Statement on behalf of the Council of Chief Medical Officers of Health

As Chief Medical Officers of Health, we are reminding people to mark World AIDS Day and the start of Indigenous AIDS Awareness Week on December 1st.

December 1^st, 2023 | Ottawa, ON

As Chief Medical Officers of Health, we are reminding people to mark World AIDS Day and the start of Indigenous AIDS Awareness Week on December 1^st. It is a time to reflect, remembering those we have lost and the contributions they made, as well as celebrate the advances in treatment that ensure people living with HIV are able to live longer, healthy lives.

Research from around the world, including here in Canada, confirms that when a person living with HIV is on treatment and the amount of HIV in their blood remains very low^{Footnote *}, they cannot transmit HIV to sexual partners. The collective research from 2007 to 2022 and the scientific consensus underpins the Undetectable equals Untransmittable (U=U) message.

This knowledge is life changing for people living with HIV as it helps reduce the stigma and discrimination they face and encourages people to access testing and treatment. Most importantly, people living with HIV who are aware of U=U are more likely to report better mental, physical and sexual health. This science has transformed what it means to live and love with HIV on a global scale.

Canada's Chief Medical Officers of Health are committed to protecting and promoting the health and wellbeing of people in Canada. We are working with public health and health care colleagues, as well as community organizations and people living with HIV, to prevent new HIV infections, increase testing, improve access to care and treatment, reduce HIV stigma, and to achieve better health outcomes for those living with HIV and their loved ones. This is why we are encouraging people across the country to share and embrace the U=U message and communicate the undeniable benefits of HIV treatment to people living with HIV and their sexual partners. We also need to improve awareness and access to the full range of effective, evidence-based prevention options for HIV and other Sexually Transmitted and Blood Borne Infections (STBBI).

Access to HIV testing and treatment is strongly influenced by various barriers in our social, economic, and physical environments. These can include the affordability of HIV medication, housing instability, food insecurity, lack of sexual health education, social and cultural norms related to sexual health, as well as stigma and discrimination related to HIV status, sex, gender, age, race, and ethnicity. Many of these barriers also contribute to the concerning rise of other STBBI, such as syphilis, chlamydia, gonorrhea, and viral hepatitis. These stigma-driven obstacles disproportionally and historically impact several populations including: Indigenous Peoples, African, Caribbean, and Black people, gay, bisexual, and other men who have sex with men, people who use drugs, and incarcerated people.

We have endorsed the global goals to end HIV as a public health concern by 2030, including the 95-95-95 global targets for HIV, which calls for 95% of people living with HIV to know their status, 95% of those diagnosed to receive antiretroviral treatment and 95% of those on treatment to have a suppressed viral load, by 2025.

At the end of 2020 in Canada, an estimated 90% of people living with HIV were aware of their diagnosis, 87% of these individuals were actively being treated, and 95% of those receiving treatment had a suppressed viral load. This suggests that while Canada has already reached one of its goals for the year 2025, there is still work to be done. Despite effective HIV prevention methods, such as U=U, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), condoms and harm reduction, there were an estimated 1,833 people newly diagnosed with HIV in 2022. This could be the result of a complex range of factors, including a decrease in access to HIV testing and services during the pandemic.

As the primary source of health information for many people in Canada, health professionals play a vital role in communicating this science, linking patients to care and treatment, and providing safe spaces for people living with HIV to seek healthcare. It is our responsibility as health professionals to challenge and stand up against stigma and discrimination and create a more inclusive and compassionate community.

Together we can celebrate these scientific advancements and ensure people receive HIV prevention, testing and treatment while recognizing all those in Canada who devote their time and effort to ending HIV as a public health concern.

Associated links

• Undetectable = Untransmittable (U=U) - Canada.ca
• Factsheet: Undetectable = Untransmittable for health professionals
• Undetectable = Untransmittable : Communication tips for health professionals
• Risk of sexual transmission of HIV in the context of viral load suppression (CCDR, 2023)
• Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review (CMAJ, 2018)
• The risk of sexual transmission of HIV in individuals with low-level HIV viraemia: a systematic review (The Lancet, 2023)
• New WHO guidance on HIV viral suppression and scientific updates released at IAS 2023