1. The HIV epidemic in Ontario: 2004 update Robert S. Remis, MD, MPH, FRCPC Ontario HIV Epidemiologic Monitoring Unit Department of Public Health Sciences, University of Toronto Ontario HIV Treatment Network Research Conference November 25, 2004

2. instructional media centre, Laboratories Branch - 2000 Background HIV epidemic in Ontario is unstable and dynamic HIV epidemic in Ontario is unstable and dynamic Critical to monitor trends in HIV transmission (incidence) and burden of HIV infection (prevalence) to evaluate effectiveness of prevention and assess the need for health and support services Critical to monitor trends in HIV transmission (incidence) and burden of HIV infection (prevalence) to evaluate effectiveness of prevention and assess the need for health and support services Dr. Robert S. Remis Public Health Sciences, University of Toronto

3. instructional media centre, Laboratories Branch - 2000 Organization of presentation Brief review of Ontario AIDS and HIV data Brief review of Ontario AIDS and HIV data Ontario HIV model 2003 Ontario HIV model 2003 Focus on evolving situations with respect to: Focus on evolving situations with respect to: MSM MSM IDU IDU HIV-endemic HIV-endemic Other heterosexual Other heterosexual Dr. Robert S. Remis Public Health Sciences, University of Toronto

4. instructional media centre, Laboratories Branch - 2000 Number of first-time HIV diagnoses by sex and proportion female, 1985–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

5. instructional media centre, Laboratories Branch - 2000 First-time HIV-positive diagnoses among males (n=21,325), Ontario, 1985–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

6. instructional media centre, Laboratories Branch - 2000 First-time HIV-positive diagnoses among females (n=3,409), Ontario, 1985–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

7. instructional media centre, Laboratories Branch - 2000 Number first-time HIV diagnoses by sex Ontario, 1999–2004* * Annual, projected from first half of year

8. instructional media centre, Laboratories Branch - 2000 Number of first-time HIV diagnoses MSM, Ontario, 1999–2004* * Annual, projected from first half of year

9. instructional media centre, Laboratories Branch - 2000 Number of first-time HIV diagnoses for selected exposure categories, 1999–2004* * Annual, projected from first half of year

10. instructional media centre, Laboratories Branch - 2000 Reported AIDS cases among MSM, Ontario, 1981–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

11. instructional media centre, Laboratories Branch - 2000 Reported AIDS cases by exposure category, Ontario, 1981–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

12. instructional media centre, Laboratories Branch - 2000 Modeled HIV prevalence and diagnoses by exposure category, Ontario, 2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

13. instructional media centre, Laboratories Branch - 2000 HIV incidence from detuned assay among MSM, Ontario, October 1999 – December 2003 Source: Laboratory Enhancement Study

14. instructional media centre, Laboratories Branch - 2000 HIV incidence from detuned assay among MSM, Toronto, October 1999 – December 2003 Source: Laboratory Enhancement Study

15. instructional media centre, Laboratories Branch - 2000 HIV incidence from detuned assay among MSM, Ottawa, October 1999 – December 2003 Source: Laboratory Enhancement Study

16. instructional media centre, Laboratories Branch - 2000 HIV incidence from detuned assay among MSM, other regions, October 1999 – December 2003 Source: Laboratory Enhancement Study

17. instructional media centre, Laboratories Branch - 2000 Modeled HIV prevalence among MSM Ontario, 1977–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

18. instructional media centre, Laboratories Branch - 2000 MSM: Epidemiologic overview 14,370 HIV-infected (61% of Ontario infections), 69% diagnosed 14,370 HIV-infected (61% of Ontario infections), 69% diagnosed New HIV diagnoses 2004 up 54% over 2001, especially in Toronto and Central West regions New HIV diagnoses 2004 up 54% over 2001, especially in Toronto and Central West regions HIV prevalence 15% (Toronto 19%, Ottawa 18%, other 8%) HIV prevalence 15% (Toronto 19%, Ottawa 18%, other 8%) 1998-2003 prevalence up 29% (annual 5%) 1998-2003 prevalence up 29% (annual 5%) 690 new infections in 2003 690 new infections in 2003 HIV incidence 0.9% (Toronto 1.1%, Ottawa 1.5%, other 0.3%) HIV incidence 0.9% (Toronto 1.1%, Ottawa 1.5%, other 0.3%) Dr. Robert S. Remis Public Health Sciences, University of Toronto

19. instructional media centre, Laboratories Branch - 2000 HIV incidence from detuned assay among IDU, Ontario, October 1999 – December 2003 Source: Laboratory Enhancement Study

20. instructional media centre, Laboratories Branch - 2000 HIV incidence from detuned assay among IDU, Toronto, October 1999 – December 2003 Source: Laboratory Enhancement Study

21. instructional media centre, Laboratories Branch - 2000 HIV incidence from detuned assay among IDU, Ottawa, October 1999 – December 2003 Source: Laboratory Enhancement Study

22. instructional media centre, Laboratories Branch - 2000 HIV incidence from detuned assay among IDU, other regions, October 1999 – December 2003 Source: Laboratory Enhancement Study

23. instructional media centre, Laboratories Branch - 2000 Modeled HIV prevalence among IDUs Ontario, 1977–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

