1, 1985, and December 31, 1999, by gender, Canada, and reported to LCDC up to February 25, 2000
Table 3A.	Number of positive HIV test reports among males between November 1, 1985, and December 31, 1999, by age group and year of test, Canada, and reported to LCDC up to February 25, 2000
Table 3B.	Number of positive HIV test reports among females between November 1, 1985, and December 31, 1999, by age group and year of test, Canada, and reported to LCDC up to February 25, 2000
Table 3C.	Number of positive HIV test reports between November 1, 1985, and December 31, 1999, by age group and year of test, Canada, and reported to LCDC up to February 25, 2000
Table 4A.	Number of positive HIV test reports among adult males between November 1, 1985, and December 31, 1999, by exposure category and year of test, Canada, and reported to LCDC up to February 25, 2000
Table 4B.	Number of positive HIV test reports among adult females between November 1, 1985, and December 31, 1999, by exposure category and year of test, Canada, and reported to LCDC up to February 25, 2000
Table 4C.	Number of positive HIV test reports among adults between November 1, 1985, and December 31, 1999, by exposure category and year of test, Canada, and reported to LCDC up to February 25, 2000
Table 4D.	Number of positive HIV test reports among children between November 1, 1985, and December 31, 1999, by exposure category and year of test, Canada, and reported to LCDC up to February 25, 2000
Table 4E.	Number of positive HIV test reports between January 1, 1998, and December 31, 1999, by exposure category and age group, Canada, and reported to LCDC up to February 25, 2000
Table 5A.	Total number of positive HIV test reports between November 1, 1985, and December 31, 1999, by province/territory and gender, Canada, and reported to LCDC up to February 25, 2000
Table 5B.	Number of positive HIV test reports between November 1, 1985, and December 31, 1999, by province/territory and year of test, Canada, and reported to LCDC up to February 25, 2000
Table 6.	Number of positive HIV test reports between January 1, 1998, and December 31, 1999, by exposure category and province/territory, Canada, and reported to LCDC up to February 25, 2000
SECTION II AIDS in Canada: AIDS Surveillance to December 31, 1999
Table 7.	Number of AIDS cases diagnosed up to December 31, 1999, by year of diagnosis, Canada, reported to LCDC up to February 25, 2000, and adjusted for reporting delay
Figure 1.	Number of AIDS cases diagnosed up to December 31, 1998, by year of diagnosis, Canada, reported to LCDC up to February 25, 2000, and adjusted for reporting delay
Table 8.	Number and cumulative total of adult AIDS cases diagnosed up to December 31, 1999, by year of diagnosis and gender, Canada, and reported to LCDC up to February 25, 2000
Table 9.	Number of pediatric and adult AIDS cases diagnosed up to December 31, 1999, by gender, Canada, and reported to LCDC up to February 25, 2000
Table 10A.	Number of male AIDS cases diagnosed up to December 31, 1999, by age group and year of diagnosis, Canada, and reported to LCDC up to February 25, 2000
Table 10B.	Number of female AIDS cases diagnosed up to December 31, 1999, by age group and year of diagnosis, Canada, and reported to LCDC up to February 25, 2000
Table 10C.	Number and percentage distribution of all cases of AIDS diagnosed up to December 31, 1999, by age group and year of diagnosis, Canada, and reported to LCDC up to February 25, 2000
Table 11A.	Number and percentage distribution of adult male cases of AIDS diagnosed up to December 31, 1999, by exposure category and year of diagnosis, Canada, and reported to LCDC up to February 25, 2000
Table 11B.	Number and percentage distribution of adult female cases of AIDS diagnosed up to December 31, 1999, by exposure category and year of diagnosis, Canada, and reported to LCDC up to February 25, 2000
Table 11C.	Number and percentage distribution of adult cases of AIDS diagnosed up to December 31, 1999, by exposure category and year of diagnosis, Canada, and reported to LCDC up to February 25, 2000
Table 11D.	Number and percentage distribution of pediatric cases of AIDS diagnosed up to December 31, 1999, by exposure category and year of diagnosis, Canada, and reported to LCDC up February 25, 2000
Table 11E.	Total number of AIDS cases diagnosed up to December 31, 1999, by exposure category and age group, Canada, and reported to LCDC up to February 25, 2000
Table 12A.	Number and male:female ratio of AIDS cases diagnosed up to December 31, 1999, by province/territory and gender, Canada, and reported to LCDC up to February 25, 2000. 27
Table 12B.	Number of male AIDS cases (all ages) diagnosed up to December 31, 1999, by province/territory and year of diagnosis, Canada, and reported to LCDC up to February 25, 2000
Table 12C.	Number of female AIDS cases (all ages) diagnosed up to December 31, 1999, by province/territory and year of diagnosis, Canada, and reported to LCDC up to February 25, 2000
Table 12D.	Total number of AIDS cases (all ages) diagnosed up to December 31, 1999, by province/territory and year of diagnosis, Canada, and reported to LCDC up to February 25, 2000
Table 13.	Number and percentage distribution of all AIDS cases diagnosed up to December 31, 1999, by province/territory and exposure category, Canada, and reported to LCDC up to February 25, 2000
Table 14.	Number and percentage distribution of all AIDS cases diagnosed up to December 31, 1999, by ethnic status, Canada, and reported to LCDC up to February 25, 2000
Table 15.	Number and cumulative total of deaths due to AIDS up to December 31, 1999, by year of death, Canada, and reported to LCDC up to February 25, 2000
SECTION III International Statistics AIDS
Appendix 1. Instructions for using Faxlink
Appendix 2. Data Sources

