HIV/AIDS Epi Update - May 2004
HIV Testing and Infection Reporting in Canada
Introduction
At A Glance
![](../../../gfx_common/bullet-sm.gif)
Nominal, non-nominal and anonymous HIV testing
is available in Canada.
![](../../../gfx_common/bullet-sm.gif)
Although anonymous testing may encourage testing,
it is not available in all provinces and territories.
![](../../../gfx_common/bullet-sm.gif)
HIV infection is notifiable in all provinces
and territories as of May 1, 2003.
There have been 18,934 AIDS cases reported to the Centre for
Infectious Disease Prevention and Control (CIDPC) between 1979 and
June 30, 2003, and 53,887 positive HIV tests reported between 1985
and the end of June 2003.1 The positive HIV test results
reported to CIDPC are from people who test positive for HIV through
nominal, non-nominal or anonymous testing in the provinces and
territories and whose results are reported to CIDPC by their
respective health authority or HIV testing laboratory.
This Epi Update summarizes the most current information
on the reporting of HIV infection in Canada, including the types of
HIV testing available and when HIV infection reporting became
notifiable in each province and territory. A notifiable disease is
one that is considered to be of such importance to public health
that its occurrence is required to be reported to public health
authorities. (The terms notifiable and reportable are used
interchangeably when discussing HIV/AIDS reporting in Canada.)
HIV Infection Becomes Notifiable Across
Canada
- As of May 1, 2003, HIV infection became legally notifiable in
all provinces and territories, therefore now both positive HIV test
reports and AIDS diagnoses are notifiable in all jurisdictions
across Canada.
- In most testing situations, laboratories and physicians are
responsible for reporting HIV infection, but this varies by
province or territory.
- When HIV infection is notifiable,
"nominal/name-based" or
"non-nominal/non-identifying" information about an
individual who tests positive for HIV infection is forwarded to
provincial or territorial public health officials. This includes
demographic data, such as the person's age and gender; risks
associated with the transmission of HIV; and laboratory data, such
as the date of the person's first positive HIV test.
- HIV infection is not legally notifiable at the national level,
yet notification to CIDPC is voluntarily undertaken by all
provinces and territories. Positive HIV test reports and reported
AIDS cases are provided non-nominally to CIDPC.
- HIV testing patterns within the general population, along with
the profile of people being tested, are important for designing and
targeting intervention programs2 and for developing a
context for HIV/AIDS surveillance data.
Three Types of HIV Testing Available in
Canada
Canadians choosing to be tested for the presence of HIV
infection may have three different testing options, depending on
the province or territory in which testing takes place:
- Nominal/name-based HIV testing
- May be carried out at numerous locations, including clinics and
the office of a health care provider.
- The person ordering the test knows the identity of the person
being tested for HIV.
- The HIV test is ordered using the name of the person being
tested.
- There is collection of patient information (such as age,
gender, city of residence, name of diagnosing health care provider,
country of birth); information detailing the HIV-related risk
factors of the person being tested; and laboratory data. The amount
of information collected is dependent upon the
province/territory.
- If the HIV test result is positive, the person ordering the
test is legally obligated to notify public health officials of the
positive test result.
- The test result is recorded in the health care record of the
person being tested.
- Non-nominal/non-identifying HIV testing
Similar to nominal/name-based testing on all points except
- The HIV test is ordered using a code or the initials of the
person being tested (not the full or partial name).
- Anonymous testing
- Usually available at specialized clinics, organized and
supported by public health departments, and by some health care
providers.
- The person ordering the HIV test does not know the identity of
the person being tested for HIV.
- The HIV test is carried out using a code. The person ordering
the HIV test and the laboratory carrying out the testing on the
blood sample do not know to whom the code belongs. Only the person
being tested for HIV knows the unique, non-identifying code.
- Information such as age, gender, HIV-related risk factors and
the ethnicity of the person being tested for HIV may be collected
during anonymous testing, depending on the province or territory in
which the test is ordered or on the test site.
- Test results are not recorded on the health care record of the
person being tested. It is only the person being tested who may
subsequently decide to give his or her name and include the HIV
test result in the medical record.
The types of HIV testing services available and HIV infection
reporting information across Canada are summarized in Table 1.
Table 1. HIV
testing and HIV reporting by province/territory |
Province/territory |
Type of HIV testing available |
Year in which HIV infection became
notifiable |
Responsibility for reporting of HIV
infection |
Type of testing reported to the province/
territory |
British Columbia |
N, NN, A |
2003 |
L, P |
N, NN* |
Yukon |
N, NN |
1995 |
P |
N |
Northwest Territories |
N, NN |
1988 |
L, P, RN |
N |
Nunavut |
N, NN |
1999 |
L, P, RN |
N |
Alberta |
N, NN, A |
1998 |
L, P |
NN |
Saskatchewan |
N, NN, A |
1988 |
L, P |
NN |
Manitoba |
NN |
1987 |
L, P |
NN |
Ontario |
N, NN, A |
1985 |
L, P |
N, NN* |
Quebec |
N, NN, A |
2002 |
L, P |
NN |
New Brunswick |
N, NN, A |
1985 |
L, P, RN |
NN |
Nova Scotia |
N, NN, A |
1985 |
L, P |
N, NN |
Prince Edward Island |
N, NN |
1988 |
L, P, RN |
N, NN |
Newfoundland and Labrador |
N, NN, A** |
1987 |
L, P |
N |
N = nominal/name-based
A = anonymous
P = physician |
NN =
non-nominal/non-identifying
L = laboratory
RN = nurse |
*In Ontario and British Columbia, data from positive HIV tests
completed by means of anonymous HIV testing (AHT) are reported
non-nominally at the provincial level.
