HIV in Canada-surveillance report, 2019

Abstract

Background: Human immunodeficiency virus (HIV) is a global public health issue. HIV has been nationally notifiable in Canada since 1985. The Public Health Agency of Canada (PHAC) monitors trends in new HIV diagnoses.

Objectives: The objective of this surveillance report is to provide an overview of the epidemiology of reported HIV cases in 2019 in Canada. The report highlights 10-year trends (2010-2019). Data on HIV diagnosed through Immigration Medical Exams (IME) and trends in perinatal transmission of HIV are also presented.

Methods: PHAC monitors HIV through the HIV/AIDS Surveillance System, a passive, case-based system that collates non-nominal data submitted voluntarily by all Canadian provinces and territories. Descriptive analyses were conducted on national data. IME data were obtained from Immigration, Refugees and Citizenship Canada (IRCC), and data on HIV-exposed pregnancies were obtained through the Canadian Perinatal HIV Surveillance Program.

Results: In 2019, a total of 2,122 HIV diagnoses were reported in Canada (5.6 per 100,000 population). Saskatchewan reported the highest provincial diagnosis rate at 16.9 per 100,000 population. The 30 to 39-year age group had the highest HIV diagnosis rate at 12.7 per 100,000 population. While the rates for both males and females fluctuated in the past decade, since 2010 the rates among males decreased overall, while the rate among females increased slightly. As in previous years, the diagnosis rate for males in 2019 was higher than that for females (7.9 versus 3.4 per 100,000 population, respectively). The highest proportion of all reported adult cases with known exposure were gay, bisexual and other men who have sex with men (gbMSM, 39.7%), followed by cases attributed to heterosexual contact (28.3%) and among people who inject drugs (PWID, 21.5%). The number of migrants who tested positive for HIV during an IME conducted in Canada was 626. The one documented perinatal HIV transmission related to a mother who had not received antepartum or intrapartum antiretroviral therapy prophylaxis.

Conclusion: The number and rate of reported HIV cases in Canada has remained relatively stable over the last decade, with minor year-to-year variations. As in previous years, the gbMSM and PWID populations represent a high proportion of HIV diagnoses, although a sizable number of cases were attributed to heterosexual contact. It is important to routinely monitor trends in HIV in light of pan-Canadian commitments to reduce the health impact of sexually transmitted and blood-borne infections by 2030.

Keywords: Canada; HIV; bixexual 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, 2010–2019^a,b Abbreviations: HIV, human immunodeficiency virus; PHAC, Public Health Agency of Canada ^a Population data source: Annual Demographic Statistics, Demography Division, Statistics Canada, July 1, 2019 ^b Overall rate excludes cases where sex is transgender, transsexual, not reported or unknown

Figure 2

HIV diagnosis rate (per 100,000 population), by province and territory, Canada, 2019^a,b Abbreviations: AB, Alberta; BC, British Columbia; HIV, human immunodeficiency virus; MB, Manitoba; ON, Ontario; QC, Québec; SK, Saskatchewan ^a Rates for the territories (Northwest Territories, Nunavut, Yukon) and Atlantic region (New Brunswick, Newfoundland and Labrador, Nova Scotia, Prince Edward Island) are presented as averages ^b National rate of 5.6 cases per 100,000 population

Figure 3

HIV diagnosis rate, all ages, by age group and year, Canada, 2010–2019 ^a,b,c Abbreviation: HIV, human immunodeficiency virus ^a Excludes cases where sex is transsexual, transgender, not reported or unknown ^b Excludes cases where age is not reported or unknown ^c Population data source: Annual Demographic Statistics, Demography Division, Statistics Canada, July 1, 2019

Figure 4

HIV diagnosis rate, all ages, by sex and age group, Canada, 2019^a,b,c Abbreviation: HIV, human immunodeficiency virus ^a Excludes cases where sex is transsexual, transgender, not reported or unknown ^b Excludes cases where age is not reported or unknown ^c Population data source: Annual Demographic Statistics, Demography Division, Statistics Canada, July 1, 2019

Figure 5

Percentage distribution of HIV cases among (a) males and (b) females (≥15 years old) by exposure category and year of diagnosis, Canada, 2010–2019^a,b Abbreviations: gbMSM, gay, bisexual and other men who have sex with men; gbMSM/PWID, gay, bisexual and other men who have sex with men and use injection drugs; HIV, human immunodeficiency virus; PWID, people who inject drugs ^a Excludes cases with no identified risk, unknown exposure category and cases reported by Québec ^b Other includes cases from Alberta identified through Immigration Refugees and Citizenship Canada, blood/blood products, perinatal, occupational exposure and other exposure categories

Figure 6

Proportion of reported HIV cases (≥15 years old) by exposure category and age group, Canada, 2019^a,b,c Abbreviations: gbMSM, gay, bisexual and other men who have sex with men; gbMSM/PWID, gay, bisexual and other men who have sex with men and use injection drugs; HIV, human immunodeficiency virus; PWID, people who inject drugs ^a Includes cases where sex was transsexual, transgender and not reported ^b Excludes cases where exposure category was not reported ^c Other exposure category includes cases from Alberta identified through Immigration Refugees and Citizenship Canada, blood/blood products, perinatal, occupational exposure and other exposure categories

Figure 7

Number of migrants who tested positive for HIV during an Immigration Medical Exam conducted in Canada, 2010–2019 Abbreviation: HIV, human immunodeficiency virus