1. HIV infection among men who have sex with men in Ontario: Analysis by race/ethnicity Robert S. Remis, Maraki Fikre Merid Ontario HIV Epidemiologic Monitoring Unit University of Toronto Ethno-racial MSM Research Forum November 15, 2004 November 15, 2004

2. MOHLTC, Laboratories Branch, IMC – 2001 Background MSM seriously affected by HIV epidemic since the beginning (~1978)MSM seriously affected by HIV epidemic since the beginning (~1978) Many developments have influenced epidemiologic trends:Many developments have influenced epidemiologic trends: Education, information and prevention Education, information and prevention Identification of HIV (1984) HIV test developed (October 1985) Antiretroviral drugs (1987) HAART (1996)

3. MOHLTC, Laboratories Branch, IMC – 2001 Objectives To examine trends reported AIDS cases and HIV diagnoses among MSM in Ontario by race/ethnicityTo examine trends reported AIDS cases and HIV diagnoses among MSM in Ontario by race/ethnicity

4. MOHLTC, Laboratories Branch, IMC – 2001 Methods: Data sources AIDS cases in Ontario diagnosed from 1981to 2003 and reported to April 2004 from Public Health Branch, MOHLTCAIDS cases in Ontario diagnosed from 1981to 2003 and reported to April 2004 from Public Health Branch, MOHLTC HIV diagnoses reported to Toronto and Ottawa public health units,1983-2004HIV diagnoses reported to Toronto and Ottawa public health units,1983-2004

5. MOHLTC, Laboratories Branch, IMC – 2001 Methods: Data analysis AIDS: Number and proportion of reported AIDS cases among MSM by race/ethnicity, health region and year of AIDS diagnosis, 1981-2003AIDS: Number and proportion of reported AIDS cases among MSM by race/ethnicity, health region and year of AIDS diagnosis, 1981-2003 HIV diagnoses: Number and proportion of HIV diagnoses among MSM by race/ethnicity and year of HIV diagnosis in Toronto and Ottawa PHU, 1983-2004HIV diagnoses: Number and proportion of HIV diagnoses among MSM by race/ethnicity and year of HIV diagnosis in Toronto and Ottawa PHU, 1983-2004

6. MOHLTC, Laboratories Branch, IMC – 2001 Reported AIDS cases by exposure category and race/ethnicity, Ontario, 1981-2003 * Proportion known = 61.8%

7. MOHLTC, Laboratories Branch, IMC – 2001 Reported AIDS cases among MSM by race/ethnicity, Ontario 1981-2003

8. MOHLTC, Laboratories Branch, IMC – 2001 Reported AIDS cases among MSM by race/ethnicity and health region, Ontario, 1981-2003 (1/2)

9. MOHLTC, Laboratories Branch, IMC – 2001 Reported AIDS cases among MSM by race/ethnicity and health region, Ontario, 1981-2003 (2/2)

10. MOHLTC, Laboratories Branch, IMC – 2001 Proportion white among annual reported AIDS cases among MSM, 1981-2003

11. MOHLTC, Laboratories Branch, IMC – 2001 Annual reported AIDS cases among MSM for selected race/ethnicities,1981-2003

12. MOHLTC, Laboratories Branch, IMC – 2001 Annual reported AIDS cases among white MSM, Toronto,1981-2003

13. MOHLTC, Laboratories Branch, IMC – 2001 Annual reported AIDS cases among MSM, Toronto for selected race/ethnicities,1981-2003

14. MOHLTC, Laboratories Branch, IMC – 2001 Annual reported AIDS cases among MSM in Ottawa by race/ethnicity,1981-2003

15. MOHLTC, Laboratories Branch, IMC – 2001 Annual reported AIDS cases among MSM in Central East Other by race/ethnicity, 1981-2003

16. MOHLTC, Laboratories Branch, IMC – 2001 HIV infections among MSM, Toronto and Ottawa public health units,1983-2004 * Proportion known = 59.5%

17. MOHLTC, Laboratories Branch, IMC – 2001 Annual HIV infections among white MSM reported to Toronto,1983-2004

18. MOHLTC, Laboratories Branch, IMC – 2001 Annual HIV infections among MSM reported to Toronto by race/ethnicity,1983-2004

19. MOHLTC, Laboratories Branch, IMC – 2001 Annual HIV infections among MSM reported to Ottawa by race/ethnicity,1983-2004

20. MOHLTC, Laboratories Branch, IMC – 2001 Summary of findings AIDS casesAIDS cases Observed decrease of cases among whites over time and increase in recent years, especially since among Blacks, Latin Americans and AsiansObserved decrease of cases among whites over time and increase in recent years, especially since among Blacks, Latin Americans and Asians Trends observed in Toronto for whites and Latin Americans and Central East Other for increase among AsiansTrends observed in Toronto for whites and Latin Americans and Central East Other for increase among Asians

21. MOHLTC, Laboratories Branch, IMC – 2001 Summary of findings HIV diagnosesHIV diagnoses Toronto: similar trends as for AIDS cases with decreasing proportion among Whites and increasing among Latin Americans, Asian and BlacksToronto: similar trends as for AIDS cases with decreasing proportion among Whites and increasing among Latin Americans, Asian and Blacks Ottawa: decrease among whites but others not clearOttawa: decrease among whites but others not clear

22. MOHLTC, Laboratories Branch, IMC – 2001 Limitations Racial/ethnicity data available for only for about 60% of HIV diagnoses and AIDS casesRacial/ethnicity data available for only for about 60% of HIV diagnoses and AIDS cases Trends possibly different in those without informationTrends possibly different in those without information Bias likely in direction of over-estimating non-white race/ethnicityBias likely in direction of over-estimating non-white race/ethnicity

23. MOHLTC, Laboratories Branch, IMC – 2001 Limitations AIDS cases subject to underreporting and delayed reportingAIDS cases subject to underreporting and delayed reporting Not likely to introduce bias in proportions over timeNot likely to introduce bias in proportions over time HIV diagnoses requires decision to undergo HIV testingHIV diagnoses requires decision to undergo HIV testing May underestimate non-white race/ethnicityMay underestimate non-white race/ethnicity

24. MOHLTC, Laboratories Branch, IMC – 2001 Conclusions HIV infection among MSM of non-white race/ethnicity growingHIV infection among MSM of non-white race/ethnicity growing Especially important in Toronto (AIDS 10%) and Central East other (AIDS 21%)Especially important in Toronto (AIDS 10%) and Central East other (AIDS 21%) Increasing substantially in Toronto in most recent yearsIncreasing substantially in Toronto in most recent years AIDS 30-40% since 1999AIDS 30-40% since 1999 HIV 20-30% since 1997HIV 20-30% since 1997

25. MOHLTC, Laboratories Branch, IMC – 2001 Acknowledgements Ontario Ministry of Health and Long-Term Care Ontario Ministry of Health and Long-Term Care Frank McGee, coordinator, AIDS Bureau Frank McGee, coordinator, AIDS Bureau Lorraine Schiedel, Public Health Division Lorraine Schiedel, Public Health Division HIV Laboratory, Central Public Health Laboratory HIV Laboratory, Central Public Health Laboratory Carol Swantee, diagnostic data Carol Swantee, diagnostic data Keyi Wu, programming Keyi Wu, programming Toronto Public Health Toronto Public Health Jo-Anne Ackery Jo-Anne Ackery Ottawa Public Health Ottawa Public Health Orhan Hassan Orhan Hassan