24. instructional media centre, Laboratories Branch - 2000 IDU: Epidemiologic overview 1,960 HIV-infected (8% of Ontario infections), 67% diagnosed 1,960 HIV-infected (8% of Ontario infections), 67% diagnosed New HIV diagnoses stable overall past five years, though increase in 2004 in Southwest and Northern regions New HIV diagnoses stable overall past five years, though increase in 2004 in Southwest and Northern regions HIV prevalence 5% (Ottawa 15%, elsewhere 4%) HIV prevalence 5% (Ottawa 15%, elsewhere 4%) 1998-2003 prevalence up 8% (annual 1.5%) 1998-2003 prevalence up 8% (annual 1.5%) 80 new infections in 2003; HIV incidence 0.2% 80 new infections in 2003; HIV incidence 0.2% Relatively reassuring Relatively reassuring Dr. Robert S. Remis Public Health Sciences, University of Toronto

25. instructional media centre, Laboratories Branch - 2000 Modeled HIV prevalence persons from HIV-endemic regions, Ontario, 1977–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

26. instructional media centre, Laboratories Branch - 2000 HIV-endemic: Epidemiologic overview 3,310 HIV-infected (13% of Ontario infections); 48% diagnosed 3,310 HIV-infected (13% of Ontario infections); 48% diagnosed HIV prevalence 0.8% HIV prevalence 0.8% Most HIV-infected persons in Toronto (75%) and Ottawa (15%) Most HIV-infected persons in Toronto (75%) and Ottawa (15%) 1998-2003 prevalence up 86% (annual 13%) 1998-2003 prevalence up 86% (annual 13%) New HIV diagnoses increased 1999 (160) to 2002 (280) then decreased somewhat (230 in 2004) New HIV diagnoses increased 1999 (160) to 2002 (280) then decreased somewhat (230 in 2004) 330 new HIV infections in 2003 (imported & Canada) 330 new HIV infections in 2003 (imported & Canada) Dr. Robert S. Remis Public Health Sciences, University of Toronto

27. instructional media centre, Laboratories Branch - 2000 Modeled HIV prevalence other persons infected heterosexually, Ontario, 1977–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

28. instructional media centre, Laboratories Branch - 2000 Heterosexual : Epidemiologic overview 3,310 HIV-infected (14% of Ontario infections), 48% diagnosed 3,310 HIV-infected (14% of Ontario infections), 48% diagnosed 1998-2003 HIV prevalence up 64% (annual 10%) 1998-2003 HIV prevalence up 64% (annual 10%) 2000 to 2004, HIV diagnoses increased 70%; increased in most regions but especially Central West (+202%), Southwest (+160%) and Toronto (+74%) 2000 to 2004, HIV diagnoses increased 70%; increased in most regions but especially Central West (+202%), Southwest (+160%) and Toronto (+74%) 320 new HIV infections in 2003 320 new HIV infections in 2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

29. instructional media centre, Laboratories Branch - 2000 Limitations Populations at risk not well characterized Populations at risk not well characterized Adjustments for HIV diagnoses, AIDS cases and HIV-related mortality subject to uncertainty Adjustments for HIV diagnoses, AIDS cases and HIV-related mortality subject to uncertainty Data on HIV incidence limited and biased Data on HIV incidence limited and biased Despite challenges, triangulation allows obtaining plausible estimates for HIV incidence and prevalence Despite challenges, triangulation allows obtaining plausible estimates for HIV incidence and prevalence Dr. Robert S. Remis Public Health Sciences, University of Toronto

30. instructional media centre, Laboratories Branch - 2000 Conclusions Good news: AIDS incidence and mortality decreasing and situation reassuring among IDUs Good news: AIDS incidence and mortality decreasing and situation reassuring among IDUs Overall, HIV epidemic in Ontario unstable Overall, HIV epidemic in Ontario unstable HIV prevalence up 36% past 5 years (17,400 to 23,600) HIV prevalence up 36% past 5 years (17,400 to 23,600) Concerning in MSM, HIV-endemic and heterosexual Concerning in MSM, HIV-endemic and heterosexual Sustained HIV transmission in these groups Sustained HIV transmission in these groups Dr. Robert S. Remis Public Health Sciences, University of Toronto

31. instructional media centre, Laboratories Branch - 2000 Acknowledgements Frank McGee, AIDS Bureau, Ontario Ministry of Health and Long Term Care (MOHLTC) Frank McGee, AIDS Bureau, Ontario Ministry of Health and Long Term Care (MOHLTC) Carol Swantee, HIV Laboratory, MOHLTC Carol Swantee, HIV Laboratory, MOHLTC Jane Njiah, FSO, PHAC / MOHLTC Jane Njiah, FSO, PHAC / MOHLTC Maraki Fikre Merid, University of Toronto Maraki Fikre Merid, University of Toronto Lorraine Schiedel, Public Health Branch, MOHLTC Lorraine Schiedel, Public Health Branch, MOHLTC Ontario HIV Treatment Network (OHTN) and Health Canada for funding Laboratory Enhancement Study Ontario HIV Treatment Network (OHTN) and Health Canada for funding Laboratory Enhancement Study