1. AN OVERVIEW OF SPECIFIC COMMUNITIES AFFECTED BY HIV/AIDS IN CANADA Canadian Global Stakeholders’ Engagement Workshop Mark Gilbert, MD, FRCPC Director, Applied Epidemiology Unit Ontario HIV Treatment Network July 2015

2. Acknowledgements I wish to acknowledge the ancestral, traditional and unceded Aboriginal territories of the Coast Salish Peoples, and the Squamish, Musqueam, and Tsleil-waututh First Nations on whose territory we stand today.

3. 10 things about Canada that shock first time visitors whenonearth.net 1.We have milk in bags 2.We say “Eh?” 3.Moose Alert Signs 4.We’re a multicultural nation 5.Hockey is everywhere 6.We line up properly 7.Canada is huge 8.Canadians say “sorry” a lot 9.We love to talk about weather 10.We’re patriotic but we don’t like to admit it

4. UNAIDS report on MDG (2015)

5. Trends in new HIV cases Public Health Agency of Canada, 2014

6. HIV diagnosis rate per 100,000 population, 2013. PHAC (2014).

7. HIV diagnosis rate per 100,000 population, 2009-2013. PHAC (2014).

8. Canada is a settler country National Household Survey, 2011 Immigration: 6.8 million (21%) foreign-born 5.7 million (17%) second generation Higher proportion in major urban centres Ethnic origin: 1.4 million (4%) Aboriginal (First Nations, Métis, Inuit) Canadian, English, French, Scottish, Irish, German, Italian, Chinese, Ukrainian, Dutch and Polish Visible Minority: 6.3 million (19%)

9. New HIV cases by Ethnicity, Canada, 2013 Public Health Agency of Canada, 2014 9

10. New HIV cases by Exposure Category, Canada, 2013 Public Health Agency of Canada, 2014

11. Ethnicity by exposure category Public Health Agency of Canada, 2014

12. Beneath the surface 12 HIV infections Biological factors Individual factors Social factors Structural or policy factors are determined by:

13. BC Provincial Health Officer Report. HIV Stigma and Society: Renewing HIV prevention for Gay and Bisexual Men (2014)

14. Lifetime experiences of marginalization among MSM Sex Now Survey, 2011 Ferlatte et al. AIDS Behav (2014) 18:1256-1263.

15. Evidence of a syndemic (<30 years) Number of Marginalization experiences Ferlatte et al. AIDS Behav (2014) 18:1256-1263.

16. Syndemics as driver of HIV risk Number of Psychosocial health problems Relationship to Condomless Anal Sex with Unknown Status Partner Odds Ratio (95% CI) NoneREF One1.2 (0.9-1.7) Two1.6 (1.2-2.2) Three or more2.0 (1.5-2.7) 34 Ferlatte et al. AIDS Behav (2014) 18:1256-1263.

17. What are the implications for an HIV cure?

18. 18 HIV infections Biological factors Individual factors Social factors Structural or policy factors are determined by:

19. What are the implications for an HIV cure? 19 HIV cures Biological factors Individual factors Social factors Structural or policy factors will be determined by:

20. Thank you mgilbert@ohtn.on.ca National surveillance data taken from: Public Health Agency of Canada. HIV and AIDS in Canada: Surveillance Report to December 31, 2013. Minister of Publlc Works and Government Services Canada; 2014.