HIV/AIDS Epi Update - May 2004

HIV Testing and Infection Reporting in Canada

Introduction

At A Glance

Nominal, non-nominal and anonymous HIV testing is available in Canada.

Although anonymous testing may encourage testing, it is not available in all provinces and territories.

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:

1. 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.
      
2. 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).
      
3. 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.

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.

• 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

1. 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.
2. 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.
3. Jürgens R, Palles M.
   HIV testing and confidentiality: a discussion paper. Canadian HIV/AIDS Legal Network and the Canadian AIDS Society, 1997: 52-69.
4. Ontario Ministry of Health.
   Anonymous HIV testing evaluation: January 1992 to June 1993. Toronto: AIDS Bureau, Ontario Ministry of Health, November 1994.
5. 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.
6. 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.
7. 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.
8. Bindman AB et al.
   Multistate evaluation of anonymous HIV testing and access to medical care. JAMA 1998;280(16); 1416-20.
9. Remis RS, Swantee C, Rottensten K et al.
   Report on HIV/AIDS in Ontario 2002. November 2003. .
10. Ministère de la santé et des services sociaux du Québec.
    Le dépistage anonyme du VIH, 2001.
11. 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.
12. 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]