1. Overview of the State of the HIV Epidemic in Canada Regional Session on USA and Canada XIX International AIDS Conference Howard Njoo MD, MHSc, FRCPC Director-General Centre for Communicable Diseases and Infection Control Public Health Agency of Canada

2. Outline of Presentation Overview of Canada HIV in Canada – Epidemiology Drivers of New HIV Infections Government of Canada’s Domestic Response to HIV Conclusion 2

3. Overview of Canada 3

4. Canada 4

5. 55 The Public Health Agency of Canada

6. 6 The Centre for Communicable Diseases and Infection Control Mandate: To create and share credible knowledge and facilitate coherent national action which contributes to the prevention and control of specific communicable diseases, with a focus on key populations at risk CCDIC is responsible for the following communicable/infectious disease areas: HIV/AIDS, tuberculosis, sexually transmitted infections, bloodborne pathogens (hepatitis B & C), and healthcare associated infections, including antimicrobial resistance

7. HIV Epidemiology in Canada 7

8. Estimated HIV prevalence in Canada over time, with range of uncertainty, 1975-2008 8

9. Estimated new HIV infections per year in Canada by exposure category,1981-2008 9 NB: Range of uncertainty omitted

10. Estimated HIV incidence in Canada by sex, 2008 Note: Range of uncertainty omitted 10

11. Estimated HIV incidence in Canada by ethnicity/country of birth, 2008 Note: Range of uncertainty omitted 11

12. 20002010 Rate (per 100,000 population) of HIV diagnoses in Canada among adults (≥15 years), 2000 and 2010 Rate per 100,000 0 – 6.06.1– 12.012.1 – 18.018.1 and higher Note: rate for the 3 northern territories together was calculated as combined 3-year average to adjust for small cell sizes and avoid outlier biases. 12

13. Epidemiologic Summary Increasing prevalence due to effective treatment and ongoing transmission Prevalence is concentrated among certain key populations Patterns of infection have shifted New infections are not declining 13

14. Drivers of New HIV Infections 14

15. Key Populations and Risk Behaviours Key populations: –gay and other MSM –people who use drugs –Aboriginal Peoples –women –youth at-risk –people from HIV-endemic countries –people in prison, –people living with HIV/AIDS Risk behaviours: –Unprotected sex –Sharing of drug use equipment 15

16. Determinants of Health and HIV Vulnerability Social and structural risk factors include: –Stigma and discrimination: e.g. racism, sexism, homophobia, HIV-phobia –Mental health: affected by stigma and discrimination, in turn affects likelihood of engaging in risk behaviours –Health care: knowledgeable, culturally competent care affects access to prevention, diagnosis, and care –Social support: connection with family, friends and communities affects vulnerability 16

17. Government of Canada’s Domestic Response to HIV 17

18. Government of Canada’s Domestic Response to HIV Provinces and territories have primary responsibility for delivery of health care and public health services Federal government plays several key roles: –Health service delivery for federal populations –National routine and enhanced surveillance –Public health guidance –Community programs, knowledge transfer and partnerships –Research –Laboratory services 18

19. A Comprehensive Prevention Approach Prevention a cornerstone of the Canadian response –Includes interventions at all levels: Primary: e.g. condom distribution, behavioural counselling Secondary: e.g. testing, diagnosis, care Tertiary: e.g. treatment, support Determinants of health: e.g. supportive housing, anti- stigma campaigns –Utilizes a range of interventions (biomedical, behavioural and structural) 19

20. Conclusion HIV remains a significant public health issue in Canada Despite notable successes, prevention remains an ongoing challenge The way forward: –Improving understanding of biomedical, behavioural and social/structural drivers of infection continues to inform program and policy –Evolution of approach – integrated approach to STBBI/TB prevention –Collaborative approach between governments, across sectors and with affected populations is key 20