HIV and AIDS in Canada

Surveillance Report to December 31, 2004

April 2005

Surveillance and Risk Assessment Division Centre for Infectious Disease Prevention and Control
Public Health Agency of Canada

PDF Version 96 Pages - (2.18 MB)

© Her Majesty the Queen in Right of Canada,
represented by the Minister of Health (2005)
Cat No. H121-1/2004-2 ISBN 0-662-69024-9
(On-line) Cat. No. H121-1/2004-2E-PDF ISBN 0-662-40374-6

---

Acknowledgements: 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 Centre for Infectious Disease Prevention and Control acknowledges the provincial/territorial HIV/ AIDS coordinators, laboratories, health care providers and reporting physicians for providing the non-nominal confidential data that enable this report to be published. Without their close collaboration and participation in HIV and AIDS surveillance, the publication of this report would not have been possible. A complete listing of these contributors is available in Appendix 5.

We also thank Scientific Publication and Multimedia Services Section of the Communications Directorate, for its contribution in editing and producing the report, both in print and on the internet.

N.B. This document must be cited as the source for any information extracted and used from it.

Suggested citation: Public Health Agency of Canada. HIV and AIDS in Canada. Surveillance Report to December 31, 2004. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, 2004.

---

Surveillance and Risk Assessment Division
Centre for Infectious Disease Prevention and Control
Public Health Agency of Canada
Tunney's Pasture, AL 0602B
Ottawa, Ontario, K1A 0K9
Tel: (613) 954-5169 Fax: (613) 957-2842

Information to the readers of HIV and AIDS in Canada

On behalf of the HIV/AIDS Surveillance Section, I would like to present you with the HIV and AIDS in Canada: Surveillance Report to December 31, 2004. This report is part of a semi-annual series providing a review of available HIV and AIDS surveillance data in Canada.

The HIV/AIDS Surveillance section is part of the Surveillance and Risk Assessment Division, at the Centre for Infectious Disease Prevention and Control. This section is responsible for data collection and management, analysis and report production. In addition, we continue to improve data quality, define and set surveillance standards, as well as support the use of these data to influence programmatic and policy action.

The main findings of the surveillance data are outlined in the section entitled At a Glance, and this is followed by a series of tables summarizing the underlying data. Technical notes in addition to references and data sources are available in the Appendices. Explanatory details specific to provincial or territorial surveillance data issues are located at the beginning of each section.

A further description of HIV and AIDS surveillance data is available in the HIV/AIDS Epi Updates reports that are also available on our website listed on the front cover of this report.

The publication of this report would not be possible without the submission of HIV and AIDS surveillance data from all provinces and territories. Their ongoing contribution to national HIV and AIDS surveillance is gratefully acknowledged and is further listed in Appendix 5.

Yours sincerely

Jennifer Geduld, MHSc
Manager
HIV/AIDS Surveillance Section
Surveillance and Risk Assessment Division

