HIV and AIDS among Aboriginal peoples in Canada: An Epidemiological Overview 2011 CAAN AGM Susanna Ogunnaike-Cooke, Jessica Halverson, Chris Archibald Surveillance and Risk Assessment Division Centre for Communicable Disease and Infection Control Public Health Agency of Canada
Presentation Outline National estimates of HIV prevalence and incidence HIV/AIDS surveillance data HIV diagnosis rates Enhanced surveillance data (Track surveillance systems)
Acknowledgements
National estimates and HIV/AIDS Surveillance data
Estimated HIV prevalence: 2008 In 2008, there were 65,000 (range: 54,000-76,000) people living with HIV (including AIDS) in Canada; Of these, the number of Aboriginal PHA at the end of 2008 was 4,300 to 6,100
Estimated HIV incidence, 2008 In 2008, there were 2,300 to 4,300 new HIV infections in Canada; 300 to 520 new HIV infections occurred in Aboriginal people in 2008 12.5% of all infections across Canada that year.
Estimated HIV incidence by race/ethnicity, Canada: 2008 (ranges of uncertainty omitted) 80 70 60 H IV in c id e n c e ra t e ( p e r 1 0 0,0 0 0 P Y ) 50 40 30 20 10 0 Ab o rig in a l p e o p le fro m H IV-e n d e m ic co u n trie s N o n -Ab o rig in a l & n o t fro m H IV e n d e m ic co u n trie s
Routine Surveillance: HIV/AIDS reporting system Person Living With HIV/AIDS Attending Health Care Provider Laboratories Regional Health Offices Provincial & Territorial Ministries PHAC
National HIV and AIDS Case Reporting Form
HIV Case Reports among Aboriginal peoples by diagnosis year 250 35 Number of positive HIV test reports among Aboriginal peoples 200 150 100 50 30 25 20 15 10 5 Percentage of positive HIV test reports with known ethnicity in Canada 0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year of test 0 Number of positive HIV test reports among Aboriginal peoples Percentage of positive HIV test reports with known ethnicity in Canada
Proportion of new diagnoses that are female, by Aboriginal vs. Non- Aboriginal Status Aboriginal Non-Aboriginal Positive HIV test reports 1998-2008 n = 1,886 n = 5,975 Female 48.8% 20.6% AIDS Diagnoses 1979-2008 n = 689 n = 16,131 Female 29.0% 9.1% n = number of cases with available information on gender and ethnicity
Age distribution of new diagnoses, by Aboriginal vs. Non-Aboriginal Status Positive HIV test reports 1998-December 31, 2008 Aboriginal Non-Aboriginal n = 1,891 n = 5,986 < 15 years 0.8% 0.6% 15-19 years 4.8% 1.0% 20-29 years 27.9% 19.6% 30-39 years 36.0% 35.8% 40-49 years 23.4% 27.6% 50+ years 7.2% 15.4% n = number of cases with available information on age and ethnicity
Perinatal HIV Transmission Between 1984 and 2008, Aboriginal infants were overrepresented among all infants perinatally exposed to HIV (16.2%), as well as among infants confirmed infected (9.5%) From 2002 to 2009, 296 Aboriginal infants were perinatally exposed to HIV; 17 of these were confirmed infected
Figure 5: Proportion of positive HIV test reports, by race/ethnicity and exposure category, 1998-2009 Percent 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% White Black Asian Aboriginal South Asian/West Asian/Arab Ethnic stat us Latin Other Heterosexual Contact Blood/Blood Products IDU MSM/IDU MSM
Rising HIV case reports in Saskatchewan
Sex and exposure categories of reported AIDS cases in Aboriginal ethnic groups in Canada between 1979 and December 31, 2008 First Nations Métis Inuit Aboriginal, unspecified n = 503 n = 52 n = 22 n = 113 % Female 29.9% 19.2% 40.9% 27.4% Exposure Category n = 482 n = 51 n = 22 n = 109 MSM 23.7% 43.1% 27.3% 34.9% MSM/IDU 7.7% 5.9% 4.5% 6.4% IDU 47.5% 29.4% 31.8% 26.6% Heterosexual 18.5% 17.6% 31.8% 28.4% Perinatal 1.0% 2.0% 0.0% 1.8% Other 1.7% 2.0% 4.5% 1.8% n= number of cases with available information on age and ethnicity
Standardized HIV Diagnosis Rates by Population
Overall HIV Diagnosis Rates by Sex Rates of new HIV diagnosis (per 100,000 per year) CANADA (excluding ON & QC) MALE FEMALE 1999-2003 2004-2008 1999-2003 2004-2008 Aboriginal Rates 41.1 35.6 31.0 35.7 White Rates 9.5 9.8 2.2 1.8
Ratios of New HIV Diagnoses by Reported Exposure (per 100,000 per year) Aboriginal Ratios White Ratios 1999-2003 1999-2003 Denominator Category Rate/100000 Rate/100000 Men 15-64y Heterosexual - Male Women 15-64y Heterosexual - Female 10.2 1.7 10.2 1.0 Men 15-64y IDU Male 24.1 2.9 Women 15-64y IDU Female 21.4 1.2 Men 15-64y MSM** 7.6 5.8 ** men reported as MSM and IDU were counted as MSM
