HIV and AIDS in Canada: A National Survey Liviana Calzavara, University of Toronto Dan Allman, University of Toronto Catherine Worthington, University of Victoria Mark Tyndall, University of Ottawa Public Health Department, Alix Adrien, Public Health Department, Montreal Health and Social Services Agency Montreal Health and Social Services Agency In partnership with CANFAR CAHR Ancillary Session Montreal, April 19, 2012

Presentation overview Rationale for conducting the national survey Specific objectives of the study Methods Characteristics of the participants Provide overview of findings Limitations Contributions and next steps

Study Rationale Increasing Burden of HIV Epidemic in Canada   Increasing incidence and prevalence   High number of people unaware they are infected   Increasing number of groups and communities affected Need for Population Surveys   Update information from previous national research study (PHAC,2003 & 2006) Sociodemographic Changes   Annual immigration of 300,000 to Canada   2 million youth now between who were not eligible at last survey Scientific Advancements   Gauge public understanding of NPTs and scientific advancements in HIV Importance for Strategic Planning   Understanding knowledge, attitudes, and behaviours of Canadian population to help assess and inform educational strategies, modify intervention efforts, and combat HIV stigma and discrimination

Objectives 1) 1)To identify and explore current trends in public attitudes, knowledge and perceptions of HIV among people living in Canada; 2) 2)To inform and support strategies at CANFAR and the SRC to best address gaps in public information; 3) 3)To support improved awareness efforts among policy makers, the general public, and the Canadian donor community; 4) 4)To improve HIV prevention interventions overall.

methods 2,139 people living in Canada 16 years of age or older Conducted in English and French in May 2011 All 10 provinces and the territories represented Recruited online panel supplemented by random digit dial (RDD) telephone interviewing The margin of error for the total sample is +/- 2.1 percentage points at the 95% confidence interval

TOPICS Knowledge and awareness of HIV Attitudes towards those with HIV Rights of those with HIV and criminal prosecution Testing behaviour Sexual behaviour Charitable giving

Characteristics of Respondents* (1) * Weighted numbers

Characteristics of respondents* (2) * Weighted numbers

Characteristics of respondents* (3) Employment Status n=2139n% Self-employed24511 Employed full-time75235 Employed part-time/term/casual23211 Unemployed but looking for work822 Student/Attending school full-time1869 Retired not in work force/full-time homemaker51224 Long-term disability/sick leave/maternity/parental leave1055 Other9- DK/NA/Ref (n=18) 1 Minority Status** n=2139n% Member of a visible minority1668 Aboriginal person332 Person with a disability1768 Sexual minority985 None DK/NA/Ref472 * Weighted numbers

Characteristics of respondents* (4) Ethnic/Cultural Group** n=2139 n % British French Other western European Eastern European Scandinavian Native American/Aboriginal 61 3 American 38 2 South Asian 36 2 Middle Eastern 25 1 African 25 1 Southeast Asian 30 1 Jewish 11 1 Latin American 21 1 Caribbean 29 1 Oceania 4 <1 Other 11 1 None/DK/NA/Ref **These questions are multi-mentions and thus proportions may add up to greater than 100%

Highlights

Other Presentation at CAHR from the HIV and AIDS in Canada: A National Survey   Trends in Attitudes Toward People with HIV - Calzavara et al., Social Sciences Track - Friday, April 20, :00am   Factors that Predict Voluntary HIV Testing in the General Canadian Population - Worthington et al., Epidemiology & Public Health - Track Friday, April 20, :00am   Attitudes on the Criminalization of HIV - Tyndall et al., Epidemiology & Public Health Track - Saturday April 20, :15 pm   Previous Involvement with and Future Intentions toward Charitable Giving for HIV and AIDS - Allman et al., Poster # P191   Is Low Condom Use Attributable to Attitudes around the Effectiveness of Condom Use? - Calzavara et al., Poster # P159

Knowledge of hiv Self-reported level of knowledge of HIV was high and unchanged since 2003   93% describe themselves as at least moderately knowledgeable about HIV There is almost universal recognition that HIV can be transmitted by sharing needles (99%) or having sexual intercourse without a condom (99%)   majority (82%) recognize that HIV can be transmitted from an HIV- positive mother to her baby during childbirth. But only 36% knew about breastfeeding A minority believe HIV transmitted by kissing (15%), sharing food (11%), coughing/sneezing (7%) More likely 2011 (89%) than in 2006 (80%) to believe that HIV treatments are effective in helping people with HIV lead normal lives

perceived importance of hiv Diseases/illnesses of greatest concern to Canadians were:   cancer (53%), cardiovascular disease (11%), Alzheimer’s (6%), Diabetes (5%), Mental illness (2%)   HIV (1%) – along with respiratory illness, obesity, MS, neurologic disorders When asked about seriousness of a selected group of illnesses:   HIV ranked as “very serious” by 29% & somewhat serious by 46%   compared to “very serious” for heart disease (68%), breast cancer (53%), child obesity (54%), Parkinson’s (20%)

