Ethnicity Reporting for AIDS and HIV in Canada

HIV/AIDS Epi Updates

April 2003

Download all of the HIV/AIDS Epi Updates
82 pages (1,223 KB) in PDF format 
(How to download PDF documents)

Ethnicity Reporting for AIDS and HIV in Canada

---

Introduction

Documentation of ethnicity among reported AIDS cases and positive HIV test reports has become an important component of AIDS and HIV surveillance due to the unique perspective it offers on the epidemic. As with other demographic identifiers, ethnic information can contribute to the creation and evaluation of targeted prevention and treatment programs as well as to the development of health policy.

This Epi Update presents a summary of ethnic information from the national AIDS and HIV surveillance system. Additional information is available in "HIV and AIDS in Canada: Surveillance Report to June 30, 2002".¹

AIDS

Improved Ethnicity Reporting Among AIDS Cases

Since 1982, when the first AIDS case was reported in Canada, a total of 85.7% (15,713/18,336) of AIDS case reports have included ethnic information. During this time, the proportion of cases with this information has increased. Between 1982 and 1991, 80.7% of reported AIDS cases indicated ethnicity. This figure increased to 89.4% in the period between 1992-2001. In the first six months of 2002, reporting of ethnicity was 85.3%.

Reported AIDS Cases and Ethnicity: A Balance of Changing Proportions

The total annual number of reported AIDS cases has declined over the last 10 years from 1,723 cases in 1992 to 297 in 2001. From January to June, 2002; 75 AIDS cases were reported.  The number of cases in some ethnic groups, however, has not declined at the same rate as others. In order to better understand trends by ethnic status, it is helpful to examine the proportion of all reported AIDS cases attributed to a particular ethnic group.

Whites have historically represented the largest proportion of reported AIDS cases, yet this proportion has declined over the last 10 years. The proportion of reported AIDS cases with known ethnicity attributed to Whites was highest in 1988 at 91.0%, but declined steadily to 67.7% in 1999.  Since that time, the proportion increased to 74.8% in 2000 and dropped to 68.4% in 2001.  In the first six months of 2002, 64.1% of reported AIDS cases with known ethnicity were among Whites.

With a decrease among Whites, there has been a corresponding increase in the proportion of reported AIDS cases among other ethnic groups. The increase in the proportion has been most notable among Aboriginal persons and the Black population since 1994 (Figure 1).

In 2001, Aboriginal persons and Blacks comprised 3.3% and 2.2% of Canada's population, respectively.²  In the same year, they respectively accounted for 5.3 % and 13.9% of reported AIDS cases with known ethnicity.  Between January and June 30, 2002 these proportions were 14.1% and 15.6% respectively.  This indicates that both Aboriginal persons and Blacks are over represented in reported AIDS cases.

---

---

HIV

Missing Pieces: Positive HIV Tests Often Reported Without Ethnicity Information

Ethnicity reporting for positive HIV test reports is not as complete as that of reported AIDS cases because ethnicity data are available only for some provinces and territories. Reporting of HIV is more recent than AIDS and there is still some concern regarding documentation of confidential information. As a result, the analysis of ethnicity information for HIV test reports presents a challenge.

Ethnicity data for positive HIV test reports have only been available since 1998, and therefore comparisons are possible only for this limited period of time. Between January 1998 and June 30, 2002, a total of 29.5% of positive HIV test reports have included ethnic information (2975/10075). The proportion of positive HIV test reports with ethnicity information was 26.5% in 1998, and peaked at 32.2% in 2000 before dropping to 31.3% in 2001. In the first six months of 2002, ethnicity reporting for positive HIV tests reports was its lowest at 25.6%.

When examining HIV data, it must also be considered that the source of the HIV reports which include ethnicity are some areas where the Aboriginal population is high in comparison with other parts of Canada. Provinces and territories that report ethnic information include British Columbia, Yukon Territory, Alberta, Saskatchewan, Manitoba, Prince Edward Island, and Newfoundland and Labrador. HIV ethnicity data are not available for the remaining provinces and territories. As a result, the ethnicity data for HIV test reports should not be viewed as representative of all of Canada.

Aboriginal Persons Constitute A Notable Proportion of Positive HIV Tests With Known Ethnicity

The majority of positive HIV test reports with ethnicity information are among Whites, similar to the situation seen in reported AIDS cases. Whites represented 67.3% of positive HIV test reports with known ethnicity in 1998.  This figure dropped to near 60.0% between 1999-2001, and was 58.5% in the first half of 2002.

