HIV in Canada

Canada.ca

This report was prepared by the Centre for Communicable Diseases and Infection Control, Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada. The publication of this report would not have been possible without the collaboration of public health surveillance and epidemiology units in all provinces and territories, whose continuous contribution to national HIV surveillance is gratefully appreciated. This report is possible because of the close collaboration and participation of all partners in HIV surveillance. 

We wish to acknowledge the invaluable contributions of the Black Expert Working Group, who critically reviewed this report: Dr. Geoffrey Maina, Dr. Lawrence Mbuagbaw, and Wangari Tharao. A special thank you and acknowledgement to Dr. Winston Husbands, whose continued advocacy for Black communities and whose collaborative efforts played an instrumental role in the development of the Black Expert Working Group. We also wish to acknowledge the contributions of the members of the People with Lived and Living Experience Working Group (PWLLE-WG); Laurel Challacombe and Andrew Brett from CATIE; Dr. Alex McClelland from Carleton University; and Dr. Nathan Lachowsky, Chris Draenos, and Ben Klassen from the Community-Based Research Centre (CBRC) who also critically reviewed this report.

Land Acknowledgement

We respectfully recognize and acknowledge that the lands on which we developed this surveillance report are the homelands of First Nations, Inuit, and Métis Peoples. We acknowledge our privilege to live and work on these lands and strive to foster equitable partnerships with First Nations, Inuit, and Métis Peoples and work collaboratively to advance reconciliation in Canada.

Data presented in this surveillance report was collected by local public health agencies and submitted to the Public Health Agency of Canada (PHAC) by provinces, territories, or other HIV surveillance programs. These public health agencies operate on lands which are the homelands of the First Nations, Inuit, and Métis Peoples.

We invite readers to reflect on the generations of First Nations, Inuit and Métis who have thrived and sustained themselves in the territories which you call home, and urge readers to recognize local Indigenous knowledge, and contribute to cultural revitalization and self-determination for Indigenous communities.

Executive summary

The HIV in Canada, Surveillance Report to December 31, 2022, published by the Public Health Agency of Canada (PHAC) presents and describes national epidemiological trends on Human Immunodeficiency Virus (HIV) diagnoses in Canada by geographic region, age at diagnosis, sex, race and/or ethnicity, and exposure category between 2013 and 2022. This surveillance report presents information on first-time diagnoses from all thirteen provinces and territories (PT), and provides robust evidence for the planning, evaluation, and implementation of HIV prevention and care programs and education.

The COVID-19 (SARS-CoV2 / Coronavirus Disease 2019) pandemic had impacts, both known and unknown, on access to HIV testing, prevention, and care services as well as on surveillance activities in Canada. For this reason, data for 2020, 2021 and 2022 should be interpreted with some caution. The true impact and lasting effects of the COVID-19 pandemic on HIV transmission in Canada may become clearer with continued collection and analysis of data in the years to come. Due to surveillance data being refined by the PT over time, as data are periodically reviewed and updated, surveillance data for previous years may also be reported by provinces and territories along with the current year’s dataset. As such, historical data presented in this report does not exactly match historical data presented in previous national reports.

Key findings include:

