Robert S. Remis, Maraki Fikre Merid Ontario HIV Epidemiologic Monitoring Unit

1. Epidemiologic trends inHIV 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. Background • MSM seriously affected by HIV epidemic since the beginning (late 1970s) • Many developments have influenced trends in the epidemic since then: Education, information and prevention Identification of HIV in 1984 HIV test developed late 1985 Antiretroviral drugs, 1987-95 HAART 1996-

3. Objective • To examine trends in incidence and prevalence of HIV infection among MSM in Ontario

4. Methods: Data sources • HIV diagnostic data • Laboratory Enhancement Study • Detuned assay • Repeat testers • Reported AIDS cases • HIV-related mortality

5. Methods: Data analysis • HIV model: Incidence and prevalence of • HIV infection • HIV diagnoses • AIDS • HIV-related mortality Dr. Robert S. Remis Public Health Sciences, University of Toronto

6. Reported AIDS cases by exposure category and sex,1981-2003 * Proportion EC known = 96.4%

7. Reported AIDS cases for selected exposure categories, 1981-2003

8. First-time HIV diagnoses (adjusted) for selected exposure categories,1985-2003

9. HIV diagnoses (adjusted) by exposure category and gender, Ontario 1985-2003

10. First-time HIV diagnoses among MSM by health region, 1985-2003

11. Number first-time HIV diagnoses, MSM selected health regions, 1999–2004

12. Number first-time HIV diagnoses, MSM, Toronto, 1999–2004

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

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

15. Measured and adjusted HIV incidence,MSM, Ontario, 1999 – 2003 Source: Laboratory Enhancement Study

16. Measured and adjusted HIV incidence MSM, Toronto, 1999 – 2003 Source: Laboratory Enhancement Study

17. Measured and adjusted HIV incidence MSM, Ottawa, 1999 – 2003 Source: Laboratory Enhancement Study

18. Measured and adjusted HIV incidence, MSM, Ontario, 1999 – 2003 Source: Laboratory Enhancement Study

19. Modeled HIV prevalence by exposure category, Ontario,December 2003

20. Modeled HIV incidence among MSMOntario, 1977–2003 Dr. Robert S. Remis Public Health Sciences, University of Toronto

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

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

23. Conclusions • Trends in risk behaviour elsewhere are consistent with trend in HIV incidence • Reasons for persisting high incidence unclear: treatment optimism? safe-sex fatigue?

24. Conclusions • Observed increase in new HIV diagnoses in 2003 of particular concern • May be due to: • increased HIV testing or • increased HIV incidence

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

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