Ken Miller - Executive Director of the Canadian AIDS Society - (Photo Supplied via Andrei Rosario Photography)
A silent crisis is creeping up on Canadians everywhere.
World AIDS Day was on Monday and this week is Indigenous AIDS Awareness Week.
Ahead of the week, the Public Health Agency of Canada released the 2023 HIV surveillance report.
“We see that Canada is experiencing a resurgence in HIV acquisition rates,” said Canadian AIDS Society, Executive Director, Ken Miller. “I would even call it a crisis created by political inaction and systemic inequities.”
HIV rates were up 35 per cent in 2023.
“It’s important to recognize that this actually follows a 24.9 per cent increase just the year before, and so these are drastic numbers moving upwards, which require drastic changes to be made immediately,” added Miller
One of the issues impacting rates is the loss of programs that positively impacted numbers.
“Ontario, Saskatchewan and Alberta rolling back proven and evidence-based programs that reduce HIV transmissions, these look like harm reduction programs, consumption and treatment sites, needle exchange programs, and these cuts have dire consequences,” explained Miller. “Especially for Indigenous people, African, Caribbean and black communities and women, as these communities are already just thrown aside, or not even acknowledged with much of the one-size-fits-all public health messaging that we’ve seen for years.”
“When I know something works and I get rid of it, what am I left with? Things that don’t work. I personally can only foresee this decision leading to far more overdoses on the street, far more deaths from drug poisoning, and we’re not only seeing it on in Ontario, we’re seeing a coordinated effort across Ontario, Saskatchewan and Alberta to diminish the harm reduction programs and implement abstinence-based programming, which have far less success rate.”
The Canadian AIDS Society fully supports abstinence-based programming, and support treatment programs, but they say there needs to be other options.
“When we implement them as the only line of defence during a time when people are dying, it is a misstep and it is harmful,” said Miller.
In addition to a cutback in programming, the Society says a lack of information, worsens the issue.
“We’re seeing is many communities that are being affected, who have not received adequate messaging or not been involved in adequate programming now having higher rates of HIV partially as a result of that,” said Miller. “We’re seeing Indigenous communities in particular face over-representation in HIV acquisition rates, and these actually mirror some countries where HIV is considered endemic, and this disparity highlights systemic neglect, as policies fail to address the specific needs of Indigenous populations.”
Progress is obtainable because there is HIV treatment in Canada.
We have medications such as long-acting injectable prep or HIV treatment that can prevent HIV transmission.
With successful treatment, HIV can reach a level referred to as U=U. This status means undetectable equals untransmittable.
According to the federal government, there is strong scientific evidence tells us that HIV is not passed on through sex when a person living with HIV is on treatment
Strong scientific evidence tells us that HIV is not passed on through sex when a person living with HIV is on treatment and the amount of HIV in their blood remains very low.
Keeping HIV levels low may also reduce the risk of passing it through non-sexual activities like sharing drug use equipment, pregnancy, or breastfeeding.
There is, however, not yet enough evidence to say that there is no risk of HIV being passed in these ways.
HIV cannot be passed through touching, kissing or hugging.
“Why are we not ensuring that 100 per cent of people who are diagnosed are receiving treatment?,” said Miller. “Because that in itself is prevention.”
It’s unclear what demographics make up the 15 per cent of people with HIV who are not currently receiving treatment.
“When we’re talking about stats and we’re talking about surveillance data, the only province that I’m aware of that is actually reporting on numbers where it creates a direct link from houselessness or unhoused people to HIV is Manitoba. So this is an issue because if no one else is reporting on this, it leaves us with a national action plan that does not highlight houselessness as being or houseless individuals as being a priority population.”
The Manitoban data shows that the unhoused population could be more susceptible to HIV.
“We see that 47.9 per cent of women who acquired HIV between 2018 and 21 were houseless and we saw a third of males who are newly diagnosed between that same time also housesless,” said Miller. “This tells me that we need to do better in not only reporting on those numbers, but investigating those numbers, and we need to do better about creating specific programming that supports people out of houselessness and into their own homes as another prevention method.”
Moving forward the Canadian AIDS Society sees political advocacy as a key to change.
They have created a call to action that they consider a clear path forward.
This was sent to every member of parliament in the country.
The call to action includes:
- Political Will and Funding: Governments must commit to sustained funding for prevention, treatment, and advocacy initiatives.
- Accessible Treatment: Long-acting injectable treatments and PrEP must be made widely available.
- Inclusive Messaging: Health campaigns must address all at-risk populations, not just narrow demographic groups.
- Public Engagement: Canadians need to recognize that HIV is no longer confined to certain populations, heterosexual contact is now the leading exposure category, and this is no longer a “gay man’s illness”.
- Decriminalization: Canada must stop criminalizing people living with HIV; law reform is needed today.
- Advocacy
In addition, to the call, a coalition of over 20 organizations, including CATIE (Canada’s Source for HIV and Hepatitis C Information), Canadian AIDS Society, Canadian Positive People Network, have sent two proposals to Health Minister Mark Holland.
“These proposals outlined what community organizations see as a good path forward and should be taken seriously,” said Miller. “One proposal is a bilateral agreement between the federal government and the provincial government, so the provinces can indicate what’s needed within their local context and have support from the federal government to make those programs.”
“The other is to top up the Community Action Fund, which is the fund that most organizations that support people living with HIV access funding from.”
According to the Public Health Agency of Canada, there were 2,434 new HIV diagnoses in 2023, with the National rate of new HIV diagnoses sitting at 6.1 per 100,000 people.
Provincial and Territorial HIV Diagnosis Rates:
- Territories – 2.2
- British Columbia – 3.3
- Alberta – 5.4
- Saskatchewan – 19.4
- Manitoba – 19.3
- Ontario – 6.0
- Quebec – 5.4
- Atlantic – 2.4
Since 2021, HIV rates have increased nationally every year.
“Canada has the tools to end the HIV epidemic, and what it needs now is the courage and commitment to use them,” said Miller.”We need to do better, we can do better, we have the initiatives and the research and the programs to end this crisis almost immediately. What we need is the political will and the funding to allow the community to do it.”
The Canadian AIDS Society is encouraging residents to reach out to their local member of parliament to advocate for change.
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