The province’s epidemiology unit, OHESI, housed at the OHTN, confirms that new HIV infections, although down from ten years ago, have been on the rise the last three years. The increase in that time period is fortunately not large but contrasts sharply with good news from other countries, notably the UK.
Why has the trend in Ontario been for the worse? OHESI says this. “Despite an overall decrease in new diagnoses over the past 10 years, there has been a slight increase in recent years. Between 2013 and 2016, there was a 10.5% increase in the number of new diagnoses and a 7.2% increase in the rate of new diagnoses per 100,000 people. This increase may be partly due to the 18.9% increase in the number of HIV tests during the same time period.”
The picture is better over the long term. “Overall” the reports says “the number and rate of new HIV diagnoses in Ontario have decreased over the past decade. Between 2007 and 2016, the number of new diagnoses each year fell from 1,013 to 881 and the annual rate of new diagnoses per 100,000 people dropped from 7.9 to 6.3.”
So it’s a good news/bad news kind of report. Good news over the long term, bad news when you look at recent years’ data.
Why are new HIV infections now growing in number? It is clearly impossible to define causes very accurately. But OHESI’s suggestion that it’s perhaps because of increases in numbers of HIV tests ignores the fact that there have also been increases in testing in the UK, while new infection numbers there are nevertheless going down.
Could it be changes in demographics, or an increasing population base, or changes in risk behaviors (if we have to use that term), or the impact (or not) of Ontario’s various prevention campaigns? It’s impossible to say without the kind of analysis that’s missing here. We can say, though, that the period under review, between 2013-2016, saw a sharp increase in chemsex. We can say that there was slow uptake of prevention technologies increasingly being leaped upon by others. PrEP was not widely available and prohibitively expensive for many. Treatment as Prevention (TasP) was routinely shot down in the province by researchers, funders and activists alike. Meanwhile condom use was falling. It was the perfect storm for an epidemic to go if not unchecked, at least, not fully under control.
Meanwhile other jurisdictions pressed on. The UK scored most prominently; HIV diagnoses there have fallen by 65% in London and by 48% outside London from their peak in 2014. AIDSmap reports “Changes are occurring as a result of greater promotion of HIV testing, greater use of new technologies for HIV testing such as self-sampling, earlier treatment and a more widespread awareness that undetectable viral load makes a person uninfectious.”
As for Ontario, here are the report's other take-home messages:
• Even though there has been a slight increase in diagnoses in recent years, the diagnosis rate in 2016 (6.3 per 100,000 people) was still lower than in all years prior to 2013.
• The recent increase in new diagnoses was more pronounced among females – with the diagnosis rate increasing by 2.5% for males and 29.3% for females between 2013 and 2016. The increase among females appears to be driven by diagnoses in individuals who were White, Indigenous and/or who use injection drugs.
• While there has been a greater relative increase in diagnoses for females compared to males in recent years, the diagnosis rate has consistently been three to four times higher for males. In 2016, the diagnosis rate per 100,000 people was 10.1 for males and 2.5 for females.
• Over the past decade, the majority of new male HIV diagnoses were gay, bisexual and other men who have sex with men and/or White, while the majority of new female diagnoses were African, Caribbean and Black. Compared to males, a higher percent of new female diagnoses were Indigenous and/or people who use injection drugs.
• HIV diagnoses were not distributed equally across the province. In 2016, the rate of new diagnoses per 100,000 people was highest in Toronto (15.0) and Ottawa (8.8) and lowest in the Central East health region (2.3).
• Differences in diagnoses between 2015 and 2016 varied by health region. Ottawa, Eastern, Central West and Southwest regions all experienced an increase in the number and rate of diagnoses from 2015 to 2016. Diagnoses decreased in the Toronto, Northern and Central East regions.
Catch that? Toronto, with its high concentration of gay, bisexual and other men who have sex with men is bucking the provincial trend. That’s not new; PositiveLite.com first reported on this in 2015. But perhaps it does speak to the province’s more visible commitment to increase HIV testing which is most apparent in Toronto. The Toronto area also has much greater exposure to prevention campaigns, such as those launched by ACT and GMSH, which are much less visible outside Toronto. But again, one has to guess.
Only a crystal ball will tell where all these numbers are heading next. But there is reason for optimism. True, we haven’t seen the kind of radical changes in testing alternatives that have been seen elsewhere – funders have consistently railed against home testing where is has scored well elsewhere. That needs to change. But PrEP is certainly more accessible. More optimal conditions for TasP to be effective seem in place now too, with U=U a household word in the HIV community, early treatment start becoming the norm and getting earlier all the time.
Here’s a prediction. Numbers of new infections will nose dive in Ontario in 2017. Any takers?