• In 2022, 1,833 newly diagnosed cases (i.e., no previous evidence of a positive test) of HIV were reported in Canada. This is an increase of 24.9% compared with 2021 (1,468 reported cases). This increase may be due, in part, to renewed access to HIV testing services in the later stages of the COVID-19 pandemic and increasing immigration volumes from across the globe (after pandemic restrictions were lifted) as noted by Immigration, Refugees and Citizenship Canada. Social determinants of health and epidemiological patterns place some immigrants at greater risk of HIV infection before and after they arrive in Canada. While the volume of immigration has increased post-pandemic, the proportion of positive HIV tests during an Immigration Medical Exam (IME) has remained low and fairly stable (0.3% or lower). The increase in cases identified by IMEs is proportional to the increased number of IMEs due to increased immigration volumes.
• The national rate of reported newly diagnosed HIV cases was 4.7 per 100,000 population in 2022, an increase from 3.8 per 100,000 population in 2021. While the 2022 rate is within pre-COVID-19 levels, this must be interpreted with caution as the diagnosis rate for 2022 includes only first-time diagnoses while data for previous years prior to 2020 may include previously diagnosed cases due to evolution in surveillance reporting methods.
• The overall trends of the past ten years show the number of first-time HIV diagnoses in Canada was relatively stable until 2020, with a previous peak of 1,850 cases in 2016 (rate of 5.2 per 100,000 population) decreasing to 1,325 cases in 2020 (rate of 3.5 per 100,000 population), followed by increases in 2021 and 2022.
• Data received by PHAC has the sex of cases classified by the mutually exclusive categories of male, female, transgender, or not provided. In some instances, sex and gender may be erroneously conflated in this data. Therefore, data for cases reported as male or female may or may not exclude transgender people, and reporting may not necessarily align with the gender identity of individuals, depending on data collection and reporting procedures by provinces and territories. HASS is actively working on improving our data collection and reporting to better represent gender-diverse communities.
• The HIV diagnosis rate was 6.3 per 100,000 population in males (male sex) and 3.1 per 100,000 population in females (female sex) in 2022; an increase from rates reported in 2021 (which were 5.5 and 2.1 HIV diagnoses per 100,000 population, respectively).
• Recent trends in the HIV diagnosis rate among males show a continued decline in rates from 8.4 per 100,000 in 2013 to 6.3 per 100,000 in 2022. Among females, the trend shows a subtle increase, peaking at 2.7 per 100,000 females in 2019 and increasing to 3.1 per 100,000 in 2022. While the 2022 rate in males remained below pre-COVID-19 pandemic levels, the rate in females was higher than pre-COVID-19 pandemic levels.
• When broken down into ten-year age groups, the HIV diagnosis rate in the 30 to 39 years age group was the highest among all age groups with 13.1 per 100,000 population in 2022.
• HIV diagnosis rates were observed to be at least two times greater in males than in females in all age groups, with the exceptions of the children <15 years (in which females had a higher HIV diagnosis rate), 15-to-19-year age group and the 40 to 59 years age group.
• While the overall national rate increased from 2021 to 2022, this was not uniform across all provinces and territories (PTs) – the rate increase was not observed in British Columbia, Saskatchewan, and the Territories.
• The highest HIV diagnosis rate across provinces and territories was in Saskatchewan, with 19.0 per 100,000 population. The lowest diagnosis rate was in the Territories region with 1.5 per 100,000 population.
• In contrast to previous years, in 2022 the largest proportion of adult HIV diagnoses was attributed to heterosexual contact (39.2%). According to reported exposure category, male-to-male sexual contact continues to account for the largest proportion of diagnoses in males (male sex), at 51.1% of diagnoses. Heterosexual contact continues to account for the largest proportion of diagnoses in females (female sex), at 60.1% of diagnoses. Injection drug use also remains a significant factor among cases in both males and females, accounting for 20.5% of all first-time diagnoses in 2022.
• Proportion of diagnoses attributable to different exposure categories also varied by age group. In the 20 to 24 year age group, male-to-male sexual contact accounted for the largest proportion of diagnoses (52.0%). By contrast, among 40 to 59 year olds, heterosexual contact accounted for the largest proportion of diagnoses (50.1%).
• Race-based data provides a key element in recognizing and understanding disparities in access to HIV care stemming from historic and ongoing colonialism, racism, and systemic and structural inequities in Canada. However, the reporting of race and/or ethnicity data varies significantly across jurisdictions. Overall, race and/or ethnicity data was reported for only 42.3% of first-time diagnoses in 2022. No race and/or ethnicity data were reported from Manitoba, Nova Scotia and Quebec.
• Among the 776 cases of new HIV diagnoses for whom race and/or ethnicity was reported, 30.5% of cases were reported as White people, 22.6% were reported as Indigenous people (First Nations, Inuit, Métis, or Indigenous-not otherwise specified), and 18.0% as Black people. Given race and/or ethnicity data is not missing randomly, these proportions are unlikely to be representative of all first-time diagnoses and should be interpreted with caution. In collaboration with community members, the National HIV Surveillance System (HASS) has established a Black Expert Working Group to provide advice and co-develop strategies to improve the completeness, interpretation, and contextualization of race and/or ethnicity data. HASS is seeking to establish similar engagements with First Nations, Inuit, and Métis representatives and/or organizations.
• An increased number of migrants (immigrants, refugees and temporary residents) tested positive for HIV during an immigration medical exam (IME) in Canada or abroad in 2022 compared to 2021. Data provided by Immigration, Refugees and Citizenship Canada (IRCC) demonstrated that in 2022 the total number of migrants who tested positive for HIV was 2,119, representing 0.26% of all IMEs, a proportion similar to pre-pandemic levels. In 2021, this proportion was lower (0.12%) where 865 migrants tested positive for HIV, corresponding with lower immigration volumes during that time, suggesting the large increase in HIV cases detected among migrants in 2022 was the result of increasing immigration volumes.
• Of the 239 infants reported to be potentially perinatally exposed to HIV in 2022, 96.2% were born to people who had received antiretroviral therapy (ART). There were six infants confirmed to have acquired HIV perinatally, two of whom were born to people who did not receive any ART, three of whom were born to people who received some or partial ART and one of whom was born to a person whose ART status was not known.
• In 2022, there were 84 cases of Acquired Immunodeficiency Syndrome (AIDS) reported, a continued decrease since 2013. However, findings should be interpreted with caution, as AIDS data were only submitted by four provinces in 2022 (New Brunswick, Nova Scotia, Ontario, and Saskatchewan) and, where this information was available, cases are likely underreported.
• In 2022, there were 129 deaths attributed to HIV. This represents a decrease compared with the 133 deaths attributed to HIV in 2021, however these deaths are still likely underreported.