In 1998, 19.2% of positive HIV tests with known ethnicity were among Aboriginal persons as compared to a high of 25.5% in 2001 (Figure 2). The proportion of positive HIV test reports attributed to Aboriginal persons between January and June 30, 2002 is 26.5%.  These proportions are higher than the proportions attributed to Aboriginal persons for reported AIDS cases. For example, in 2001, Aboriginal persons comprised 5.3% of reported AIDS cases with known ethnicity. This difference is likely due in part to HIV ethnicity information being primarily from western provinces where the Aboriginal population is greater. For additional information on HIV/AIDS among Aboriginal people, refer to the Epi Update entitled "HIV/AIDS Among Aboriginal Persons in Canada: A Continuing Concern", April 2003.³

Compared to other non-White ethnic groups, Aboriginal persons account for a higher proportion of positive HIV test reports where ethnicity has been recorded (Figure 2). However, one must remember that the two largest provinces, Ontario and Quebec are not represented in the HIV ethnicity data.

---

---

Positive HIV Tests Reflect Differences Among Ethnic Groups

Of the 2975 positive HIV test reports with ethnic information reported between January 1998 and June 30, 2002; 692 were among Aboriginal people, 211 among the Black population and 1836 among Whites.  The remaining 236 reports were attributed to other ethnic categories. Table 1 shows the distribution of gender, age and exposure category among positive HIV test reports for the three named ethnic groups. Such information may be of assistance in the design and targeting of prevention and care programs.

---

Table 1: Comparison of Positive HIV Test Reports Between Selected Ethnic Groups, 1998-June 30, 2002

MSM = Men who have sex with men; IDU = Injecting Drug Users; HET = Heterosexual Risk (Originate from a Pattern II country, Sexual contact with a person at risk, No Identified Risk Heterosexual). Subtotals differ due to unknown gender, age and exposure in some reports. Provinces with ethnicity reported include BC, YK, AB, SK, MB, PEI, NFLD and Labrador).

---

As shown in Table 1, available evidence suggests that among Aboriginal persons and the Black population, in contrast to Whites, positive HIV test reports with known ethnicity are equally distributed between males and females and there is a higher proportion at a younger age.  Injecting drug use has been a key mode of transmission among Aboriginal persons. As shown in Table 1, injecting drug users comprised 60.6% of positive HIV test reports among Aboriginal persons between 1998-June 30, 2002.

Among Whites, the highest proportion of positive HIV test reports was attributed to men who have sex with men (38.8%) and injecting drug users (34.7%). People whose HIV infection was attributed to heterosexual exposure represented the largest proportion of positive HIV test reports among the Black population (80.1%). The majority of these (113/165) are categorized to the subgroup indicating origin in Pattern II country (a country where heterosexual transmission of HIV predominates).

Limitations of Ethnicity Data from Reported HIV and AIDS Cases

There are several significant limitations regarding the accuracy of ethnicity data obtained from AIDS and HIV surveillance information. The following should be kept in mind when examining such data:

• Misclassifications of ethnic status may occur at the time of HIV or AIDS diagnosis.

• People in certain communities may not wish to identify their ethnicity, resulting in under representation.

• For AIDS reporting, patients and health care providers are constrained by the list of ethnic categories available on the AIDS Case Report Form that may compromise the accuracy of ethnicity reporting.

• Not all provinces and territories routinely collect and/or report ethnicity.

• Variations in the completeness of ethnicity reporting between and within provinces may result in a systematic over-or under representation of specific communities.

• Reporting delay may vary by ethnicity, and may therefore affect the representativeness of ethnicity data for recently reported HIV and AIDS cases.

Given these limitations, caution should be exercised in interpreting the AIDS and HIV ethnicity data presented. This is particularly true of positive HIV test reports for which there is less complete ethnicity information.

Comment

Community health groups and public health officials may use ethnicity data on HIV/AIDS to more effectively plan prevention and care programs for the different ethnic communities. When combined with other epidemiologic descriptors of the HIV/AIDS epidemic, such as gender, age group, and exposure category, such information becomes a powerful tool for directing programs to where they will have the most impact. To increase our ability to do this, it is essential that the completeness and accuracy of ethnicity reporting in surveillance data be improved.

References

1. Health Canada. HIV and AIDS in Canada: Surveillance Report to June 30, 2002. Division of HIV/AIDS Epidemiology and Surveillance, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, Health Canada, April 2002.

2. Statistics Canada. http://www12.statcan.ca/english/census01/products/highlight/Ethnicity/
   Page.cfm?Lang=E&Geo=PR&View=1&Table=1&StartRec=1&
   Sort=2&B1=Counts, January 30, 2003.

3. Health Canada. HIV/AIDS among Aboriginal Persons in Canada: A Continuing Concern, HIV/AIDS Epi Update, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, Health Canada, April 2003.

For more information please contact:

---

Health Canada

---