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AIDS 2010

Vienna, July 2010

HIV/AIDS and People from Countries where HIV is endemic –

Black people of African and Caribbean descent living in Canada

Findings from the development of a Population Specific HIV/AIDS Status Report

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Presentation Outline1. The Canadian Health

System

2. The Public Health Agency of Canada

3. The Federal Initiative to Address HIV/AIDS in Canada

4. The Population-Specific HIV/AIDS Status Report

5. Demographic Profile – People from HIV Endemic Countries

6. HIV/AIDS Surveillance and Epidemiology

7. Health Determinants and Vulnerability to HIV/AIDS

8. Current HIV/AIDS Research

9. Community Response to HIV/AIDS

10. Conclusions

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The Canadian Health System

•Health is a shared responsibility between federal and provincial/territorial governments

•Under the Canada Health Act, the management, organization and delivery of health services is a provincial/territorial responsibility

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Public Health Agency of Canada

Mission:To promote and protect the health of Canadians through leadership, partnership, innovation and action in public health

Role of the Agency is to:

• Promote health• Prevent and control chronic diseases and injuries• Prevent and control infectious diseases• Prepare for and respond to public health emergencies• Strengthen public health capacity in a manner

consistent with a shared understanding of the determinants of health and of the common factors that maintain health or lead to disease and injury

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Overview of the Federal Initiative to Address HIV/AIDS in Canada

Strategic Areas of Focus

Programs and Policy Interventions, including:• National & Regional Funding • Federal Prisons• First Nations on-reserve

Knowledge Development• Surveillance & Epidemiology • Laboratory Science• Research

Communications & Social Marketing

Coordination, Evaluation & Reporting

Global Engagement

Partners

Public Health

Agency of Canada

Health Canada

Correctional Service of

Canada

Canadian Institutes of

Health Research

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Federal Initiative Key Populations• People living with HIV/AIDS• Gay men and other men who have sex with

men• People who use injection drugs• Aboriginal Peoples• People in prisons• Women• People from countries where HIV is

endemic• Youth-at-risk

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Status Report Structure

• Introduction• Demographic Profile• Status of HIV and AIDS among People from

Countries where HIV is Endemic• Vulnerability to HIV• Current HIV/AIDS Research• The Response to HIV/AIDS among People from

Countries where HIV is Endemic• Conclusion

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HIV-Endemic Countries

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Focus on African and Caribbean HIV-Endemic Countries

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Demographic Profile – People from Caribbean and African

HIV-Endemic Countries

• Comprise 2.3% of Canadian population

• Younger than the general population

• 63% Ontario; 19% Quebec

• 96% Urban (50% in Toronto)

• Between 2001 and 2006 the population increased by 14%

• From 2001 to 2006, 7.9% of new immigrants were from countries where HIV is endemic

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Estimated Proportion of Risk Exposure Categories Among new HIV Infections, by

Time Period, Canada

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

1981-83 1984-86 1987-90 1996 1999 2002 2005 2008

Time period

Per

cen

tag

e

MSM IDU Heterosexual/Non-endemic Heterosexual/Endemic

Source: PHAC Epi Updates, July 2010.

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Geographic Distribution of HIV-Endemic AIDS Cases

Ontario451/ 36.1%

Quebec690/ 55.3%

Atlantic Canada14/: 1.2%

British Columbia37/: 3.1%

Prairie Provinces56/ 4.4%

Number of reported AIDS cases by province and national proportional

distribution for the HIV-endemic exposure subcategory, cumulative to

December 31, 2006 (n=1248)

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Health Determinants and Vulnerability to HIV/AIDS

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Biology, Gender

• Women’s biological susceptibility to HIV/AIDS

is exacerbated by their social and economic

circumstances, and cultural norms

• Sexual and physical violence against women

has a direct impact on their ability to practice

HIV prevention and care

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Migration, Social Support

• Positive HIV diagnosis poses challenges

around disclosure, reunification, fear of

authorities, and access to services

• Many immigrants experience a loss of

support from extended family due to

physical distance

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Culture, Racism

• Racism produces risks for HIV infection and compounds the stigma faced by Black PLWHAs

• Within the Black communities there is stigma towards HIV+ people; homophobia; taboos around sex and death

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Income, Employment, Physical Environments

Relative to the overall Canadian population, Canada’s

Black population is disproportionately affected by:– lower levels of income and higher

unemployment rates– limited access to safe, affordable housing– greater risk of living on the street and being

homeless– over-representation in the offender

community (6% of those in federal facilities)

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Access to Health Services

• The assumption that most people have considerable faith in the health care system and seek its services may not hold for many of those at risk of HIV infection

• Access challenges include:– lack of culturally sensitive and appropriate

information– communication difficulties– lack of awareness of availability of services

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Current HIV/AIDS Research

• 19 research projects focus on people from countries where HIV is endemic were identified; most are taking place at the municipal level in Alberta, Ontario, and Québec

• The following are general areas of investigation:- Knowledge of, and attitude towards, HIV/AIDS- Risk-taking behaviour – contributing factors and mitigating

strategies- Community needs and priorities for HIV/AIDS programs and

services- Strategies for increasing access to programs and services- Strategies to enhance design and delivery of programs and

services

• There is a need to conduct more research on this population, including community-based research

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Community Response to HIV/AIDS Among Black

Canadians

57 projects led by 43 organizationsProject breakdown according to organization categories (n=57)

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28%

11

20%

17

29%

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23% HIV/AIDS organizations

HIV/AIDS ethnocultural, ethnoracialorganizations

Ethnocultural, ethnoracial organizations

Other

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Governments’ Response

• Governments have developed HIV/AIDS strategies that identify people from countries where HIV is endemic or ethno-cultural communities as a key population

• In 2007, PHAC initiated a second-generation HIV surveillance system, E-Track, to better understand the dynamics of HIV transmission and the potential areas for prevention programs among this population

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Conclusions

• People from countries where HIV is endemic - Black people of African and Caribbean descent - make up a disproportionate segment of those affected by HIV/AIDS in Canada

• Challenges in collecting and presenting relevant surveillance information regarding ethnicity persist

• There are ongoing challenges in access to services for HIV+ immigrants

• The evolution of HIV is linked to the determinants of health

• There is a need for appropriate culturally sensitive health services and information

• Communities play a critical role in addressing HIV/AIDS issues

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For Information…

http://www.phac-aspc.gc.ca/aids-sida/

publication/ps-pd/fs-info-eng.php

http://www.phac-aspc.gc.ca/aids-sida/

publication/ps-pd/fs-info-fra.php