HIV/AIDS Epi Notes

Understanding the HIV/AIDS Epidemic among Aboriginal Peoples in Canada: The Community at a Glance

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• Information Regarding the Epi Note
• Aboriginal peoples are overrepresented in the HIV epidemic in Canada
• Aboriginal peoples make up a growing percentage of positive HIV reports and reported AIDS cases
• Injecting drug use continues to be a key mode of HIV transmission in the Aboriginal community
• HIV/AIDS has a significant impact on Aboriginal women
• Aboriginal peoples are being infected with HIV at a younger age compared to Non-Aboriginal persons
• Increasing Number of Aboriginal Peoples Living with HIV/AIDS and among New HIV Infections
• Summary
• Glossary of Terms
• Acknowledgements
• Need more information?

Information Regarding the Epi Note

This Epi Note is the product of collaboration between the Surveillance and Risk Assessment Division of the Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, and the National Aboriginal Council on HIV/AIDS, whose members helped to select the content and design layout of this publication as well as to facilitate its review by community members.

In this document, the HIV/AIDS epidemic among Aboriginal peoples has been compared to that among non-Aboriginal peoples. Comparing these two groups has helped researchers identify where the HIV/AIDS epidemic is the same and where it is different. Specifically, it helps to clarify the unique issues facing Aboriginal peoples. With greater understanding, individuals, Aboriginal leadership and agencies providing HIV/AIDS support services and prevention programs are better able to focus their attention and deal with current realities. The information in this Epi Note will help with advocacy efforts to develop and sustain culturally relevant prevention, education and support services for Aboriginal communities across Canada. Please be aware, however, that this Epi Note is not national in scope because two of the largest provinces in Canada do not report ethnicity information on HIV surveillance data to the Public Health Agency of Canada.¹

It is also important to note that caution should be used when reviewing the percentages in this document. They can change considerably with the addition of one case, particularly when total numbers are small.

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Aboriginal peoples are overrepresented in the HIV epidemic in Canada

AIDS

• 87.8 % (16,986) of the total reported AIDS cases in Canada (19,344) have information on ethnicity (1979 to December 31, 2003)
• 520 of these cases were among Aboriginal peoples
• According to this information, Aboriginal peoples make up 3.1% of reported AIDS cases
• According to the 2001 Census, Aboriginal peoples make up 3.3% of the Canadian population

HIV

• 27.1% (3,765) of the total positive HIV test reports in Canada (13,883) had information on ethnicity (1998 to December 31, 2003)
• 882 of these cases were among Aboriginal peoples
• According to this information, Aboriginal peoples represent 23.4% of reports with information on ethnicity
• Aboriginal communities make up 6.0% of the population in the provinces and territories that report ethnic information with positive HIV tests

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Aboriginal peoples make up a growing percentage of positive HIV reports and reported AIDS cases

For cases and reports where information on ethnicity was provided:

AIDS

• Before 1993, 1.2% of reported AIDS cases were among Aboriginal peoples
• This increased to 13.4% in 2003

HIV

• In 1998, 18.8% of positive HIV test reports were among Aboriginal peoples
• This increased to 25.3% in 2003

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Injecting drug use continues to be a key mode of HIV transmission in the Aboriginal community

For cases and reports among Aboriginal peoples where exposure category was known:

AIDS

• Before 1993, 10.9% of reported AIDS cases among Aboriginal peoples were attributed to injecting drug use
• This figure increased to 58.3% by 2003

HIV

• Of the 860 reports on Aboriginal peoples with known exposure category, 517 were among injecting drug users (IDU) (60.1%). This was the most common way in which HIV was transmitted among Aboriginal peoples between 1998 and December 31, 2003

Figure 1. Reported AIDS cases and positive HIV test reports by exposure category:
A comparison of Aboriginal and non-Aboriginal peoples*

*For reported AIDS cases, includes data from 1979 to December 31, 2003. For positive HIV test reports, includes data from 1998 to December 31, 2003 and from provinces/territories with reported ethnicity (BC, YT, AB, NT, NU, SK, MB, NB, NS, PEI, NL).

As Figure 1 indicates, there are notable differences between Aboriginal and non-Aboriginal peoples with respect to exposure category for both reported AIDS cases and positive HIV test reports.

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HIV/AIDS has a significant impact on Aboriginal women

For cases and reports among Aboriginal peoples where gender was known:

AIDS

• Before 1993, females represented 11.9% of reported AIDS cases among Aboriginal peoples
• In the year 2003, this percentage increased to 44.0%

HIV

• During 1998 – 2003, females represented 44.6% of positive HIV test reports among Aboriginal peoples

In contrast to the non-Aboriginal population, females make up a comparatively larger part of Aboriginal HIV and AIDS cases (Figure 2).

Figure 2. Reported AIDS cases and positive HIV test reports by percentage of females:
A comparison of Aboriginal and non-Aboriginal peoples*

*For reported AIDS cases, includes data from 1979 to December 31, 2003. For positive HIV test reports, includes data from 1998 to December 31, 2003 and from provinces/territories with reported ethnicity (BC, YT, AB, NT, NU, SK, MB, NB, NS, PEI, NL).

