HIV and AIDS in Canada

Surveillance Report to June 30, 2001

Information to readers

The Divisions of HIV/AIDS Epidemiology and Surveillance, and Retrovirus Surveillance, of the Bureau of HIV/AIDS, STD and TB, Centre for Infectious Disease Prevention and Control, Health Canada, are pleased to provide you with HIV and AIDS in Canada: Surveillance Report to June 30, 2001.

The Division of HIV/AIDS Epidemiology and Surveillance is responsible for all data analyses, writing and coordination of the publication of this report. This Division works in close collaboration with the Division of Retrovirus Surveillance, which manages the collection of HIV and AIDS surveillance data.

Two trends will be important to monitor in the coming months. Specifically, these are the decline in the proportion of positive HIV tests among MSM reported in the first 6 months of 2001 after the rise observed in 2000, and the finding that the proportion of positive HIV test reports among heterosexuals has risen after a decline seen in 2000.

Please note that the number of positive HIV test reports for the province of Quebec is based on the minimum number of HIV positive individuals. Please refer to the Limitations outlined in our Technical Notes section for further explanation.

We are continuing to make improvements to this report and always welcome and appreciate your comments and suggestions.

Yours sincerely,

Table of Contents

At a glance
TABLES
SECTION I HIV in Canada: Positive HIV Test Reports to June 30, 2001, and Reported to CIDPC up to August 17, 2001
1.	Number of positive HIV test reports by year of test
2.	Cumulative number of positive HIV test reports occurring in adults and children by gender between November 1, 1985 and June 30, 2001
3A.	Number of positive HIV test reports among males by age group and year of test
3B.	Number of positive HIV test reports among females by age group and year of test
3C.	Number of positive HIV test reports by age group and year of test
4A.	Number of positive HIV test reports among adult males (>= 15 years) by exposure category and year of test
4B.	Number of positive HIV test reports among adult females (>= 15 years) by exposure category and year of test
4C.	Number of positive HIV test reports among adults (>= 15 years) by exposure category and year of test
4D.	Number of positive HIV test reports among children (< 15 years) by exposure category and year of test
4E.	Number of positive HIV test reports by exposure category and age group between January 1, 2001 and June 30, 2001
5A.	Number of positive HIV test reports by province/territory and gender between November 1, 1985 and June 30, 2001
5B.	Number of positive HIV test reports by province/territory and year of test
6.	Number of positive HIV test reports by exposure category and province/territory between January 1, 2001 and June 30, 2001
SECTION II Report of the Canadian Perinatal HIV Surveillance Program, 1984-2000
7.	Number of Canadian perinatally HIV-exposed infants by year of birth and maternal exposure category, 1984-2000
8.	Number of Canadian perinatally HIV-exposed infants by year of birth, current status and use of antiretroviral therapy (ART) for prophylaxis, 1984-2000
9.	Cumulative number of Canadian perinatally HIV-exposed infants by geographic region and current status, 1984-2000
SECTION III AIDS in Canada: AIDS Surveillance to June 30, 2001, and Reported to CIDPC up to August 17, 2001
10.	Number of reported AIDS cases by year of diagnosis to June 30, 2001 (all ages)
11.	Number of reported adult AIDS cases (>= 15 years) by year of diagnosis and gender
12.	Cumulative number of reported AIDS cases grouped by age at AIDS diagnosis and gender up to June 30, 2001
13A.	Number of male AIDS cases by age group and year of diagnosis
13B.	Number of female AIDS cases by age group and year of diagnosis
13C.	Number of AIDS cases by age group and year of diagnosis
14A.	Number and percentage distribution of adult male AIDS cases (>= 15 years) by exposure category and year of diagnosis
14B.	Number and percentage distribution of adult female AIDS cases (>= 15 years) by exposure category and year of diagnosis
14C.	Number and percentage distribution of adult AIDS cases (>= 15 years) by exposure category and year of diagnosis
14D.	Number and percentage distribution of AIDS cases among children (< 15 years) by exposure category and year of diagnosis
14E.	Total number of AIDS cases among adults (>= 15 years), by exposure category and age group up to June 30, 2001
14F.	Total number of AIDS cases in children (< 15 years) by exposure category and age group up to June 30, 2001
15A.	Number of AIDS cases (all ages) by province/ territory and gender up to June 30, 2001
15B.	Number of male AIDS cases (all ages) by province/territory and year of diagnosis
15C.	Number of female AIDS cases (all ages) by province/territory and year of diagnosis
15D.	Number of AIDS cases (all ages) by province/ territory and year of diagnosis
16.	Number and percentage distribution of all AIDS cases (all ages) by province/territory and exposure category to June 30, 2001
17.	Number of AIDS cases (all ages) by year of diagnosis and ethnic status
18.	Number of deaths due to AIDS among adults and children by year of death
SECTION IV International Statistics on AIDS
APPENDICES
Appendix 1. Technical Notes Appendix 2. Data Limitations Appendix 3. Terminology Appendix 4. References Appendix 5. Data Sources