Ratios of New HIV Diagnoses by Reported Exposure (per 100,000 per year) Aboriginal Ratios White Ratios 2004-2008 2004-2008 Denominator Category Rate/100000 Rate/100000 Men 15-64y Heterosexual Male Women 15-64y Heterosexual Female 9.5 1.7 11.9 0.9 Men 15-64y IDU Male 19.1 2.1 Women 15-64y IDU Female 23.7 0.9 Men 15-64y MSM** 6.6 6.9 ** men reported as MSM and IDU were counted as MSM
Ratios of New HIV Diagnoses by Reported Exposure (per 100,000 per year) Aboriginal Ratios 1999-2003 2004-2008 Denominator Category Rate/100000 Rate/100000 Men 15-64y Heterosexual - Male 10.2 9.5 Women 15-64y Heterosexual - Female 10.2 11.9 Men 15-64y IDU Male 24.1 19.1 Women 15-64y IDU Female 21.4 23.7 Men 15-64y MSM** 7.6 6.6 White Ratios 1999-2003 2004-2008 Denominator Category Rate/100000 Rate/100000 Men 15-64y Heterosexual Male 1.7 1.7 Women 15-64y Heterosexual Female 1.0 0.9 Men 15-64y IDU Male 2.9 2.1 Women 15-64y IDU Female 1.2 0.9 Men 15-64y MSM** 5.8 6.9 ** men reported as MSM and IDU were counted as MSM
Reported HIV Diagnosis Rates by Country (average rate per year per 100,000 population) Aboriginal White Canada men (2004-2008) 35.6 9.8 Canada women (2004-2008) 35.7 1.8 USA both sexes (2008) 11.9 8.2 Aboriginal Non-Aboriginal Australia men (2008) 6.0 7.8 Australia women (2008) 1.5 0.5 New Zealand both sexes (2004-2008) 2.6 2.8 Source data: CDC (USA), University of Otago (NZ), UNSW (Aus)
Enhanced Surveillance data Source: Track surveillance systems = Behavioural + Biological Surveillance of key populations
M-Track, 2005-2008 Method: Voluntary, anonymous, cross sectional surveillance survey in 5 sentinel sites; Participants: Approx 4,800 men across 5 sentinel sites Almost 3% most strongly identified as Aboriginal however, 6% of respondents reported Aboriginal ancestry. In Winnipeg, nearly half of the participants most strongly identified as Aboriginal.
M-Track, 2005-2008 Sexual and other risk behaviours among Aboriginal participants 68% reported multiple male sex partners (oral and/or anal sex) in the 6 months preceding survey administration; 39% reported consistent condom use with a casual male partners in the past 6 months; 20% reported receiving money, drugs or other good or services in exchange in sex;
M-Track, 2005-2008 HIV prevalence, testing and treatment history Most men who participated in M-Track reported having been tested for HIV (86%) 88% of Aboriginal participants who reported that their most recent HIV test was negative had been tested for HIV in the 2 years preceding survey participation; Survey biological component: Overall HIV prevalence was 15% - approximately 23% among Aboriginal participants A higher proportion of Aboriginal respondents were aware of their HIV status, 93% vs. 80% among others
Observations/Conclusions Seroprevalence of HIV is high among MSM from participating sentinel sites across Canada; Testing for HIV is high, but a non-negligible proportion of participants were unaware of their HIV positive status; Many men are having safer sex, but potential for the transmission of HIV and other STBBI among MSM in Canada still exists, since a significant proportion of men still report unprotected anal intercourse.
Phase 2 I-Track Sites: 2005 to 2008 Prince George Central and Northern Interior Vancouver Island: Campbell River Nanaimo Port Alberni Courtenay Duncan Port Hardy Victoria Edmonton Regina Thunder Bay Sudbury Toronto Kingston SurvUDI Network: Ottawa/Outaouais Montreal Québec City Montérégie Maurice/Centre du Québec Saguenay/Lac St-Jean Estrie (Eastern Townships) Abitibi/Témiscamingue
I-Track, 2005-2008 Method: Voluntary, anonymous, cross sectional surveillance survey in 10 sentinel sites; Participants: Approx 3300 participants across 10 sentinel sites; 2/3 (68%) were male; mean & median age 38 years. 1/4 self-identified as Aboriginal (FN, Métis, or Inuit) Differences noted across sentinel sites: 3 sites with <10%: Kingston, SurvUDI network, Toronto 3 sites with 20%-25%: Victoria, Victoria islands, Sudbury 4 sites with over 60%: PG, Edmonton, Thunder Bay, Regina
I-Track, 2005-2008 Injecting behaviours Approx. 20% reported using used needles or syringes in the preceding 6 months; Similar proportions reported borrowing from sex partners (45% overall) and/or close friends (41% overall); Differing proportions reported borrowing from family (15% of Aboriginal respondents vs 2% of other); people not known well (8% of Aboriginal respondents vs 20% of other); Person most frequently borrowed from: Sex partners (50% of Aboriginal respondents vs 42% of other ethnicities) and family (11% of Aboriginal respondents vs 1% of other ethnicities).