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Commentary on Surveillance of Positive HIV Test Reports and AIDS Diagnoses

Reported Positive HIV Tests
A cumulative total of 45,534 positive HIV tests were reported in Canada up to December 31, 1999, and reported to the Bureau of HIV/AIDS, STD and TB, LCDC, by February 25, 2000.

In the twelve-month period from January to December 1999, a total of 2,231 positive HIV tests (with duplicates removed to the degree possible) were reported. In previous years, there were 2,330 positive HIV test reports in 1998 compared with 2,537 in 1997, 2,783 in 1996 and 2,989 in 1995.

Positive HIV test reports among women
As of December 31, 1999, adult women account for 13.0% of cumulative positive HIV test reports for which age and gender are known. The proportion of positive HIV test reports among adult women is increasing. In 1999, adult females accounted for 24.3% (512/2106) of positive HIV tests among all adults. In 1998, 21.7% of all adult positive test reports for which gender was known were among women. In 1997, the corresponding figure was 19.8%.

Positive HIV test reports among heterosexuals
There is an increase in positive HIV reports attributable to heterosexual sexual contact. In 1999, 19.4% (216/1114) of all positive HIV tests among adults for which exposure category was known were attributable to heterosexual contact. In 1998, this exposure category accounted for 17.2% of positive HIV test reports; the proportion during 1985-1994 was 6.2%.

Positive HIV test reports among injection drug users
The proportion of positive HIV reports has also increased among injection drug users, from 8.9% (of all adult positive HIV test reports for which exposure category was known) during 1985-1994 to 29.8% in 1995 and 33.0% in 1997 (Table 4C). For 1998 and 1999, the proportion of positive HIV test reports in this exposure category declined slightly to 28.4% and 28.3%, respectively.

Positive HIV test reports among men who have sex with men
In contrast, men who have sex with men account for a decreasing proportion of the positive HIV test reports: 74.7% of reports for which exposure category was indicated during 1985-1994 as compared with 44.3% in 1995, 37.0% in 1998 and 37.1% in 1999 (Table 4C).

Reported AIDS Diagnoses
A cumulative total of 16,913 AIDS cases were diagnosed in Canada up to December 31, 1999, and reported to the Bureau of HIV/AIDS, STD and TB, LCDC, by February 25, 2000; 16,717 were adults and 196 children (<15 years).

Delay-adjusted AIDS cases
Since 1995, the number of delay-adjusted AIDS cases per year has been decreasing (Figure 1), probably due at least in part to the new antiretroviral treatments. Since 1997, however, this rate of decline has slowed and the curve is beginning to level off.

Reported AIDS cases among women
From the beginning of the epidemic to the end of the current reporting period, 8.0% of all reported AIDS cases (where age and gender are known) were among females and 7.4% were among adult women. In 1999, the percentage of AIDS cases diagnosed among adult women was 16.3% (41/252).

Reported AIDS Deaths
There has been a cumulative total 11,748 AIDS-related deaths reported (69.5% of all reported AIDS cases), although this is likely an underestimate due to reporting delays and an unknown degree of underreporting.

From highs exceeding 1,400 reported AIDS deaths per year in 1994 and 1995, there were only 249 and 106 AIDS deaths reported in 1998 and 1999, respectively. This is a dramatic difference, even taking into account that these numbers are not adjusted for reporting delay.