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Overview of the State of the HIV Epidemic in Canada. Regional Session on USA and Canada XIX International AIDS Conference Howard Njoo MD, MHSc, FRCPC Director-General Centre for Communicable Diseases and Infection Control Public Health Agency of Canada. Outline of Presentation .

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Overview of the state of the hiv epidemic in canada

Overview of the State of the HIV Epidemic in Canada

Regional Session on USA and Canada

XIX International AIDS Conference

Howard Njoo MD, MHSc, FRCPC

Director-General

Centre for Communicable Diseases and Infection Control

Public Health Agency of Canada


Outline of presentation
Outline of Presentation

  • Overview of Canada

  • HIV in Canada – Epidemiology

  • Drivers of New HIV Infections

  • Government of Canada’s Domestic Response to HIV

  • Conclusion





The centre for communicable diseases and infection control
The Centre for Communicable Diseases and Infection Control

Mandate: To create and share credible knowledge and facilitate coherent national action which contributes to the prevention and control of specific communicable diseases, with a focus on key populations at risk

CCDIC is responsible for the following communicable/infectious disease areas: HIV/AIDS, tuberculosis, sexually transmitted infections, bloodborne pathogens (hepatitis B & C), and healthcare associated infections, including antimicrobial resistance


HIV Epidemiology

in Canada

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Estimated new hiv infections per year in canada by exposure category 1981 2008
Estimated new HIV infections per year in Canada by exposure category,1981-2008

NB: Range of uncertainty omitted


Estimated hiv incidence in canada by sex 2008
Estimated HIV incidence in Canada by sex, 2008 category,1981-2008

Note: Range of uncertainty omitted

10


Estimated hiv incidence in canada by ethnicity country of birth 2008
Estimated HIV incidence in Canada category,1981-2008 by ethnicity/country of birth, 2008

Note: Range of uncertainty omitted

11


Rate (per 100,000 population) of HIV diagnoses in Canada among adults (≥15 years), 2000 and 2010

2000

2010

Rate per 100,000

0 – 6.0

6.1– 12.0

12.1 – 18.0

18.1 and higher

Note: rate for the 3 northern territories together was calculated as combined 3-year average to adjust for small cell sizes and avoid outlier biases.

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Epidemiologic summary
Epidemiologic Summary among adults (≥15 years), 2000 and 2010

  • Increasing prevalence due to effective treatment and ongoing transmission

  • Prevalence is concentrated among certain key populations

  • Patterns of infection have shifted

  • New infections are not declining

13


Drivers of new hiv infections

Drivers of among adults (≥15 years), 2000 and 2010New HIV Infections

14


Key populations and risk behaviours
Key Populations and among adults (≥15 years), 2000 and 2010Risk Behaviours

  • Key populations:

    • gay and other MSM

    • people who use drugs

    • Aboriginal Peoples

    • women

    • youth at-risk

    • people from HIV-endemic countries

    • people in prison,

    • people living with HIV/AIDS

  • Risk behaviours:

    • Unprotected sex

    • Sharing of drug use equipment

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Determinants of health and hiv vulnerability
Determinants of Health and among adults (≥15 years), 2000 and 2010HIV Vulnerability

  • Social and structural risk factors include:

    • Stigma and discrimination: e.g. racism, sexism, homophobia, HIV-phobia

    • Mental health: affected by stigma and discrimination, in turn affects likelihood of engaging in risk behaviours

    • Health care: knowledgeable, culturally competent care affects access to prevention, diagnosis, and care

    • Social support: connection with family, friends and communities affects vulnerability


Government of canada s domestic response to hiv

Government of Canada’s among adults (≥15 years), 2000 and 2010Domestic Responseto HIV

17


Government of canada s domestic response to hiv1
Government of Canada’s among adults (≥15 years), 2000 and 2010Domestic Response to HIV

  • Provinces and territories have primary responsibility for delivery of health care and public health services

  • Federal government plays several key roles:

    • Health service delivery for federal populations

    • National routine and enhanced surveillance

    • Public health guidance

    • Community programs, knowledge transfer and partnerships

    • Research

    • Laboratory services


A comprehensive prevention approach
A Comprehensive Prevention Approach among adults (≥15 years), 2000 and 2010

  • Prevention a cornerstone of the Canadian response

    • Includes interventions at all levels:

      • Primary: e.g. condom distribution, behavioural counselling

      • Secondary: e.g. testing, diagnosis, care

      • Tertiary: e.g. treatment, support

      • Determinants of health: e.g. supportive housing, anti-stigma campaigns

    • Utilizes a range of interventions (biomedical, behavioural and structural)


Conclusion
Conclusion among adults (≥15 years), 2000 and 2010

  • HIV remains a significant public health issue in Canada

  • Despite notable successes, prevention remains an ongoing challenge

  • The way forward:

    • Improving understanding of biomedical, behavioural and social/structural drivers of infection continues to inform program and policy

    • Evolution of approach – integrated approach to STBBI/TB prevention

    • Collaborative approach between governments, across sectors and with affected populations is key

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