Attitudes* & LEVEL OF COMFORT WITH PHA A minority indicated negative attitudes toward those living with HIV & attitudes have remained relatively stable since 2006   16% afraid of PHA (67% not) [16% in 2011 & 13% in 2006]   8% could not become friends with PHA (82% would) [8% in 2011 & 9% in 2006]   11% that infected have only themselves to blame (70% disagree) – [11% in 2011 &14% in 2006] Reasons for fear & discomfort   contact with blood, contracting it, not want to be around “those type of people” * 3 questions, 7-point scale, agreement (5-7), neither (4), disagree (1-3)

LEVEL OF COMFORT* WITH PHA in different social contexts (2) Level of comfort interacting with PHA has increased since 2006   Comfort with working in an office with a PHA increased from 74% to 77%   Comfort having a child attend school where another child has HIV increased from 56% to 60%   Comfort shopping at a store where owner has HIV remained the same (from 71% to 72%) Comfort remains substantially lower when considering a friend or family member dating a PHA (43% comfortable in 2011 & 43% in 2006) * comfortable=very or somewhat comfortable Vs. somewhat or very uncomfortable

Rights of pha & criminalization on non-disclosure 91% agree PHA entitled to same rights to employment, health care and housing Only 45% agree PHA have same rights to be sexually active – similar to 2006 (48%) Agreement increases if PHA take steps to disclose or reduce sexual transmission   82% agree PHA have the same rights to be sexually active if they inform partners of their status   71% agree as long as PHA practice safe-sex 87% aware PHA can be criminally prosecuted for non- disclosure to sex partners   74% feel imprisonment is appropriate

Sexual Behaviour 94% reported ever having had sexual intercourse and 74% had sex in the past 12 months.   22% (323/1481) of those who had sex in past 12 months used a condom at last sexual intercourse Condom use among those with higher-risk practices:   42% of those with multiple sex partners & 47% of those with casual sex partners in the previous year reported condom use at last intercourse Only 50% of all participants viewed condoms as “very effective” in reducing sexual transmission of HIV   those who perceived condoms to be “very effective” had high levels of education and high perceived and actual HIV- knowledge

Hiv testing 48% have ever been tested & 47% have never been tested 48% have ever been tested & 47% have never been tested  If exclude testing for immigration, insurance, blood donation or research, 29% have voluntarily tested to learn their HIV status  Percentage voluntarily testing to learn their HIV status is little changed from 2003 when 27% reported testing Most common reasons for testing is for blood donation (20%) Most common reasons for testing is for blood donation (20%)

Charitable giving 83% had donated to charitable or not-for-profit organization in the previous year   62% of donations made to cure/treat diseases/illness   Cancer, heart and stroke, MS and diabetes were the diseases most frequently donated to   8% of donations made to HIV in previous year and 22% had ever made a donation to HIV   47% expressed willingness to consider donations to HIV in future 93% believed to a “large or moderate extent” that it was government’s responsibility to continue to fund HIV research   79% believed the private sector had a responsibility to fund HIV research   72% indicated that a company’s history of giving to causes like HIV research positively influences their impressions of the company and its goods and services

Study limitations Low levels of participation in national survey(s) Potential social desirability bias Numbers too small for some sub-group analyses - lack of statistical power Households and individuals without telephones, such as street youth, are underrepresented. Households and individuals without telephones, such as street youth, are underrepresented.

Anticipated Contributions Identifies gaps and areas for action and response Informs policies and programming to improve HIV prevention efforts on local, regional and national level Informs improvements to educational strategies to boost awareness and combat complacency

Next steps Continue with more in-depth data analyses Consult with key stakeholders in various sectors Disseminate findings more broadly & develop strategies for targeting specific populations Conduct additional targeted studies to help better understand and respond to new and emerging trends in specific populations Other steps?

Acknowledgements Survey was made possible by:   Donation from Andy Pringle   In-kind support of the SRC which is funded by Canadian Institutes of Health Research (CIHR) Special thanks to:   Study participants   The Strategic Counsel for conducting the survey   CANFAR & Christopher Bunting for their collaboration on the project   SRC staff & members – Laura Bisaillon, Caroline Godbout, Jill Morse, Robin Montgomery and Melissa Walters

For more information and copies of summary & technical reports visit:

Extra slides – anything from these that needs to be added?Extra slides – anything from these that needs to be added?

Progress to Date (1) Strategic Counsel commissioned to conduct survey Strategic Counsel commissioned to conduct survey Involved10 provinces & territories, held in English and French in May 2011 Involved10 provinces & territories, held in English and French in May 2011 Media release in June 2011 Media release in June 2011 Technical and summary reports drafted Technical and summary reports drafted Website to be launched Website to be launched CAHR ancillary session on April 19, 2012 CAHR ancillary session on April 19, oral and 2 poster presentations at CAHR 3 oral and 2 poster presentations at CAHR 1 poster presentation at AIDS poster presentation at AIDS 2012

Progress To Date (2) Anticipated contributions Will identify gaps and areas for action and response Will identify gaps and areas for action and response Will inform policies and programming to improve HIV prevention efforts on local, regional and national level Will inform policies and programming to improve HIV prevention efforts on local, regional and national level Will inform improvements to educational strategies to boost awareness and combat complacency and disinterest in HIV Will inform improvements to educational strategies to boost awareness and combat complacency and disinterest in HIV Proposed next steps Conduct additional targeted study(-ies) to help better understand and respond to new and emerging trends in specific populations Conduct additional targeted study(-ies) to help better understand and respond to new and emerging trends in specific populations