**If someone tests positive for HIV through AHT, that individual
then becomes part of the nominal/ name-based system, in which
counselling, follow-up care and HIV data reporting are all done
nominally. |
The availability of anonymous HIV testing (AHT) may
increase testing
Information regarding the status of anonymous HIV testing in
Canada is summarized in Table 2.
Table 2.
Status of anonymous HIV testing (AHT) by
province/territory |
Province/territory |
Year in which AHT became available |
Number of AHT sites |
AHT data reported* |
Counselling services available |
British Columbia |
1985 |
Any physician's office |
Yes |
Yes |
Yukon |
- |
- |
- |
- |
Northwest Territories |
- |
- |
- |
- |
Nunavut |
- |
- |
- |
- |
Alberta |
1992 |
3 |
Yes |
Yes |
Saskatchewan |
1993 |
3 |
No |
Yes |
Manitoba |
- |
- |
- |
- |
Ontario |
1992 |
33 |
Yes |
Yes |
Québec |
1987 |
60+ |
No |
Yes |
New Brunswick |
1998 |
7 |
- |
Yes |
Nova Scotia |
1994 |
1 |
No |
Yes |
Prince Edward Island |
- |
- |
- |
- |
Newfoundland and Labrador |
** |
6 |
Yes† |
Yes† |
*Refers to whether or not data from positive HIV tests from AHT
are reported to the Centre for Infectious Disease Prevention and
Control, Canada.
**AHT is available upon request but is not part of the official
guidelines for the province.
†If someone tests positive for HIV infection through AHT,
that individual then becomes part of the nominal/name-based system,
in which counselling, follow-up care and HIV data reporting are all
done nominally. |
- An evaluation study of AHT in Ontario suggested that AHT
provides testing to populations that are not otherwise accessing
it.4
- Several studies in the USA have shown that AHT programs
encourage people to be tested for HIV infection, especially those
at high risk or those who would not volunteer for testing under
nominal/name-based or non-nominal/ non-identifying
circumstances.5-7
- Interviews of 835 patients with newly diagnosed AIDS in the USA
revealed that the availability of anonymous testing was associated
with testing closer to the time of HIV infection and, thus, earlier
access to medical care.8
- In Ontario, the proportion of HIV testing done anonymously has
remained steady since 1992, at approximately 4%.9
- In Quebec, between 1994 and 1998, over 45% of the anonymous
test users declared that the anonymity of the test was one of their
primary reasons for getting tested.10
Comment
HIV infection is now legally notifiable in all provinces and
territories; however, each has a different practice for reporting
HIV infection. Legislation of HIV infection reporting in all
Canadian provinces and territories may increase the number of tests
received at CIDPC. A change to mandatory reporting of HIV infection
in Alberta in 1998 resulted in a significant increase in HIV tests
among both men and women.11 As a result, having HIV
notifiable across Canada should allow for the collection of more
complete epidemiological data as well as enable more accurate and
timely monitoring of the HIV epidemic.
All provinces and territories in Canada offer at least one of
three forms of HIV testing: 1) nominal/name-based, 2)
non-nominal/non-identifying, and/or 3) anonymous testing. At
present, nominal/name-based and non-nominal/non-identifying HIV
testing is widely available in Canada; however, anonymous HIV
testing is available in only eight provinces. Increased
availability and accessibility to different types of HIV testing
may allow individuals to choose the testing and counselling
environment in which they feel most comfortable, thereby
encouraging more people to be tested and facilitating the targeting
of intervention and treatment programs.12
References
- Health Canada.
HIV and AIDS in Canada:
surveillance report to June 30, 2003. Surveillance and
Risk Assessment Division, Centre for Infectious Disease Prevention
and Control, Health Canada, 2003.
- Houston S, Archibald CP, Strike C, Sutherland D.
Factors associated with HIV testing among Canadians:
results of a population-based survey. Int J STD AIDS
1998;9:341-46.
- Jürgens R, Palles M.
HIV testing
and confidentiality: a discussion paper. Canadian HIV/AIDS
Legal Network and the Canadian AIDS Society, 1997: 52-69.
- Ontario Ministry of Health.
Anonymous
HIV testing evaluation: January 1992 to June 1993. Toronto: AIDS Bureau, Ontario Ministry of Health, November
1994.
- Keagles SM, Catania JA, Coates TJ et al.
Many people who seek anonymous HIV-antibody testing would
avoid it under other circumstances. AIDS
1990;4(6):585-88.
- Hoxworth T, Hoffman R, Cohn D et al.
Anonymous HIV testing: does it attract clients who would
not seek confidential testing? AIDS Public Policy J
1994;9(4):182-88.
- Hertz-Picciotto I, Lee LW, Hoyo C.
HIV
test-seeking before and after the restriction of anonymous testing
in North Carolina. Am J Public Health
1996;86(10):1446-50.
- Bindman AB et al.
Multistate evaluation
of anonymous HIV testing and access to medical care. JAMA
1998;280(16); 1416-20.
- Remis RS, Swantee C, Rottensten K et al.
Report on HIV/AIDS in Ontario 2002.
November 2003. .
- Ministère de la santé et des services sociaux du
Québec.
Le dépistage
anonyme du VIH, 2001.
- Jayaraman GC, Preiksaitis JK, Larke B. Mandatory reporting
of HIV infection and opt-out prenatal screening for HIV infection:
effect on testing rate. Can Med Assoc J
2003;168(6);679-82.
- Hong BA, Berger SG. Characteristics of individuals using
different HIV/AIDS counseling and testing programs. AIDS
1994;8:259-62.
[Back] [Table of Contents] [Next]