1. Epidemiologic trends in HIV infection among men who have sex with men in Ontario: The situation in 2004 Robert S. Remis, Maraki Fikre Merid Ontario HIV Epidemiologic Monitoring Unit Department of Public Health Sciences University of Toronto Gay Men’s HIV Prevention Working Group Toronto, Ontario, November 18, 2004

2. MOHLTC, Laboratories Branch, IMC – 2001 Background MSM seriously affected by HIV epidemic since the beginning (late 1970s)MSM seriously affected by HIV epidemic since the beginning (late 1970s) Many developments have influenced trends in the epidemic since then:Many developments have influenced trends in the epidemic since then: Education, information and prevention Education, information and prevention Identification of HIV in 1984 HIV test developed late 1985 Antiretroviral drugs, 1987-95 HAART 1996-

3. MOHLTC, Laboratories Branch, IMC – 2001 Objective To examine trends in incidence and prevalence of HIV infection among MSM in OntarioTo examine trends in incidence and prevalence of HIV infection among MSM in Ontario

4. MOHLTC, Laboratories Branch, IMC – 2001 Methods: Data sources HIV diagnostic dataHIV diagnostic data Laboratory Enhancement StudyLaboratory Enhancement Study Detuned assayDetuned assay Repeat testersRepeat testers Reported AIDS casesReported AIDS cases HIV-related mortalityHIV-related mortality

5. MOHLTC, Laboratories Branch, IMC – 2001 Methods: Data analysis HIV model: Incidence and prevalence ofHIV model: Incidence and prevalence of HIV infectionHIV infection HIV diagnosesHIV diagnoses AIDSAIDS HIV-related mortalityHIV-related mortality Dr. Robert S. Remis Public Health Sciences, University of Toronto

6. MOHLTC, Laboratories Branch, IMC – 2001 Reported AIDS cases by exposure category and sex,1981-2003 * Proportion EC known = 96.4%

7. MOHLTC, Laboratories Branch, IMC – 2001 Reported AIDS cases for selected exposure categories, 1981-2003

8. MOHLTC, Laboratories Branch, IMC – 2001 First-time HIV diagnoses (adjusted) for selected exposure categories,1985-2003

9. MOHLTC, Laboratories Branch, IMC – 2001 HIV diagnoses (adjusted) by exposure category and gender, Ontario 1985-2003

10. MOHLTC, Laboratories Branch, IMC – 2001 First-time HIV diagnoses among MSM by health region, 1985-2003

11. MOHLTC, Laboratories Branch, IMC – 2001 Number first-time HIV diagnoses, MSM selected health regions, 1999–2004

12. MOHLTC, Laboratories Branch, IMC – 2001 Number first-time HIV diagnoses, MSM, Toronto, 1999–2004

13. MOHLTC, Laboratories Branch, IMC – 2001 HIV incidence among MSM repeat testers, with 95% CLs, 1992-2002 (37,711 PY) Source: Polaris Seroconversion Study

14. MOHLTC, Laboratories Branch, IMC – 2001 Measured and adjusted HIV incidence, MSM by health region,1999 – 2003 Source: Laboratory Enhancement Study

15. MOHLTC, Laboratories Branch, IMC – 2001 Measured and adjusted HIV incidence,MSM, Ontario, 1999 – 2003 Source: Laboratory Enhancement Study

16. MOHLTC, Laboratories Branch, IMC – 2001 Measured and adjusted HIV incidence MSM, Toronto, 1999 – 2003 Source: Laboratory Enhancement Study

17. MOHLTC, Laboratories Branch, IMC – 2001 Measured and adjusted HIV incidence MSM, Ottawa, 1999 – 2003 Source: Laboratory Enhancement Study

18. MOHLTC, Laboratories Branch, IMC – 2001 Measured and adjusted HIV incidence, MSM, Ontario, 1999 – 2003 Source: Laboratory Enhancement Study

19. MOHLTC, Laboratories Branch, IMC – 2001 Modeled HIV prevalence by exposure category, Ontario, December 2003

20. MOHLTC, Laboratories Branch, IMC – 2001 Modeled HIV incidence among MSM Ontario, 1977–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

21. MOHLTC, Laboratories Branch, IMC – 2001 Modeled HIV prevalence among MSM, Ontario, 1977–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

22. MOHLTC, Laboratories Branch, IMC – 2001 Conclusions Gay men in Ontario continue to be severelyGay men in Ontario continue to be severely affected by the HIV epidemic Remains most important groupRemains most important group 14,400 MSM HIV-infected14,400 MSM HIV-infected HIV prevalence: ~16% (varies regionally, 10-20%)HIV prevalence: ~16% (varies regionally, 10-20%) Past 5 years, Increase in MSM living with HIV infection 29%, 5.4% annuallyPast 5 years, Increase in MSM living with HIV infection 29%, 5.4% annually HIV incidence (i.e. new infections) not decreasing; increasing in OttawaHIV incidence (i.e. new infections) not decreasing; increasing in Ottawa

23. MOHLTC, Laboratories Branch, IMC – 2001 Conclusions Trends in risk behaviour elsewhere are consistent with trend in HIV incidenceTrends in risk behaviour elsewhere are consistent with trend in HIV incidence Reasons for persisting high incidence unclear: treatment optimism? safe-sex fatigue?Reasons for persisting high incidence unclear: treatment optimism? safe-sex fatigue?

24. MOHLTC, Laboratories Branch, IMC – 2001 Conclusions Observed increase in new HIV diagnoses in 2003 of particular concernObserved increase in new HIV diagnoses in 2003 of particular concern May be due to:May be due to: increased HIV testingincreased HIV testingor increased HIV incidenceincreased HIV incidence

25. MOHLTC, Laboratories Branch, IMC – 2001 Conclusions Likely due, at least in part, to increased HIV incidence since:Likely due, at least in part, to increased HIV incidence since: increase in HIV+ tests > increase in testsincrease in HIV+ tests > increase in tests proportion identified as seroconverters by linked tests or serologic evidence is stableproportion identified as seroconverters by linked tests or serologic evidence is stable incidence in repeat testers increasingincidence in repeat testers increasing data from elsewhere and syphilis epidemic evidence for increased risky sexual behaviourdata from elsewhere and syphilis epidemic evidence for increased risky sexual behaviour

26. MOHLTC, Laboratories Branch, IMC – 2001 Acknowledgements AIDS Bureau, Ontario Ministry of Health and Long-Term Care Frank McGee, coordinator Frank McGee, coordinator HIV Laboratory, Central Public Health Laboratory HIV Laboratory, Central Public Health Laboratory Carol Swantee, diagnostic data Carol Swantee, diagnostic data Keyi Wu, programming Keyi Wu, programming Jane Njihia Jane Njihia Laboratory Enhancement Study Laboratory Enhancement Study Chris Archibald, CIDPC, Health Canada Chris Archibald, CIDPC, Health Canada Ontario HIV Treatment Network Ontario HIV Treatment Network