At a Glance

Introduction

This section highlights the main findings observed in the HIV and AIDS surveillance data reported by Canadian provinces and territories to the Centre for Infectious Disease Prevention and Control (CIDPC) up to June 30, 2001. It is important to note that reported positive HIV tests and AIDS cases as presented in this surveillance report represent only those individuals who seek testing and/or medical care. The number of positive HIV test reports provides a description of those who came forward for testing, were diagnosed with HIV infection and were reported. It does not, however, represent the total number of individuals living with HIV (prevalence) or newly infected each year (incidence). Similarly, the number of reported AIDS cases does not represent true AIDS incidence but only those who sought medical care, were diagnosed with AIDS and were reported to CIDPC.

HIV Surveillance Data

Up to June 30, 2001, there have been 49,155 positive HIV tests reported to CIDPC since November 1985, when reporting to Health Canada began. The annual number (new diagnoses) reported declined from 2,987 in 1995 to 2,119 in 2000. There have been 1,088 positive HIV tests reported to CIDPC in the first 6 months of 2001, 23 fewer than at the same time in 2000 (Table 1).

Since 1985, adult females have represented 14.1% of positive tests (among adults) for which age and gender were reported. Although the number of positive tests among males continues to be higher, the proportion of females each year has risen, from 9.9% in the years between 1985 and 1994 to nearly 25% of adult positive HIV test reports between January 1999 and June 2001 (Tables 3A and 3B).

There was a steady increase in the proportion of positive reports (adults) attributed to the heterosexual exposure category until 1999. This category includes sub-categories of heterosexual contact with a person at risk for HIV, origin in a country where HIV is endemic and heterosexual as the only identified risk (NIR-HET). The proportion increased from 7.5% in 1985-1994 to 28.4% in 1999. There was a slight decrease to 25.6% in 2000, and in the first 6 months of 2001 the proportion increased again, to 31.9% (Figure 1 and Table 4C).

Among adults, the proportion of positive HIV test reports attributed to men who have sex with men (MSM) decreased from 74.7% during 1985-1994 to 36.8% between 1997 and 1999. This decline was followed by an increase to 41.8% in 2000, and a decrease to 36.2% in the first half of 2001 (Figure 1 and Table 4C).

FIGURE 1
Proportion of reported adult positive HIV tests by exposure category

AIDS Surveillance Data

Since the beginning of the epidemic in the early 1980s, there have been 17,818 AIDS cases reported to CIDPC (Table 10). Among reported adult AIDS cases, the proportion of females increased from 5.6% during the period 1979-1991 to 16.2% in 1999. In 2000, this proportion dropped to10.9% and has since risen to 14.7% in the first 6 months of 2001. The proportion of AIDS cases among Aboriginal people reached a peak in 1999 at 11.1% of all AIDS cases and was just over 8% between January 2000 and June 2001 (Figure 2, Table 11 and 17).

Figure 3 outlines the trends in the distribution of exposure categories among reported AIDS cases in the last decade. The proportion of MSM among reported adult AIDS cases steadily decreased to 43.7% in 1999 and then rose to 50.1% in 2000. The first part of 2001 shows that the proportion has dropped to 46.5%. There was a steady rise in the proportion of IDU, from 2.3% between 1979 and 1991 to 21.4% in 1998, and a levelling off until the first 6 months of 2001, when it dropped to 16.3%. The proportion of reported adult AIDS cases attributed to heterosexual transmission steadily increased to 29.1% in 1999, dropped to 22.7% in 2000 and increased to 30.2% for the period January to June 2001 (Table 14C).

FIGURE 2
Ethnic categories as a percentage of all reported AIDS cases

FIGURE 3
Proportion of reported adult AIDS cases by exposure category

Interpretation

It is important to be cautious when interpreting the surveillance data for the first half of the reporting year because of small sample sizes, and delayed and under-reporting. The Bureau of HIV/AIDS, STD and TB will continue to monitor the surveillance data and will clarify whether these findings are sustained when data for the full year are reported.