Executive summary: Population-Specific HIV/AIDS Status Report: People living with HIV/AIDS

Executive Summary

An estimated 71,300 people were living with HIV/AIDS in Canada at the end of 2011. Although anyone can contract HIV, certain populations are particularly vulnerable to HIV infection, or are disproportionately represented among people living with HIV/AIDS (PHA); these include gay and other men who have sex with men, people who use injection drugs, Aboriginal Peoples, people in prisons, at-risk youth, people from countries where HIV is endemic, and women.

The burden of HIV in Canada is shifting. When HIV reporting began in 1985, the men who have sex with men (MSM) exposure category accounted for over 80% of all cases. Between 2000 and 2011, the MSM exposure category accounted for 42.1% of new positive HIV test reports among adults, followed by the heterosexual contact (30.8%) and injection drug use (20.7%) exposure categories. Between 1985 and 1999, women accounted for only 13% of new positive HIV test reports; in 2011 they accounted for 26%. At the end of 2011, people who were born in a country where HIV is endemic made up approximately 2.2% of the overall population, but accounted for an estimated 14.9% of prevalent infections. Aboriginal Peoples made up approximately 3.8% of the overall population, but accounted for an estimated 8.9% of prevalent infections.

The increasing diversity of those living with HIV in Canada means that PHA may have very different life experiences both prior to and following HIV infection. This report acknowledges the diverse experiences of PHA while also looking at commonalities related to the experience of living with HIV in Canada, including testing and diagnosis, prevention, medical issues related to HIV/AIDS, treatment issues including medication adherence and side effects, diet and exercise, HIV within the family, sexual health, aging with HIV, palliative care and bereavement.

Determinants of health play a strong role in influencing vulnerability to HIV infection, and continue to influence PHA quality of life, treatment adherence and outcomes, and mortality. Although treatment is widely available to PHA in Canada, a range of socioeconomic factors affect access and adherence to treatment, as well as the health of PHA. Guided by a determinants of health approach, this report examines the impact on PHA of factors such as income, employment status, social environments including stigma and discrimination, social support networks, physical environments, culture, gender, access to health services and personal health practices.

Key determinants that emerge from the research include stigma and discrimination and the role of social support as a source of resilience. Stigma and discrimination affect numerous aspects of PHA lives, from their relationships with intimate partners, family and friends, to their community, their work place and society at large. For many, this stigma is compounded by other forms of discrimination including racism, sexism and homophobia. Social support and community engagement has been a central part of the response to HIV/AIDS in Canada since the beginning, and continues to be a key source of resilience for PHA.

The report also provides an overview of research projects funded by major Canadian research organizations. It identifies 148 time-limited research projects underway between 2008 and 2010 that focus on PHA in Canada. Of these, 79 addressed specific populations. Research on basic science, clinical medicine, microbiology and on vulnerability to HIV infection was excluded. General areas of research include the determinants of health, access to treatment, mental health and resilience.

The report also examines the current response to HIV/AIDS among PHA at the policy and programmatic levels. This includes an overview of national, provincial and territorial population-specific strategies; population-specific networks, coalitions and advisory bodies; and projects that address HIV/AIDS among PHA. 155 projects were identified, indicating that a broad range of organizations are involved in delivering prevention, care, treatment and support services to PHA. Organizations involved in the response include community-based HIV/AIDS service organizations, health or sexual health services, and governmental organizations.

Community organizations and governments across Canada are involved in providing treatment, care, support and services to PHA, and work on prevention, education and countering stigma and discrimination. Despite these important and significant efforts, much remains to be done. Effective and tailored efforts in preventing the acquisition and transmission of HIV and improving the quality of life of PHA are required to successfully address HIV and AIDS. The meaningful engagement of PHA in the programs, services and policies that affect them remains key to identifying challenges and developing effective responses to better serve their needs.