---

Table of Contents

At a Glance
Tables
Section I
HIV in Canada: Poitive HIV test reports to December 31, 2004 and reported to CIDPC up to February 21, 2005
1.	Number of positive HIV test reports by year of test (all ages)
2.	Cumulative number of positive HIV test reports occurring in adults and children by gender between November 1, 1985, and December 31, 2004
3.	Number of positive HIV test reports among adults (≥ 15 years) by year of test and gender
4A.	Number of positive HIV test reports by age group and year of test
4B.	Number of positive HIV test reports among males by age group and year of test
4C.	Number of positive HIV test reports among females by age group and year of test
5A.	Number and percentage distribution of positive HIV test reports among adults (≥ 15 years) by exposure category and year of test
5B.	Number and percentage distribution of positive HIV test reports among adult males (≥ 15 years) by exposure category and year of test
5C.	Number and percentage distribution of positive HIV test reports among adult females (≥ 15 years) by exposure category and year of test
5D.	Number and percentage distribution of positive HIV test reports among children (< 15 years) by exposure category and year of test
5E.	Number of positive HIV test reports by exposure category and age group between January 1, 2004, and December 31, 2004
6A.	Number of positive HIV test reports by province/territory and gender between November 1, 1985, and December 31, 2004 (all ages)
6B.	Number of positive HIV test reports by province/territory and year of test (all ages)
7.	Number of postitive HIV test reports by exposure category and province/territory between January 1, 2004, and December 31, 2004 (all ages).
8.	Number of positive HIV test reports by year of test and ethnic status for those provinces that submitted ethnicity data between 1998 and December 31, 2004 (all ages).
Section II Report of the Canadian Perinatal HIV Surveillance Program, 1984-2004
9.	Number of Canadian perinatally HIV-exposed infants by maternal exposure and year of infant birth, 1984-2004
10.	Number of Canadian perinatally HIV-exposed infants by year of birth, current status and use of antiretroviral therapy (ART) for prophylaxis, 1984-2004
11.	Cumulative number of Canadian perinatally HIV-exposed infants by geographic region and status at last report, 1984-2004
12.	Cumulative number of Canadian perinatally HIV-exposed infants by ethnic status and current status, 1984-2004
Section III AIDS in Canada: AIDS Surveillance to December 31, 2004 and Reported to CIDPC up to February 21, 2005
13.	Number of reported AIDS cases by year of diagnosis (all ages)
14.	Cumulative number of reported AIDS cases occurring in adults and children by gender between 1979 and December 31, 2004
15.	Number of reported AIDS cases among adults (≥ 15 years) by year of diagnosis and gender
16A.	Number of reported AIDS cases by age group and year of diagnosis
16B.	Number of reported AIDS cases among males by age group and year of diagnosis .
16C.	Number of reported AIDS cases among females by age group and year of diagnosis .
17A.	Number and percentage distribution of reported AIDS cases among adult (≥ 15 years) by exposure category and year of diagnosis.
17B.	Number and percentage distribution of reported AIDS cases among adult males (≥ 15 years) by exposure category and year of diagnosis
17C.	Number and percentage distribution of reported AIDS cases among adult females (≥ 15 years) by exposure category and year of diagnosis .
17D.	Number and percentage distribution of reported AIDS cases among children (< 15 years) by exposure category and year of diagnosis
17E.	Number of reported AIDS cases among adults (≥ 15 years) by exposure category and age group between 1979 and December 31, 2004
17F.	Number of reported AIDS cases among children (< 15 years) by exposure category and age group between 1979 and December 31, 2004 .
18A.	Number of reported AIDS cases by province/ territory and gender between 1979 and December 31, 2004 (all ages)
18B.	Number of reported AIDS cases by province/ territory and year of diagnosis (all ages)
18C.	Number of reported AIDS cases among males by province/territory and year of diagnosis (all ages)
18D.	Number of reported AIDS cases among females by province/territory and year of diagnosis (all ages).
19.	Number and percentage distribution of reported AIDS cases by province/territory and exposure category to December 31, 2004 (all ages). .
20.	Number of reported AIDS cases by year of diagnosis and ethnic status (all ages)
Section IV a. Mortality due to HIV/AIDS in Canada: Surveillance to December 31, 2004, and Reported to CIDPC up to February 21, 2005
21.	Reported deaths among reported AIDS cases by year of death (all ages)
22.	Cumulative number of reported deaths among reported AIDS cases occurring in adults and children by age of death and gender between 1979 and December 31, 2004
23.	Reported deaths among reported AIDS cases among adults (≥ 15 years) and children by year of death.
24.	Reported deaths among reported AIDS cases among adults (≥ 15 years) by year of death and gender
25A.	Reported deaths among reported AIDS cases and percentage distribution of adults (≥ 15 years) by exposure category and year of death
25B.	Reported deaths among reported AIDS cases and percentage distribution of adult males (≥ 15 years) by exposure category and year of death
25C.	Reported deaths among reported AIDS cases and percentage distribution of adult females (≥ 15 years) by exposure category and year of death
b	Mortality due to HIV/AIDS in Canada: Vital Statistics from 1987 to December 31, 2002
21S.	Deaths attributed to HIV infection by year of death (all ages) .
22S.	Number of deaths attributed to HIV infection by age of death and gender from 1987 to December 31, 2002
23S.	Deaths attributed to HIV infection among adults (≥ 15 years) and children by year of death
24S.	Deaths attributed to HIV infection among adults (≥ 15 years) by year of death and gender
Section V 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