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Aboriginal peoples are being infected with HIV at a younger age compared to Non-Aboriginal persons

For cases and reports among Aboriginal peoples where age group was known:

AIDS

• Before 1993, 40.6% of Aboriginal AIDS cases were among youth (<30 years), whereas from 1999 to 2003 youth represented 13.0% of Aboriginal AIDS cases

HIV

• Youth made up 31.4% of positive HIV test reports among Aboriginal peoples from 1998 to 2003
• As indicated in Table 1, a higher percentage of Aboriginal peoples test positive for HIV at a younger age when compared to non-Aboriginal persons. This is also true of the receipt of an AIDS diagnosis

Table 1. Comparison of age at time of diagnosis of reported AIDS cases and at time of test for positive HIV test reports among Aboriginal and non-Aboriginal peoples*

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Increasing Number of Aboriginal Peoples Living with HIV/AIDS and among New HIV Infections

New Infections (Incidence)

• It has been estimated that 250 to 450 Aboriginal people in Canada were newly infected with HIV during 2002
• This is an estimated 6% to 12% of Canadians newly infected with HIV in 2002. This proportion is noteworthy as it is higher than the percentage of Aboriginal peoples in the Canadian population (3.3%)

Living with HIV/AIDS (Prevalence)

• It has been estimated that 3,000 to 4,000 Aboriginal people in Canada were living with HIV (including AIDS) in 2002
• This is an estimated 5% to 8% of all people living with HIV in Canada

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Summary

The HIV epidemic among Aboriginal peoples shows no signs of slowing down. Evidence suggests that injecting drug use is the most common mode of HIV transmission among Aboriginal peoples, Aboriginal women make up a large part of the HIV epidemic in their communities, and Aboriginal peoples are infected at a younger age than non-Aboriginal persons. This indicates the different characteristics of the HIV epidemic among Aboriginal peoples and emphasizes the complexity of Canada's HIV epidemic. More complete information on the pattern of HIV/AIDS in Canada and HIV testing among Aboriginal peoples are needed to guide prevention and control strategies. In addition, it is vital to conduct further research to increase our understanding of the specific impact of HIV on Aboriginal peoples.

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Glossary of Terms

Ethnicity:

In reporting AIDS cases and positive HIV test reports in Canada, a person's ethnic group may be described. An ethnic group is a group of people who share a distinctive cultural and historical tradition, and is often associated with race or nationality. The optional categories for national HIV/AIDS reporting include Aboriginal (Inuit, Métis, Native Indian and Aboriginal Unspecified), Asian, Black, Latin American, South Asian/West Asian/Arab, White and other. When this information is provided, it is known as ethnicity reporting. NOTE: information on ethnicity is missing for some reported AIDS cases and positive HIV test reports.

Exposure category:

In HIV/AIDS surveillance, exposure category refers to the most likely way a person became infected with the HIV virus; that is, the most likely route through which HIV was transmitted to that person. Categories used in this document include men who have sex with men (MSM), injecting drug users (IDU), and those exposed through heterosexual contact (heterosexual transmission).

1. Men who report having had sex with men: Referred to as MSM. This includes men who report either homosexual or bisexual contact (i.e., some will also report having had sex with women as well). It is important to note here that this exposure category refers to sexual behaviour and not to a person's self-identified sexual identity.
2. Injecting drug users: People who inject drugs. The acronym IDU is used and is also often applied to the behaviour of injecting drug use, or what is also commonly referred to as injection drug use.
3. Heterosexual transmission: Those who have had sexual contact with a person of the opposite sex who is HIV-infected or is at risk for HIV, those who were born in a country where heterosexual transmission is most common, and those who have not identified any risk apart from sexual contact with the opposite sex.

Estimate:

Reported AIDS cases and positive HIV test reports relate only to HIV positive individuals who seek testing or medical care and whose positive HIV test was reported to public health authorities. Therefore, these cases and reports do not represent the total number of people who become infected with HIV each year (incidence) or the total number of people living with HIV infection (prevalence). To take this into account, these numbers are estimated using a variety of data sources using a combination of different methods.

1. The provinces and territories that report an ethnic category with positive HIV test reports are British Columbia (BC), Yukon Territory (YT), Alberta (AB), Northwest Territories (NT), Nunavut (NU), Saskatchewan (SK), Manitoba (MB), New Brunswick (NB), Nova Scotia (NS), Prince Edward Island (PE), and Newfoundland and Labrador (NL).
   

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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. The Centre for Infectious Disease Prevention and Control acknowledges the provincial/territorial HIV/AIDS coordinators, public health units, laboratories, health care providers, and reporting physicians for sharing non-nominal, confidential data for national surveillance.

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Need more information?

Further information on HIV/AIDS among Aboriginal peoples, including data from targeted studies and data specific to Canada's three Aboriginal communities, can be found in the Epi Update, HIV/AIDS Among Aboriginal Peoples in Canada: A Continuing Concern, May 2004.

Information on frequently asked questions and terms can be found in either in Understanding HIV/AIDS Epidemiology: HIV/AIDS Surveillance Among Canada's Aboriginal Peoples, available through the Canadian Aboriginal AIDS Network or in A Guide to HIV/AIDS Epidemiological and Surveillance Terms, available through the Public Health Agency of Canada.

For information on this document or related products, please contact:

Surveillance and Risk Assessment Division
Centre for Infectious Disease Prevention and Control
Public Health Agency of Canada Tunney's Pasture, Postal Locator 0602B
Ottawa, Ontario K1A OK9
E-mail: HASS@phac-aspc.gc.ca
Fax: (613) 946-8695