HIV/AIDS EPI UPDATES CHAPTER 1: NATIONAL HIV PREVALENCE ANd INCIDENCE ESTIMATES FOR 2011 October 2014 PROTECTING CANADIANS FROM ILLNESS TO PROMOTE AND PROTECT THE HEALTH OF CANADIANS THROUGH LEADERSHIP, PARTNERSHIP, INNOVATION AND ACTION IN PUBLIC HEALTH. —Public Health Agency of Canada HIV/AIDS Epi Update—Chapter 1: National HIV Prevalence and Incidence Estimates for 2011 is available on Internet at the following address: www.phac-aspc.gc.ca Également disponible en français sous le titre : Actualités en épidémiologie du VIH/sida – Chapitre 1 : Estimations de la prévalence et de l’incidence de l’infection à VIH au Canada pour 2011 To obtain a copy of the report, send your request to: Centre for Communicable Diseases and Infection Control Public Health Agency of Canada 100 Eglantine Driveway, Health Canada Building A.L. 0602C, Tunney’s Pasture Ottawa, Ontario K1A 0K9 Email: [email protected] Or from: Canadian AIDS Treatment Information Exchange (CATIE) 555 Richmond Street West, Suite 505 Toronto, Ontario M5V 3B1 Toll free: 1-800-263-1638 Email: [email protected] This publication can be made available in alternative formats upon request. © Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2014 Publication date: October 2014 This publication may be reproduced for personal or internal use only without permission provided the source is fully acknowledged. Cat.: HP40-56/1-2014E-PDF ISBN: 978-1-100-24888-2 Pub.: 140254 CENTRE FOR COMMUNICABLE DISEASES AND INFECtion Control—2014 HIV/AIDS Epi Updates I HIV/AIDS EPI UPDATES CHAPTER 1: NATIONAL HIV PRevaLENCE AND INCIDENCE ESTIMATES FOR 2011 October 2014 CENTRE FOR COMMUNICABLE DISEASES AND INFECtion Control—2014 II HIV/AIDS Epi Updates 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 Communicable Diseases and Infection Control acknowledges the provincial/territorial HIV/AIDS coordinators, public health units, laboratories, healthcare 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. In addition, we acknowledge Dr. Robert Remis of the University of Toronto for his input into the estimation methodology. N.B. This document must be cited as the source for any extracted information. Suggested citation: Public Health Agency of Canada. HIV/AIDS Epi Updates: National HIV Prevalence and Incidence Estimates for 2011. Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, 2014. CENTRE FOR COMMUNICABLE DISEASES AND INFECtion Control—2014 HIV/AIDS Epi Updates III TaBLE OF CONTENTS ACKNOWLEDGEMENTS ............................................................................................................ II At A GLANCE ............................................................................................................................1 INTRODUCTION ........................................................................................................................1 METHODS ..................................................................................................................................2 RESULTS .....................................................................................................................................4 HIV PREvaLENCE IN CANADA ...................................................................................................4 HIV PREvalence—tIME TREND ...............................................................................................4 HIV PREvalence—exposure cATEGORIES ...........................................................................5 HIV PREvalence—AborIGINAL STATUS .................................................................................5 HIV PREvalence—SEX ..............................................................................................................6 HIV PREvaLENCE BY PROVINCE ...............................................................................................7 HIV INCIDENCE IN CANADA ......................................................................................................7 HIV INCIdence—tIME TREND ..................................................................................................7 HIV INCIdence—exposure cATEGORIES ..............................................................................9 HIV INCIdence—AborIGINAL STATUS ....................................................................................9 HIV INCIdence—SEX .................................................................................................................9 HIV INCIDENCE BY PROVINCE ................................................................................................11 HIV INCIDENCE RATE AMONG KEY POPULATIONS ..............................................................13 DISCUSSION ...........................................................................................................................16 LIMITATIONS ............................................................................................................................18 CONCLUSION ..........................................................................................................................18 REFERENCES ...........................................................................................................................19 CENTRE FOR COMMUNICABLE DISEASES AND INFECtion Control—2014 IV HIV/AIDS Epi Updates TaBLES Table 1. HIV exposure categories used for HIV case surveillance and HIV prevalence and incidence estimation process .........................................................................................2 Table 2. Estimated number of prevalent HIV infections and associated ranges of uncertainty, Canada, at the end of 2011 and 2008, by exposure category, sex and ethnicity (point estimates and ranges are rounded) ..............................................................6 Table 3. Estimated number of prevalent HIV infections and associated ranges of uncertainty, Canada, at the end of 2011, by exposure category and province/region (point estimates and ranges are rounded).............................................................................8 Table 4. Estimated number of new HIV infections and associated ranges of uncertainty, Canada, in 2011 and 2008, by exposure category, sex and ethnicity (ranges are rounded) ...........................................................................................................10 Table 5. Estimated number of new HIV infections and associated ranges of uncertainty, Canada, 2011, by exposure category and province/region (point estimates and ranges are rounded) ........................................................................................................................12 Table 6. Estimated size of key populations in Canada, 2011 ..............................................14 Table 7. Estimated HIV incidence number (range of uncertainty omitted), rate per 100,000, rate ratio for different sub-populations, by exposure category, ethnicity, origin and sex, Canada, 2011 ..............................................................................................15 FIGURES Figure 1. Estimated number of prevalent HIV infections in Canada, by year ........................5 Figure 2. Estimated number of new HIV infections in Canada for selected years (bars indicate range of uncertainty) .......................................................................................7 Figure 3. Estimated number of incident HIV infections in Canada over time, by exposure category (range of uncertainty omitted) .........................................................10 Figure 4. Distribution of estimated new HIV infections in Canada over time, by exposure category ..........................................................................................................11 CENTRE FOR COMMUNICABLE DISEASES AND INFECtion Control—2014 HIV/AIDS Epi Updates 1 AT A GLANCE • More Canadians are living with HIV infection: Approximately 71,300 people were living with HIV at the end of 2011 compared with 64,000 at the end of 2008. • Approximately 3,175 new HIV infections occurred in 2011 (range: 2,250 to 4,100) compared with approximately 3,335 in 2008 (range: 2,370 to 4,300). Over the past decade, the annual number of new HIV infections has remained relatively stable in Canada. • In 2011, the estimated HIV incidence rate among men who have sex with men was 71 times higher than the rate for other men. The HIV incidence rate for people who inject drugs was 46 times higher than the rate among people who had never injected drugs. • Aboriginal people and people from HIV-endemic countries continue to be over-represented in Canada’s HIV epidemic. • The HIV incidence rate for males was 14.2 per 100,000 population, which was 3.3 times greater than the rate of 4.3 per 100,000 for females. INTRODUCTION This HIV/AIDS Epi Update outlines the estimates of the total number of people living with human immunodeficiency virus (HIV) infection in Canada at the end of 2011 (prevalence) and the number of new HIV infections in Canada in 2011 (incidence). Estimates published in this report replace all previous