I-Track, 2005-2008 Sexual behaviours 4% reported receiving money, drugs goods or services in exchange for sex; Amongst Aboriginal participants, greater proportion of females reported receiving money, drugs goods or services in exchange for sex (7%) compared to males (1%) Of those who reported vaginal sex with a casual partner, approximately 50% reported consistent condom use.
I-Track, 2005-2008 HIV prevalence, testing and treatment history Most participants (90%) reported having been tested for HIV Of those whose most recent HIV test was negative, almost 80% of Aboriginal participants been tested for HIV in the 2 years preceding the survey; Survey biological component: Overall HIV prevalence was 14% similar for Aboriginal and non-aboriginal participants; range from 3% in Kingston to 21% in SurvUDI network; 18% in PG, 9% in Regina; 13% in Edmonton A lower proportion of Aboriginal respondents were aware of their HIV positive status, 73% vs. 82% among others
I-Track, 2005-2008 HCV exposure Overall, 69% who provided specimens for testing had been exposed to HCV; Approximately 10% had antibodies to both HIV and HCV. Note: HCV testing was performed using the Ortho HCV version 3.0 EIA. Confirmatory testing is not performed for samples that test positive. A positive result indicates past or present HCV infection, and does not discriminate acute from chronic or resolved infections.
Observations/conclusion Seroprevalence of HIV and HCV are high among I-Track participants in sentinel sites across Canada; Testing for HIV is high, but an important proportion of participants were unaware of their HIV positive status; Potentially important differences in patterns of sharing injecting paraphernalia between I-Track participants of Aboriginal ethnicity versus other ethnicities.
Overall Summary HIV among Aboriginal peoples in Canada
Summary of Data on HIV among Aboriginal peoples in Canada Estimates indicate an HIV infection rate 3.6 times higher among Aboriginal peoples in Canada in 2008 Aboriginal women and youth are disproportionately affected by HIV compared to non-aboriginal Canadians Injection drug use exposure is attributed to the majority of new HIV diagnoses among Aboriginal peoples Heterosexual contact also accounts for a large proportion of cases
Summary of Data on HIV among Aboriginal peoples (continued) Available data indicate that First Nations peoples may be overrepresented in diagnoses among Aboriginal peoples Surveillance data reveal higher burden of HIV in certain geographic regions; the recent rise in new HIV diagnoses primarily among Aboriginal peoples in Saskatchewan is of particular concerns Diagnosis rates and ratios reveal that Aboriginal peoples in Canada are many times more likely to be diagnosed with HIV compared to White Canadians; across all age groups and among both sexes Data from other high-income countries do not indicate disparities to the same extent as observed among indigenous people in Canada
PHAC reports and resources Surveillance Reports accessible at: http://www.phac-aspc.gc.ca/aids-sida/publication/indexeng.php#surveillance Epidemiology updates and National HIV Estimates accessible at: http://www.phac-aspc.gc.ca/aids-sida/publication/index-eng.php#er Population-specific status report: Aboriginal peoples http://www.phac-aspc.gc.ca/aids-sida/publication/ps-pd/aboriginalautochtones/index-eng.php For questions or additional information: susanna.ogunnaikecooke@phac-aspc.gc.ca jessica.halverson@phac-aspc.gc.ca
Thank you
Ethnic/racial breakdown of HIV case reports in Canada
HIV Diagnosis Rates per 100,000 per year, by Sex and Age Group Aboriginal Rates Age group MALE FEMALE 1999-2003 2004-2008 1999-2003 2004-2008 15-19y 4.5 5.4 15.1 21.6 20-29y 34.8 34.7 45.4 53.6 30-39y 77.4 61.9 45.5 49.5 40-49y 60.4 49.9 34.6 36.5 50+ 17.6 17.3 5.9 8.5 White Rates Age group MALE FEMALE 1999-2003 2004-2008 1999-2003 2004-2008 15-19y 0.3 0.4 0.8 0.7 20-29y 8.4 9.2 3.6 2.6 30-39y 18.5 16.8 3.3 2.8 40-49y 13.2 15.5 2.2 2.0 50+ 4.3 4.9 0.3 0.5