The Current State of the Epidemic:
Why We Need to Step Up Our Efforts

1. The epidemic is increasing

The number of Canadians living with HIV continues to grow. At the end of 2002, an estimated 56,000 people were living with HIV infection 2 (including AIDS), representing an increase of about 12% from 1999. In terms of exposure category, these prevalent infections in 2002 comprised 32,500 men who have sex with men (MSM) (58% of total); 11,000 people who use injection drugs (20% of total); 10,000 heterosexuals (18% of total); 2,200 MSM/people who use injection drugs (4% of total); and 300 attributed to other exposures (<1% of total).

of the estimated 56,000 prevalent infections in 2002, about 17,000 or 30% were unaware of their HIV infection. These individuals, named the "hidden epidemic,"; are particularly important because, until they are diagnosed, they are not able to access support, treatment and prevention services that could help them manage the illness and prolong their lives. A significant number of people in this group are not diagnosed until late in the course of HIV disease, when medications are of little help.

The number of new infections (incident infections) continues at approximately the same rate as three years ago. In Canada, there were an estimated 2,800 to 5,200 new HIV infections in 2002; of these, between 600 and 1,200 were among women, representing 23% of all new infections.

HIV continues to have a disproportionate impact on certain segments of our society. Examining the 2002 estimates by exposure category, MSM continue to comprise the greatest number of new infections: 1,000 to 2,000 (40% of the national total of new infections). The proportion of new infections among people who use injection drugs was 30%, and 24% was attributed to the heterosexual exposure category.

The heterosexual exposure category is a diverse group that includes those who have had sexual contact with a person who is either HIV-infected or at increased risk for HIV (such as a person who uses injection drugs or a bisexual male), those who were born in a country where HIV is endemic, and those who have not identified any risk apart from sexual contact with the opposite sex. It is estimated that in 2002 there were approximately 3,700 to 5,700 prevalent HIV infections and 250 to 450 incident infections among persons who were born in a country where HIV is endemic. These numbers represent approximately 7-10% of total prevalent infections and 6-12% of total incident infections in Canada.

Aboriginal people continue to be overrepresented among HIV infections in Canada. They made up only 3.3% of the general Canadian population in 2001. It was estimated, however, that 5-8% of all prevalent HIV infections and 6-12% of all new HIV infections were among Aboriginal people in 2002.

Although current epidemiological evidence suggests that HIV prevalence is low among youth, data on sexual behaviour and sexually transmitted infections (STIs) clearly indicate that the potential exists for the spread of HIV among young Canadians. Those youth most at risk of HIV infection are those who are street-involved, engaged in the sex trade and/or who inject drugs.

Based on epidemiological evidence, the overall rate of HIV infection in prisons is estimated to be far higher than the rate in the general Canadian population. The need for accessible and innovative prevention and treatment programs for prison inmates is crucial because of the high rate of drug injection, unsafe tattooing and piercing, unprotected sex and other high-risk activities.

Footnotes

2
Health Canada. Estimates of HIV prevalence and incidence in Canada, 2002. Canada Communicable Disease Report. Vol. 29 No 23. 1 December 2003.

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