HIV in Canada-Surveillance Report, 2018

Abstract

Background: Human immunodeficiency virus (HIV) is a global public health issue, with an estimated 36.9 million people living with HIV in 2017. HIV has been reportable in Canada since 1985 and the Public Health Agency of Canada (PHAC) continues to monitor trends in new HIV diagnoses.

Objective: The objective of this surveillance report is to provide an overview of the epidemiology of all reported diagnoses of HIV in Canada since 1985 with a focus on 2018 overall, and by geographic location, age group, sex, and exposure category.

Methods: PHAC monitors HIV through the national HIV/AIDS Surveillance System, a passive, case-based system that collates nonnominal data that is voluntarily submitted by all Canadian provinces and territories. Descriptive epidemiological analyses were conducted on national data and those relating to specific populations provided by Immigration, Refugees and Citizenship Canada and the Canadian Perinatal HIV Surveillance Program.

Results: In 2018, a total of 2,561 HIV diagnoses were reported in Canada, an increase of 8.2% compared with 2017. The national diagnosis rate increased to 6.9 per 100,000 population in 2018 from 6.5 per 100,000 population in 2017. Saskatchewan reported the highest provincial diagnosis rate at 14.9 per 100,000 population. The 30-39 year age group continued to have the highest HIV diagnosis rate at 15.4 per 100,000 population. Overall, the diagnosis rate for males continued to be higher than that of females (9.8 versus 4.0 per 100,000 population, respectively); however, females experienced a larger increase in reported cases and diagnosis rate. The gay, bisexual and other men who have sex with men (gbMSM) exposure category continued to represent the highest proportion of all reported adult cases (41.4%), though the proportion has decreased over time. Five perinatal HIV transmissions were documented, three were related to the mother not receiving perinatal antiretroviral therapy prophylaxis.

Conclusion: The number and rate of reported HIV cases in Canada increased in 2018, gbMSM continued to account for the largest exposure category and the number and rate of reported HIV cases among women increased. PHAC will continue to work with its national partners to refine the collection, analysis and publication of national data to better understand the burden of HIV in Canada.

Keywords: Canada; HIV; bisexual and other men who have sex with men; gay; heterosexual contact; people who inject drugs; perinatal HIV; surveillance.

Figure 1

Number of reported cases of HIV and diagnosis rates overall, by sex and year, Canada, 1996–2018^{a a} Overall rate includes cases where sex is transgender, transsexual, not reported or unknown

Figure 2

HIV diagnosis rate (per 100,000 population) by province and territory, Canada, 2018^a Abbreviations: AB, Alberta; BC, British Columbia; MB, Manitoba; ON, Ontario; QC, Quebec; SK, Saskatchewan; ≥, greater than or equal to ^a Rates for the territories (Yukon, Nunavut, and Northwest Territories) and Atlantic region (Prince Edward Island, New Brunswick, Nova Scotia and Newfoundland and Labrador) are presented as averages ^b National rate of 6.9 cases per 100,000 population

Figure 3

HIV diagnosis rate, by age group and year, Canada, 2014–2018^a Abbreviations: <, younger than, ≥ older than or equal ^a Excludes cases where age is not reported or unknown Population data source: Annual Demographic Statistics, Statistics Canada (15)

Figure 4

Proportion of new HIV cases, by age group and sex, Canada, 2018^a,b Abbreviations: <, younger than; ≥, older than or equal ^a Excludes cases where sex is transsexual, transgender, not reported or unknown
^b Excludes cases where age is not reported or unknown

Figure 5

Proportion of reported HIV cases (≥15 years of age) by exposure category and age group, Canada, 2018^a,b Abbreviations: gbMSM, gay, bisexual and other men who have sex with men; PWID, people who inject drugs; ≥, older than or equal ^a Excludes cases where exposure category was “not reported” ^b “Other exposure” category includes cases from Alberta identified through Immigration Refugees and Citizenship Canada, blood/clotting, and other exposure categories

Figure 6

Number of migrants who tested positive for HIV during an Immigration Medical Exam conducted in Canada, 2009–2018