EPIDEMIOLOGIC CHARACTERISTICS OF HIV INFECTION AND AIDS RENFREW AND EASTERN ONTARIO PUBLIC HEALTH UNITS,

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1 EPIDEMIOLOGIC CHARACTERISTICS OF HIV INFECTION AND AIDS RENFREW AND EASTERN ONTARIO PUBLIC HEALTH UNITS, 98-2 Robert S. Remis, Maraki Fikre Merid Department of Public Health Sciences University of Toronto Community Planning Initiative Ottawa, October 2, 24

2 Introduction Community planning initiative as part of the new HIV/AIDS response strategy, AIDS bureau, Ministry of Health and Long-Term Care of Ontario OHEMU received mandate for local epidemiologic analysis Provides an epidemiologic update and summarizes the extent of the epidemic of HIV/AIDS in Renfrew and Eastern Ontario public health units as of December 2

3 Methods: Data sources HIV serodiagnostic data: First-time HIV positive diagnoses at HIV Laboratory, Ontario Ministry of Health and Long-Term Care (OMHLTC), Reported AIDS cases: Cases diagnosed to December 2 and reported to Public Health Division, OMLTC by April 24 Laboratory Enhancement Study: Data used to adjust HIV diagnoses for unknown risk factors and previous HIV testing and to obtain estimates of HIV incidence (detuned assay)

4 Methods: Data analysis HIV diagnoses: First-time HIV positive diagnoses by year, sex and exposure category; cumulative incidence rates by sex and PHU AIDS: Reported cases by year, sex, and exposure category; cumulative incidence rate by sex and PHU Populations at risk (MSM, MSM-IDU, IDU): Numbers estimated based on population in each public health unit, proportion 8+ years and proportion male. Proportion MSM and IDU based on previous studies and analysis HIV incidence: From detuned assay by exposure category and year, Eastern other region,999-2 Modeled HIV infection: Based on LES, HIV diagnoses and reported AIDS cases, HIV-related deaths

5 First-time HIV diagnoses (adjusted), Renfrew and Eastern Ontario public health units, Renfrew Eastern Ontario Both PHUs HIV diagnoses Year

6 First-time HIV positive diagnoses by exposure category and sex, Renfrew Public Health Unit, SM SM-IDU DU Males no. Prop 4% % 4% Females No. Prop % % % Total No. Total (adj.) No. Prop % % 5% lot/trans IV-endemic 2 29% % % % 5% 5% R hetero R hetero % 4% % % % % nknown 9 2 otal 6 % 4 % 2 2 %

7 First-time HIV positive diagnoses(adjusted) by exposure category and sex, Eastern Ontario, Males Females Total No. Prop No. Prop No. MSM 6 5% % 6 MSM-IDU 6 % % 6 IDU 24% 7 4% 48 Prop 42% % % Clot/Trans 2 2% 7% 2 % HIV-endemic 8 6% 4 % 2 8% HR hetero % 7% % LR hetero 4 4% 6 2% 7% Other/Perinatal % % % Total 25 % 26 % 5 %

8 First-time HIV-positive diagnoses (adjusted) Renfrew Public Health Unit (n=2), % MSM 2.9% MSM-IDU IDU 2.7% Clot/Tran HIV-endemic.% 2.8%.% 5.5% 4.7% HR hetero LR hetero Other/perinatal

9 First-time HIV-positive diagnoses among males, Eastern Ontario Public Health Unit (n=25), %.% MSM MSM-IDU IDU Clot/Tran HIV-endemic HR hetero.%.%.6% 6.4%.7% 24.5% LR hetero Other/Peri

10 First-time HIV-positive diagnoses among females, Eastern Ontario Public Health Unit (n=26),985 2.%.4%.% IDU Clot/Tran HIV-endemic 64.4%.% 22.2% HR hetero LR hetero Other/Peri

11 Cumulative HIV incidence rate per, by sex and public health unit, Public health unit Males Females Total Eastern Other Health region Rate Rate Rate Rank Eastern Ontario Hastings Prince Edward Kingston Frontenac Leeds-Grenville Renfrew Ottawa Toronto,

12 Trends in HIV diagnoses From ,.67% of Ontario HIV diagnoses in these public health units versus.79% in (p =.4): Renfrew,, proportion increased. fold (p=.) Eastern Ontario,. fold increase (p=.8, NS)

13 Reported AIDS cases, Renfrew and Eastern Ontario public health units, Renfrew Eastern Ontario Both PHUs HIV diagnoses Year