The following report outlines HIV and AIDS surveillance data providing a description of persons who have been diagnosed with HIV and AIDS in Canada. Surveillance data understate the magnitude of the HIV epidemic and consequently do not represent the number of people infected with HIV (prevalence) or the number infected each year (incidence). Some of the reasons for this include the fact that surveillance data are subject to delays in reporting, underreporting and changing patterns in HIV testing behaviours (who comes forward for testing). In addition, surveillance data can only tell us about persons who have been tested and diagnosed with HIV or AIDS and not those who remain untested and undiagnosed. Furthermore, because HIV is a chronic infection with a long latent period, many persons who are newly infected in a given year may not be diagnosed until later years.

HIV Surveillance

A total of 57,674 positive HIV tests have been reported to the Public Health Agency of Canada (PHAC) from November 1985, (when reporting began) up to December 31, 2004. There has been a 20% rise in the number of positive HIV test reports in the last five year (from 2,111 in 2000 to 2,529 in 2004). Over one quarter of the positive HIV test reports in 2004 were among woman, which is a notable change from the years prior to 1995, where they represented less than 10%. The largest rise in this proportion is seen among the 15-29 year age group where females represented 13.2% of reports in 1985-1994 and 42.4% in 2004 (Figure 1 - Proportion of females among positive HIV test reports by age group) .

The heterosexual exposure category represents a growing number and proportion of positive HIV test reports (Figure 2 - Positive HIV test reports by exposure category and year of test) . In the last four years, close to one third of all positive HIV test reports were attributed to this diverse exposure category. In 2004, breakdown of this proportion by the three heterosexual subcategories was 7.6% among persons from an HIV-endemic country, 12.3% among persons who heterosexual contact with someone who was either HIV-infected or at increased risk for HIV and 10.5% among those with heterosexual sex as the only identified risk.

Immmigration

Changes to policies at Citizenship and Immigration Canada (CIC) can explain some of the increase in the number of positive HIV test reports in the last three years¹. On January 15, 2002, CIC added routine HIV screening for all applicants who require an Immigration Medical Examination (IME) and are 15 years and over, as well as on those children who have received blood or blood products, have a known HIV-positive mother or are potential adoptees. In June 2002, the Immigration and Refugee Protection Act (IRPA) was implemented requiring that applicants be assessed for the health grounds of inadmissibility (danger to public health, danger to public safety and excessive demands on health or social services); however, IRPA also exempted certain groups of immigrants from excessive demand evaluation. Information on this legislation is available on the CIC Web site .

Between January 15, 2002 and December 31, 2004, 1,474 applicants tested positive for HIV during their IME². Of these, 918 were identified via testing in Canada, and 556 were identified outside of Canada. In most provinces and territories, for the HIV screening conducted in Canada, positive HIV test reports are handled in the same manner as all other positive HIV tests and are included in provincial/ territorial HIV reporting to PHAC. In September 2004, CIC introduced reporting to provincial/ territorial health authorities of HIV cases, medically examined overseas, who have entered Canada.

Of the 1,474 HIV-positive diagnoses, 981 (67%) were born in Africa and the Middle East, 334 (23%) in the Americas, 109 (7%) in Asia and 50 (3%) in Europe. The 918 positive HIV test reports identified in Canada represent 12% (918/7522) of the positive HIV test reported to PHAC during the January 2002 to December 31, 2004 time period.

Figure 3
Proportion of AIDS cases by exposure category

Canadian Perinatal HIV Surveillance Program

There have been 2,005 infants identified as perinatally exposed to HIV born between 1984 and 2004 in Canada. The number of HIV-exposed infants reported per birth-year has increased steadily from 87 infants in 1993 to 163 in 2004. The overall proportion of HIV-exposed infants whose mothers' HIV status was attributed to the exposure category of heterosexual contact was 70.6%, and 27.7% were attributed to injecting drug use.

