Epidemiologic trends in HIV infection among men who have sex with men in Ontario: The situation in 2

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Epidemiologic trends inHIV infection among men
who have sex with men in Ontario The situation
in 2003

• Robert S. Remis, Maraki Fikre Merid
• Ontario HIV Epidemiologic Monitoring Unit
• Department of Public Health Sciences
• University of Toronto
• Gay Mens HIV Prevention Summit
• AIDS Bureau, Ontario Ministry of Health and
  Long-term CareToronto, Ontario, March 17-18, 2004

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Background

• MSM seriously affected by HIV epidemic since the
  beginning (late 1970s)
• Many developments have influenced trends in the
  epidemic since then
• Education, information and prevention
• Identification of HIV in 1984
• HIV test developed late 1985
• Antiretroviral drugs, 1987-95
• HAART 1996-

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Objectives

• To examine trends in incidence and prevalence of
  HIV infection among MSM in Ontario
• To assess trends in HIV testing
• To examine recent increasing trends in number of
  HIV diagnoses and interpret observations

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Methods Data sources

• HIV diagnostic data
• Laboratory Enhancement Study
• Detuned assay
• Repeat testers
• Reported AIDS cases
• HIV-related mortality

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Methods Data analysis

• HIV model incidence and prevalence of
• HIV infection
• HIV diagnoses
• AIDS
• HIV-related mortality

Dr. Robert S. Remis Public Health Sciences,
University of Toronto
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Reported AIDS cases for selected exposure
categories, 1981-2002
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First-time HIV diagnoses (adjusted) for selected
exposure categories,1985-2002
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First-time HIV diagnoses among MSM by health
region, 1985-2002
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First-time HIV diagnoses (adjusted) MSM, by
quarter, 2000-03
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Number of HIV tests (adjusted) MSM, 1992-2002
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HIV incidence among MSM repeat testers, with 95
CLs, 1992-2001 (30,881 PY)
Source Polaris Seroconversion Study
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HIV incidence among MSM repeat testersby age
group, 1992-99
Source Polaris Seroconversion Study
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HIV incidence from detuned assay MSM by health
region, Oct 1999 Dec 2002
Source Laboratory Enhancement Study
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HIV incidence from detuned assay MSM by region
by period, Oct 1999 Dec 2002
Source Laboratory Enhancement Study
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Modeled HIV incidence among MSMOntario, 19772002
Dr. Robert S. Remis Public Health Sciences,
University of Toronto
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Modeled HIV prevalence among MSM Ontario,
19772002
Dr. Robert S. Remis Public Health Sciences,
University of Toronto
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Modeled MSM population at risk, HIV prevalence
and incidence by health region, Ontario, 2002
Dr. Robert S. Remis Public Health Sciences,
University of Toronto
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Modeled HIV prevalence and number diagnosed by
exposure category, 2002
Dr. Robert S. Remis Public Health Sciences,
University of Toronto
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Conclusions

• Gay men in Ontario continue to be severely
• affected by the HIV epidemic
• HIV prevalence 15 (regional variation10 -20)
• HIV incidence (i.e. new infections) not
  decreasing and likely increasing
• Trends in risk behaviour elsewhere are consistent
  with trend in HIV incidence
• Reasons for persisting high incidence unclear
  treatment optimism? safe-sex fatigue?

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Conclusions

• Observed increase in new HIV diagnoses in 2002 of
  particular concern
• May be due to
• increased HIV testing
• or
• increased HIV incidence

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Conclusions

• Likely due, at least in part, to increased HIV
  incidence since
• increase in HIV tests gt increase in tests
• proportion identified as seroconverters by linked
  tests or serologic evidence is stable
• incidence in repeat testers increasing (data not
  shown)
• data from elsewhere and syphilis epidemic
  evidence for increased risky sexual behaviour

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Acknowledgements

• AIDS Bureau, Ontario Ministry of Health and
  Long-Term Care
• Frank McGee, coordinator
• HIV Laboratory, Central Public Health Laboratory
• Carol Swantee, diagnostic data
• Keyi Wu, programming
• Jane Njihia
• Laboratory Enhancement Study
• Chris Archibald, CIDPC, Health Canada
• Ontario HIV Treatment Network