14 AIDS cases by exposure category and sex, Renfrew Public Health Unit, 98 to 2 Males Females Total No. % No. % No. % MSM 5 % % 5 28% MSM-IDU % % % IDU 2% % 4 22% HIV-endemic % % % Hetero 2 % % 7% Clot/transfusion 2% % 4 22% Other* 2 % % 2 % Total 5 % % 8 % * Other includes perinatal, occupational and NIR cases

15 AIDS cases by exposure category and sex, Eastern Ontario Public Health Unit, 98-2 Males Females Total No. % No. % No. % MSM 6 55% % 6 48% MSM-IDU % % % IDU % % 9% HIV-endemic % % % Hetero % 2 5% 9% Clot/transfusion % % % Other* 8 28% 2 5% % Total 29 % 4 % %

16 Reported AIDS cases among males (n=5), Renfrew Public Health Unit,98 2.%.% 2.%.% MSM.% MSM-IDU IDU HIV-endemic Hetero 2.% Clot/Tran.% Other*

17 Reported AIDS cases among females (n=) Renfrew Public Health Unit,985 2.%.%.%.%.%.%.%.% IDU HIV-endemic Hetero Clot/Tran Transfusion Perinatal Occupational NIR

18 Reported AIDS cases among males (n=29), Eastern Ontario Public Health Unit, %.4%.% MSM MSM-IDU IDU HIV-endemic 27.6%.4%.%.% Hetero Clot/Tran Other*

19 Reported AIDS cases among females (n=4), Eastern Ontario Public Health Unit, % 5.% IDU HIV-endemic Hetero Clot/Trans 5.%.%.% Other*

20 Cumulative AIDS incidence rate per, by sex and public health unit, Males Females Total Public health unit Rate Rate Rate Rank Eastern Other Health region Eastern Ontario Hastings Prince-Edward Kingston Frontenac Leeds-Grenville Renfrew Ottawa Toronto

21 Figure. Measured and adjusted HIV-incidence (per person-years) for MSM, Eastern Other health region, HIV incidence density IDmeasured IDadjusted

22 Figure.2 Measured and adjusted HIV-incidence (per person-years) for IDU, Eastern Other health region, HIV-incidence density ID measured ID adjusted

23 Figure. Measured and adjusted HIV-incidence (per person-years) for hetero, Eastern Other health region, HIV-incidence density ID measured ID adjusted

24 Estimated number of persons at risk for HIV infection, Renfrew and Eastern Ontario public health units, 2 Renfrew Eastern Ontario Both PHUs MSM ,52 MSM-IDU IDU ,8

25 Modeled number of HIV-infected persons in Renfrew and Eastern Ontario public health units, based on HIV serodiagnostic data, 22 enfrew and astern Ontario PHUs MSM 66 MSM-IDU 7 IDU 59 HIVendemic Hetero Clot/Tran 5 Total 7 ntario (adjusted) 6, , 2,2 2, ,264 roportion.4%.7% 2.9%.64%.6%.7%.7% odeled Ontario 22),6 6,95 2,6,5 2 22,9 umber HIV-infected roportion 4.9% 7.% 6.%.7%.6%.9%.% IV prevalence 4.8% 2.2% 5.%

26 Modeled number of HIV-infected persons in Renfrew and Eastern Ontario public health units based on reported AIDS cases, 22 enfrew and astern Ontario PHUs MSM 2 HIVendemic MSM- IDU IDU 7 Hetero 6 Clot/Tran 4 Total 9 ntario 5, ,8 roportion.4%.% 2.%.%.97%.6%.54% odeled Ontario 22),6 6,95 2,6,5 2 22,9 umber HIV-infected roportion 45.4%.8%.9%.% 24.7% 2.6%.% IV prevalence 4.7% 4.%.6%

27 Summary of findings Renfrew Public Health Unit 2 HIV diagnoses (IDU 5%, Clot 5%, LR %) 8 AIDS cases (MSM %, IDU 25%) Eastern Ontario Public Health Unit 5 HIV diagnoses (MSM 42%, IDU %) AIDS cases (MSM 7%. IDU and Hetero %)

28 Summary of findings HIV incidence increased among MSM since 2 but decreased among IDUs Modeled HIV prevalence (both public health units): Based on HIV data, 57 Based on AIDS data, 2

29 Limitations Populations at risk (especially MSM, IDU) not well characterized (e.g. size, regional variations) Adjustments for HIV diagnoses AIDS cases subject to uncertainty (under-reporting and reporting delays) Data on HIV incidence limited

30 Conclusions HIV epidemic not entirely stable in these two regions HIV incidence rate in the Eastern Ontario PHU ranked high compared to other PHUs in Ontario (rank 8 of 7) but not AIDS incidence (rank ) In recent years, more Ontario HIV diagnoses in the Renfrew PHU