1 People Living with HIV/AIDS in Canada: A Determinants of Health Perspective Preliminary Findings of the Population-Specific HIV/AIDS Status Report OHTN 2011: Toronto, November 15, 2011 Tanya Lary, Centre for Communicable Diseases and Infection Control
2 A Population-Specific Approach The Public Health Agency of Canada, through The Federal Initiative to Address HIV/AIDS in Canada is developing discrete approaches to address HIV/AIDS for key populations: People living with HIV/AIDS People from countries where HIV is endemic Aboriginal Peoples Women Youth at-risk Gay, Two Spirit, Bisexual, and other Men who have Sex with Men People who inject drugs People in prison Supports a more effective and targeted HIV response
The Population-Specific HIV/AIDS Status Report: A Tool for Knowledge Exchange 3 A detailed synthesis of current evidence on the epidemiology of people living with HIV/AIDS (PHA) in Canada, the determinants of health that affect them, and the research, policy and program response Provides an evidence-base to inform future directions of policy, programs and research Developed with guidance of expert working group Commitment to GIPA principle
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5 Key Findings Diversity of PHA experiences, associated with pre-existing determinants of health and life experience Ongoing challenges of stigma and discrimination HIV as a life cycle issue choices around pregnancy, children born with HIV, HIV in the family, HIV and aging Key role of community engagement and support
6 PHA in Canada: Epidemiology
Number of prevalent HIV infections 7 Estimated number of people living with HIV infection in Canada 80000 70000 60000 50000 40000 30000 20000 10000 0 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008 Year
8 The Growing Diversity of PHA in Canada 4% 8% 1985-1994 2% 2000-2009 4% 2% 9% 30% 41% 75% 1% 22% 2% MSM IDU MSM/IDU Blood/Blood Products Heterosexual Contact Other MSM MSM/IDU IDU Blood/Blood Products Heterosexual Contact Other Proportion of positive HIV test reports in adults, by exposure category
Number of positive HIV test reports 9 Number of positive HIV test reports among males and females (= 15 years) by exposure category, Canada, 2000-2009 10000 9000 8000 7000 5259 6000 5000 4000 3000 2000 1000 0 272 1731 1078 2101 1858 71 332 49149 Adult Males Adult Females Sex MSM MSM/IDU IDU Hetero Blood/Blood Products Other
10 Living with HIV and AIDS: Key Issues Disclosure to sexual and drug-sharing partners, family, friends, colleagues, employers and children is a key challenge for PHA Issue of HIV/AIDS as an episodic disability versus chronic manageable condition Despite major advances in treatment, PHA on HAART continue to experience higher rates of certain diseases Ability and willingness to adhere to prescribed treatment is related to psychosocial factors
11 Health Determinants and People Living with HIV/AIDS
12 Determinants of Health: Key Findings
13 Income, Socio-economic Status Relationship between HIV and income is bi-directional: many of those at risk for HIV in Canada already live in poverty; for many of those with relatively higher incomes prior to infection, living with HIV means a reduction in income Different experiences based on income, poor and homeless PHA experience more stigma and discrimination Clear relationship between low income and treatment access
14 Employment PHA face challenges in managing health at work need for accommodation, supportive environment PHA identify stigma and discrimination at work as an ongoing issue; disclosure is a complex challenge Disincentives to return to work: concerns about loss of government income and medication coverage; personal health status; workplace discrimination Benefits of work: financial security, independence, empowerment, identify, socialization, self-worth, daily structure, distraction form health concerns
15 Social Environments Stigma and discrimination against PHA reinforces existing social inequalities and can lead to social isolation Stigma is associated with feelings of low self-worth, psychological distress, loneliness, hopelessness, depression Fear of stigma and discrimination has been found to contribute to silence and denial around topics of sex, sexual health, drug use, and sexual orientation Impact on health care access and health status
16 Social Support Networks Social support is key to resilience and overcoming the impacts of stigma and discrimination Conversely, lack of social support, has negative health consequences for PHA Community engagement, faith and spirituality are key sources of resilience
17 The Response to HIV/AIDS: Research, Policy and Programs
18 Current Research on PHA 148 research projects identified with a PHA focus (2008-2010) Of the 79 identifying a specific population: women (35), people from HIV-endemic countries (15), Aboriginal (13), gay men (10), youth (10), people who inject drugs (9) 53 specifically identified a determinant of health: access to health care (19), social environments (14), gender (8), personal health practices (8), culture (7), social support (7), multiple DoH (6)
19 Policy and Programmatic Response Governments across Canada have HIV/AIDS or STBBI strategies that address PHA Strong tradition of community response from local to national level 111 projects address PHA Ontario (34), BC (23), Quebec (21), Alberta (8), Newfoundland (5), Saskatchewan (4), Manitoba (4), Nova Scotia (4), New Brunswick (4), PEI (1), Yukon (1), NWT (1), Nunavut (0)
20 Research Implications Lack of national data on health status, comorbidities Lack of information on PHA s income and social status, education and literacy levels, healthy child development, and the relationship with health status Further research on personal and societal factors contributing to PHA resilience
21 Acknowledgements Sincere appreciation to National Expert Working Group members for their exceptional commitment: Stephen Alexander, Canadian AIDS Society (Ottawa, ON) Riyas Fadel, Coalition des organismes communautaires québécois de lutte contre le sida (Montreal, QC) Paul MacPherson, the Ottawa Hospital, Ottawa University (Ottawa, ON) Peetanacoot Nenakawekapo,Nine Circles Community Health Centre (Winnipeg, MB) Jeanne Nzeyimana, Canadian Treatment Action Council (BC) Joanne Otis, Université du Québec à Montréal (Montreal, QC) Troy Perrot, AIDS PEI (Charlottetown, PEI) Greg Robinson, Canadian Working Group on HIV and Rehabilitation (Toronto, ON) Darien Taylor, Canadian AIDS Treatment Information Exchange (Toronto, ON) Catherine Worthington, Faculty of Social Work, University of Calgary (Calgary, AB) Jeannine McNeil, Atlantic Region, PHAC (Halifax, NS) Programs and Partnerships Division, PHAC: Kimberly L. Hawkins, Alain Houde, Leslie McLaughlin, Tanya Lary, Brian Gottheil, Surveillance and Epidemiology Division, PHAC: Chris Houston, Kristina Lalonde Tomas, Jill Tarasuk
22 Contact Information Tanya Lary Senior Policy Advisor Populations and Health Determinants Section Programs and Partnerships Division Centre for Communicable Diseases and Infection Control tanya.lary@phac-aspc.gc.ca Brian Gottheil Manager Populations and Health Determinants Section Programs and Partnerships Division Centre for Communicable Diseases and Infection Control brian.gottheil@phac-aspc.gc.ca