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Rising HIV cases in Canada: Putting the numbers in perspective

A recent Health Canada report outlining a 35.2 per cent rise in human immunodeficiency virus (HIV) infection across the country has garnered widespread media attention and sparked concerns about the effectiveness of our public health system.

However, while this rise, juxtaposed with global trends showing a decline in new cases since 2010, poses a significant challenge to our health-care system, more context is required to fully understand the complex dynamics at play and to evaluate the magnitude of the HIV burden in Canada.

We have seen a steady rise in reported HIV infections over the past several years: an increase of 10.9 per cent from 2020 to 2021; 24.9 per cent between 2021 and 2022; the above mentioned 35.2 per cent in 2023, which represents 2,434 new HIV diagnoses.

Though that might indicate that the public health system has failed in containing HIV, the raw numbers don’t tell the full story. Comparing crude case numbers between years is like comparing apples to oranges as the nature of the population changes every year. Over the past three years, Canada has experienced significant population growth, largely due to immigration. With a larger population, it’s natural that the absolute number of HIV diagnoses would rise. To properly assess trends over time, we need to consider the rate of new cases relative to the population at risk.

When normalized to the population, the incidence rate of newly diagnosed HIV in 2023 was 6.1 cases per 100,000 people; the rates in 2022 and 2021 were 4.7 and 3.8, respectively. The newly reported 2023 rate is comparable with the historical average, as it matches the 2011 rate and is well within the range observed between 2011 and 2019, when incidence fluctuated between 5.3 and 6.2 cases per 100,000 individuals. The reduction in incidence rate between 2020 and 2023 can be attributed to the COVID-19 pandemic, when HIV surveillance was limited and people were discouraged from making non-urgent health-care visits. When the pandemic was better controlled in 2022, restriction to health-care access was eased, and HIV testing increased. Thus, the increase in rate is not a true increase but a post-pandemic rebound.

The increase in rate is not a true increase but a post-pandemic rebound.

In fact, the rate of newly diagnosed HIV cases is significantly lower in Canada than other countries that have equally developed health care and surveillance systems. Between 2011 and 2022, when new HIV diagnoses in Canada fluctuated between 3.8 and 6.2 cases per 100,000 individuals, France reported a rate between 5.3 and 8.6. In the United Kingdom, the incidence rates varied between 5.0 and 9.8.

The fluctuations during the pandemic also were observable in France, the U.K., Sweden, Norway and other European nations. The most dramatic change was in Belgium, which saw its incidence rate drop from 8.6 in 2019 to 4.5 in 2021, only for it to double to 9.1 in 2022.

Canada’s public health system deserves recognition for its consistent and effective efforts in HIV prevention, which have kept incidence rates stable over the past decade and significantly lower than those of comparable nations. Taking the recent increase in newly diagnosed cases out of context creates a misleadingly grim narrative that fails to reflect the reality of our public health achievements. Such oversimplifications also undervalue the substantial progress made in managing HIV through prevention, testing, and treatment programs.

However, this does not mean there is room for complacency. While the rate of new HIV diagnoses has remained consistent, the absolute number of people living with HIV in Canada continues to grow. This is largely due to the life-extending benefits of highly effective antiretroviral therapy that allows individuals with HIV to live long, healthy lives. But as a chronic condition, HIV requires lifelong management, including regular monitoring of viral loads, adherence support for medication and timely treatment of opportunistic infections.

These ongoing needs present a mounting challenge for Canada’s health-care system, which is already grappling with severe staff shortages, extended wait times and strained resources. The growing demand for long-term management of chronic conditions like HIV further exacerbates this burden. Tackling this issue requires proactive and strategic planning, including investments from both provincial and federal governments to expand health-care capacity, attract and retain skilled health-care workers, support research into innovative solutions, and increase funding for surveillance systems to address the challenges posed by a rapidly expanding population.

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Authors

Dat Nguyen

Contributor

Dat Nguyen is a cancer biologist working with the University Health Network in Toronto. He has a Bachelor’s degree in public health and a Master’s in Microbiology and Immunology.

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