Although the number of HIV-exposed infants has increased for each birth-year, the proportion of infants confirmed to be HIV infected has decreased from 47% in 1993 to 2% in 2004. Correspondingly, the proportion of HIV-positive mothers receiving antiretroviral therapy has increased steadily reaching a high of 96% in 2004 (Section II).

Figure 4 - Proportion of reported AIDS diagnoses by ethnic category and year of diagnosis (all ages)

AIDS Surveillance

It is important to note the limitations associated with AIDS diagnoses reported for the year 2004 as no data were available from Quebec for this year. Further details regarding this data limitation are available in Section III. Moreover, a description of AIDS diagnoses adjusted for reporting delay was not available at the time of the printing.

A total of 19,828 AIDS diagnoses were reported to PHAC up to December 31, 2004. Adult females represent a growing proportion of AIDS diagnoses in Canada. Prior to 1994, only 6.2% of AIDS diagnoses were among adult females, this has risen to just over 20% in the last two years. Although this rising trend is seen in all age groups, it is most striking in the 15-29 year age group where the proportion of AIDS diagnoses attributed to females increased from 9.9% before 1994 to 45.0% in 2004. This trend in AIDS diagnoses is similar to that noted for HIV.

There have been a number of changes in the distribution of exposure category over the last decade (Figure 3). Prior to 1994, men who have sex with men (MSM) represented over three quarters of AIDS diagnoses and heterosexual exposure category accounted for just over 10%. In 2004, MSM accounted for a much smaller proportion (36.2%) whereas the heterosexual exposure category represented 37.8% of all AIDS diagnoses. Increases in the diverse heterosexual exposure category between these two periods are observed in each of its three subcategories.

The relative distribution of AIDS diagnoses among ethnic category has been changing over the last decade as outlined in Figure 4. While the total number of AIDS diagnoses from 1994 to 2004 has decreased from 1,776 to 237, there has been an increase in the proportion attributed to Black Canadians from 8.3% to 15.5% and to Aboriginal persons from 2.3% to 14.8%.

Interpretation

The data presented in this report provides information on how the HIV/AIDS epidemic is changing in Canada. Two of the most notable changes observed in the surveillance data are: increases in the positive HIV test reports (overall and within specific population groups), and the increase in the proportion of women among positive HIV test reports and AIDS cases.

The collection of adequate ethnicity data as part of the national HIV/AIDS surveillance system is important to better understand the HIV epidemic among Aboriginal and Black Canadians living in Canada. Although surveillance data has demonstrated increases in positive HIV test reports and AIDS cases in both of these groups, the full extent of the HIV epidemic in these groups remains unclear as ethnicity data are typically only available for about a third of positive HIV test reports. There is a need for complete ethnicity data for both HIV and AIDS cases to adequately plan and deliver programs across the continuum of HIV prevention, testing, diagnosis and treatment.

There have been a number of changes in the distribution of exposure category over the last decade to both HIV and AIDS surveillance data, as noted above. Overall trends include a slight rise among men who have sex with men, a decrease among injecting drug users and an overall increase in the heterosexual exposure category. Although more years of observation are required to determine if these trends will persist, they are important surveillance findings that need further attention. As the heterosexual exposure category accounts for an increasing proportion of HIV test reports and AIDS cases, it is necessary that HIV prevention and control programs also consider how the epidemic is changing.

¹ Citizenship and Immigration Canada. Immigration and Refugee Protection Act. Statutes of Canada 2001. Chapter 27. Also available at url: http://www.cic.gc.ca/english/pdf/pub/C-11_4.pdf  or url: http://www.ci.gc.ca/cicexplore/english/org/bpd/bps/irpa_lipr/act_loi/C-11_4.pdf

² Medical Services Branch, Citizenship and Immigration Canada, 17 March 2005.

PDF Version 96 Pages - (2.18 MB)