Good news: In Canada’s largest city, new infection rates are finally on the way down, although not uniformly.
Let me set the stage. For those that are fuzzy about Canadian geography, Ontario is Canada’s most populous province and Toronto by far its largest city. With a population pegged at about 2.6 million, or twice that if you include the greater metropolitan area, it has a significant population of gay and bisexual men living downtown whose number is hard to measure. However, it’s estimated that about 25% of these are HIV-positive. (I was one of them until I moved to the country twenty years ago.)
Says the AIDS Committee of Toronto (ACT's) website “It is estimated that over 19,000 people are currently living with HIV/AIDS in Toronto - over 16,000 have been diagnosed with HIV with an estimated 20% (3,200) who are HIV-positive but do not know it as they have not been diagnosed.” This equates to about 1 in 120 in the city being HIV-positive. (That’s what termed prevalence as opposed to incidence which relates to numbers of new infections.)
But here’s the good news. New infection rates are falling and have done for two years. According to the city’s annual report on Communicable Diseases for the second consecutive year, the annual incidence rate of HIV/AIDS declined, this time from 17.7 cases per 100,000 in 2012 to 14.3 cases per 100,000 in 2013, a drop of 19% Incidence rates in 2013 decreased for both males and females, representing the lowest number of reported cases over the entire 11-year surveillance period for both genders.”
(Not that Toronto is unique. On the world stage, according to UNAIDS, new infections globally have decreased from roughly 3.5 million per annum to 2.5 million in the last decade.)
Back to Toronto, what about men who have sex with men? They are, and always have been, heavily represented in the numbers. Gay, bisexual, and other men who have sex with men (MSM) accounted for 83% of all new HIV diagnoses among men in 2013, and 75% of all the HIV diagnoses in Toronto in 2013. In 2012, they accounted for 82% of all new HIV diagnoses among men, and 65% of all the HIV diagnoses.
Toronto’s recent record in reducing new infections exceeds that of Canada as a whole; the following chart illustrates the numbers
Clearly the age category with the most new infections is the 25-29 year-old group although the range is wide. The median age of diagnosis is in fact now 42, as opposed to 36 ten years ago.
Why the drop in numbers? Certainly in Toronto this is despite an increase in HIV testing locations and hours of operation which would at first be expected to increase the number of new diagnoses – those who in fact are aware of their status. And this is also despite a presumed increase in barebacking that we have seen elsewhere, but cannot be confirmed here because of a lack of recent data specific to Toronto. Could it be that barebacking is becoming “less risky”, as more poz men and women are a) diagnosed and then b) achieve undetectable viral load. Or are prevention campaigns such as those employed by ACT, paying off? Or are there still other factors at play? It’s hard to say – and it always will be.
We can say that the use of PrEP (pre exposure prophylaxis) is likely not a cause for any reduction in new infections as in 2013, its use would almost certainly be very minimal.
I asked ACT’s Communications Coordinator Chris Thomas for his take on why the numbers are down. Says Chris “if you unpack the numbers you see a little bit more where the drop is coming from. Where we have seen the most dramatic decrease is among women, specifically African-Caribbean-Black women, so in that population there was a 57% drop in new infections in 2013 compared to 2012, which is enormous. That may be because there are fewer undiagnosed women living in Toronto and that can hold true for any other population. We might just be biting into that group of people who are unaware of their status. In terms of other factors, something that may be lurking behind those numbers is supressed viral load and by other new prevention technologies that are being embraced by the community more widely.”
Whatever the reasons, it’s welcome news.