Why are HIV rates rising in Canada, even as the number of people infected with HIV is declining around the world?

The number of people diagnosed with and dying from HIV/AIDS is decreasing around the world. However, progress has been uneven, with only a few countries on track to meet the global goal set by the United Nations to eliminate HIV as a public health threat by 2030. It has been suggested that new research from Lancet HIV Medical journal.

From 2010 to 2021, the number of new HIV infections worldwide decreased by almost 22%. This decline is primarily due to progress in sub-Saharan Africa. But in Canada, the opposite is happening. In 2023, 2,434 people were newly diagnosed with HIV here, an increase of 35% compared to the previous year. The number of new infections has been on a downward trend from 2016 to 2020. Despite the increase in infections, the number of deaths from HIV is decreasing in Canada.

The authors of the Lancet report said that globally, HIV-related deaths also fell by almost 40% between 2010 and 2021, and that antiretroviral therapy (a combination of drugs that usually blocks the virus from replicating) He points out that it is thanks to him. Most people who take the drug every day for several months have so little virus in their blood that it goes undetected by tests and cannot infect others.

“The biggest lesson is that progress is possible, but it requires continued focus,” said Austin, a research scientist at the University of Washington Institute for Health Metrics and Evaluation and one of the study's authors.・Mr. Carter said.

The most dramatic improvements in both diagnoses and deaths were seen in sub-Saharan Africa. However, the region still leads the world in mortality rates. “Some patients get tested too late, and HIV testing is not free nationwide,” says Gertrude Comoyo, who works with Médecins Sans Frontières to care for patients with advanced HIV in Bangui, Central African Republic. The doctor speaks.

“The problem is that we have forgotten.”

Canada is not the only country where the number of people infected with HIV is increasing. Researchers say this is a pattern seen in other wealthy countries as well.

“The story in high-income countries is that it is difficult to eliminate HIV,” Carter said.

He said the numbers reflected not only a decline in interest in HIV care but also an increase in high-risk populations, including men who have sex with men and men who inject drugs.

Almost 40 per cent of new diagnoses in Canada were due to heterosexual contact. 36% involved sexual contact between men. 18% involved injection drug use.

“The problem is that we've forgotten,” said Dr. Rejean Thomas, who witnessed the worst of the 1980s AIDS crisis at his clinic in Montreal's Gay Village.

At that time, most of the AIDS patients he treated died within a year. He is now following patients who have contracted the virus and become older.

“Some days I'm doing geriatrics,” Thomas said.

“In the '80s, this was a new disease that was killing people. There was no cure, but now there is a cure. This is a chronic disease, but it's more difficult to educate and prevent. .”

better prevention and treatment

Prevention involves self-testing and taking a daily pill known as PrEP (pre-exposure prophylaxis), which significantly reduces the risk of HIV infection.

And in the future, easier prevention methods may emerge. Doctors Without Borders begins roll out An injectable HIV prevention drug has been developed in southern Africa that will replace daily pills with bimonthly injections. In Canada, the drug was approved This spring, some at-risk youth and adults will be eligible.

Another drug, lenacapavir, has also been shown to be effective for conditions such as: HIV prevention It is an injection twice a year. The drug is not yet approved for preventing infection, but already in use It is used as an antiretroviral treatment in Canada.

Dr. Antonio Flores, an HIV expert with Médecins Sans Frontières, said injectable preventive drugs like lenacapavir could be a game-changer in the HIV epidemic, but there are already concerns about access.

“We expect this to be a game-changer once it becomes widely available and reaches the people who will benefit from it,” he said, adding that it could effectively eliminate HIV as a public health threat around the world. To do so, he pointed out, a long-acting injectable drug is needed. The price is similar to oral PrEP, and it is “currently very cheap.”

Harm reduction, culturally sensitive solutions

In Canada, the prairies of Saskatchewan and Manitoba are the worst affected. Much higher incidence of new diabetes That's higher than other states, according to PHAC.

In Regina, which has one of the highest rates of HIV diagnosis in Canada, according to PHAC, community workers are focusing on meeting people where they are and providing information about where and how they can receive care. I'm leaving it there.

Vidya Reddy, education coordinator for the South Saskatchewan AIDS Program, says she feels like she's playing catch-up since the pandemic. PHAC's figures suggest many more people were infected during the pandemic, but Reddy said testing couldn't keep up because medical resources were stretched.

Ready said unsafe injection drug use, including sharing syringes and needles, is a key factor associated with the spread of HIV in Saskatchewan. This reinforces the need for harm reduction programs, such as providing sterile injection equipment, he says.

“People don't have access to safe supplies and not enough people know if they have HIV,” he said.

Another concern among those working on HIV prevention is that some people, especially those who already have difficulty accessing health care, are concerned.

Margaret Kisikou Piesis, CEO of the Canadian Indigenous AIDS Network, said she has learned that many Indigenous people are reluctant to get tested in health care facilities for fear of facing discrimination. He says he is.

“There are some barriers to them getting this type of care,” she says. “Why would I worry about getting tested for HIV if I don't have a place to live?”

Piesis seeks culturally sensitive solutions by and for Indigenous peoples.

“Solutions that are truly guided by our indigenous knowledge and our knowledge. They have to come to life again,” she said, adding that programs focused on these solutions include more He emphasized that government funding is needed.

Thomas said increasing funding for HIV prevention is a long-term bargain for health systems when compared to long-term treatment costs.

“This epidemic is not over yet,” he said. “I hope the government continues to recognize that this infection remains important.”