Infectious Disease Surveillance 2014 Human Immunodeficiency Virus (HIV)

Data Collection

Surveillance data for HIV to the end of calendar year 2014 were analyzed. The number of tests, new case reports, HIV prevalence, and treatment uptake were reported via the CSC Infectious Disease Surveillance System (IDSS) (to the end of 2012) and via the enhanced web-enabled WebIDSS for 2013 and 2014.

Analysis and Results

HIV Testing and Diagnosis

HIV testing among new admissions increased steadily from 37% in 2000 to 78% in 2014. Follow up HIV testing uptake among inmates during incarceration has remained fairly stable since 2007 and was 20% in 2014 (see Figure 1).

The broken-line and bar graph shows the rate of participation in HIV testing from 2000 to 2014. The blue line shows the fluctuations in new admissions, and the red line shows the information in relation to the general population. Both lines show percentages for each year: the trend shows that testing has increased steadily since 2000. The lines cannot accurately show the percentages for each year. The prevalence of HIV is shown in blue, and the pink shows this data in relation to the general population. The bars show the steady increase in the prevalence of HIV in the general population.

Newly Diagnosed HIV Cases

The number of newly diagnosed cases (where the previous status was negative or unknown) and the diagnostic yield (rate per 1,000 tests) is shown in Table 1. In 2014 there were 5 (1.3/1,000 tests) and 5 (1.7/1,000 tests) newly diagnosed HIV cases among new admissions and the general inmate population respectively.

Table 1: Newly Diagnosed HIV Cases and Rate per 1,000 tests
  2007 2008 2009 2010 2011 2012 2013 2014
On admission 9
(3.6)
8
(2.8)
4
(1.4)
8
(2.3)
9
(2.3)
11
(2.5)
8
(2.0)
5
(1.3)
While Incarcerated 8
(2.3)
6
(1.9)
8
(2.6)
4
(1.3)
13
(3.8)
8
(2.5)
5
(1.5)
5
(1.7)

HIV Prevalence

The number of HIV cases and HIV point-prevalence increased slightly between 2004 (188 cases and 1.43%, respectively) and 2007 (253 cases and 2.02%, respectively) before decreasing to 170 cases, or 1.19%, in 2014 (Figure 2). The point prevalence varied by gender; prevalence among women was generally two to three times higher than that among men, peaking in 2007 with 6.02% and decreasing to 2.49% in 2014 (compared to 1.87% in 2007 and 1.14% in 2014 among men).

The broken-line and bar graph shows the prevalence of HIV and frequency by gender. The number of cases of HIV per year from 1999 to 2014 is shown in blue. The green line shows the proportion of the prevalence among males, and the purple line shows the proportion of the prevalence among females. The orange line shows the proportion of the prevalence of HIV overall.

HIV Treatment

Between 2007 and 2014, the majority of HIV-positive inmates were on therapy (see Table 2). Consistent with recent move to “treatment as prevention”, the proportion of CSC inmates known to have HIV infection on treatment was 91% in 2014.

Table 2: HIV Treatment Uptake, 2007-2014
  2007 2008 2009 2010 2011 2012 2013 2014
Proportion of inmates with HIV on HAART 55% 65% 57% 63% 77% 84% 90% 91%

Summary

Testing for HIV on admission and throughout incarceration continues to be an important public health function. The majority of HIV cases (85%) are aware of their status or are diagnosed at admissionFootnote 1. The overall trend in annual HIV prevalence since 2007 indicates a decline in HIV prevalence to 1.19% in 2014 but female offenders continue to have a higher prevalence of HIV compared to men. The year-end HIV prevalence estimates are consistent with the estimated period prevalence 2005-2012 (1.76%)Footnote 2. Consistent with community trends of “treatment as prevention” HIV treatment uptake among inmates in CSC has increased to more than 90% in 2014.

Footnotes

Footnote 1

Health Services Quick Facts: HIV: Age, Gender and Aboriginal Ancestry. CSC 2016

Return to footnote 1

Footnote 2

Ibid

Return to footnote 2