EPIDEMIOLOGIC CHARACTERISTICS OF HIV INFECTION AND AIDS AMONG WOMEN ONTARIO, 1981-2004

instructional media centre, Laboratories Branch - 2000

EPIDEMIOLOGIC CHARACTERISTICS OF EPIDEMIOLOGIC CHARACTERISTICS OF HIV INFECTION AND AIDSHIV INFECTION AND AIDS

AMONG WOMENAMONG WOMENONTARIO, 1981-2004ONTARIO, 1981-2004

Robert S. Remis, Maraki Fikre MeridRobert S. Remis, Maraki Fikre MeridDepartment of Public Health Sciences Department of Public Health Sciences

University of TorontoUniversity of Toronto

Women and HIV Working GroupWomen and HIV Working GroupToronto, August 25, 2005 Toronto, August 25, 2005


Methods: Data sourcesMethods: Data sources

•HIV serodiagnostic data: First-time HIV positive HIV serodiagnostic data: First-time HIV positive diagnoses at HIV Laboratory, Ontario Ministry diagnoses at HIV Laboratory, Ontario Ministry of Health and Long-Term Care (OMHLTC), of Health and Long-Term Care (OMHLTC), 1985-20041985-2004

•Reported AIDS cases: Cases diagnosed to Reported AIDS cases: Cases diagnosed to December 2003 and reported to December 2003 and reported to Public Health Public Health Division, OMLTC Division, OMLTC by April 2004 by April 2004

•Laboratory Enhancement Study: Data used to Laboratory Enhancement Study: Data used to adjust HIV diagnoses for unknown risk factors adjust HIV diagnoses for unknown risk factors and previous HIV testing and to obtain and previous HIV testing and to obtain estimates of HIV incidence (detuned assay)estimates of HIV incidence (detuned assay)


Number of first-time HIV diagnoses by Number of first-time HIV diagnoses by sex and proportion female, 1985–2004sex and proportion female, 1985–2004

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Year

Nu

mb

er

HIV

dia

gn

os

es

0%

5%

10%

15%

20%

25%

30%

35%

Pro

po

rtio

n f

em

ale

(%

)

MalesFemales% female

Dr. Robert S. RemisPublic Health Sciences, University of Toronto


Number and proportion of HIV diagnoses Number and proportion of HIV diagnoses (adjusted) by exposure category and sex, (adjusted) by exposure category and sex, Ontario, 1985-2003Ontario, 1985-2003

100% 24,734 100% 3,409 100% 21,325 Total

1.9% 470 6.7% 228 1.1% 242 Other, peri

5.3% 1,314 16% 559 3.5% 755 LR hetero

3.5% 863 20% 683 0.8% 180 HR hetero

8.2% 2,021 33% 1,120 4.2% 901 HIV-endemic

2.8% 701 6.4% 219 2.3% 483 Clot/trans

8.1% 2,010 18% 600 6.6% 1,410 IDU

3.9% 973 4.6% 973 MSM-IDU

66% 16,382 77% 16,382 MSM

%No.%No.%No.

TotalFemalesMales


HIV diagnoses among males (n=21,325)HIV diagnoses among males (n=21,325)Ontario, 1985–2003Ontario, 1985–2003

4.2% 1.3%

4.6%6.6%

1.0%

3.5%

0.8%0.8%

0.3%

76.8% MSMMSM-IDUIDUClotting factorTransfusionHIV-endemicHR heteroLR heteroPerinatalOther



HIV diagnoses among females (n=3,409)HIV diagnoses among females (n=3,409)Ontario, 1985–2003Ontario, 1985–2003

4.8%5.3%1.1%

32.9%

17.6%1.9%

16.4%

20.0%

IDU

Clotting factor

Transfusion

HIV-endemic

HR hetero

LR hetero

Perinatal

Other



HIV diagnoses for selected exposure HIV diagnoses for selected exposure categories among women, 1985–2004categories among women, 1985–2004

0

20

40

60

80

100

120

140

160

180

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Year

Nu

mb

er

HIV

dia

gn

os

es Endemic

HeteroIDU



Proportion HIV diagnoses in selected Proportion HIV diagnoses in selected exposure exposure categories among women, 1985–2004categories among women, 1985–2004

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Year

Nu

mb

er

HIV

dia

gn

os

es

EndemicHeteroIDU



HIV diagnoses by health region and sex, HIV diagnoses by health region and sex, Ontario 1085-2003Ontario 1085-2003

100%19% 2,775 11,614 14,389 Ontario

6.6%19% 184 802 986 Southwest

8.1%24% 226 700 926 Central West

7.3%26% 202 583 785 Central East Other

53%17% 1,472 7,474 8,946 Toronto

3.0%19% 84 368 452 Eastern Other

18%29% 500 1,429 1,929 Ottawa

3.9%29% 107 258 365 Northern

OntariofemaleFemalesMalesBoth sexes

ProportionProportion


Number of AIDS diagnoses by sex and Number of AIDS diagnoses by sex and proportion female, 1985–2004proportion female, 1985–2004

0

100

200

300

400

500

600

700

800

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Year

Nu

mb

er

HIV

dia

gn

os

es

0%

5%

10%

15%

20%

25%

Pro

po

rtio

n f

em

ale

(%

)

MalesFemales% female



Number and proportion of AIDS cases Number and proportion of AIDS cases by exposure category and sex, Ontario, by exposure category and sex, Ontario, 1981-20031981-2003

* Other includes perinatal, occupational and NIR cases

100%7,514100%551100%6,963TotalTotal

4.4%33410%544.1%280Other*

3.4%25311%592.7%194Clot / trans

8.2%61837%2045.9%414Hetero

5.5%41628%1563.7%260HIV-endemic

4.5%33614%783.7%258IDU

4.0%2994.3%299MSM-IDU

70%5,25876%5,258MSM

%No.%No.%No.

TotalFemalesMales


Modeled HIV prevalence and diagnoses Modeled HIV prevalence and diagnoses by exposure category, women in Ontario, by exposure category, women in Ontario, 20032003


TotalTotal

TransfusionTransfusionClottingClottingHeterosexualHeterosexualHIV-endemicHIV-endemicIDUIDU

64%64%2,2032,203100%100%3,4363,436

100%100%19190.6%0.6%1919100%100%550.1%0.1%55

55%55%96296251%51%1,7431,74375%75%78478430%30%1,0411,04169%69%43343318%18%628628

diagnoseddiagnoseddiagnoseddiagnosedOntarioOntarioprevalenceprevalence

ProportionProportionHIVHIVProportionProportionHIVHIV


Modeled HIV prevalence by health region and Modeled HIV prevalence by health region and exposure category, women in Ontario, December exposure category, women in Ontario, December 20032003

3,500 25 630 1,040 1,780 Ontario

2600 30 40 190 Southwest

2500 40 40 170 Central West

2805 40 60 180 Central East Other

170015 210 670 800 Toronto

1700 60 20 90 Eastern Other

6505 190 190 260 Ottawa

1700 60 20 90 Northern

TotalOtherIDUEndemicHetero


Modeled HIV prevalence, proportions (row Modeled HIV prevalence, proportions (row %) %) by health region and exposure categoryby health region and exposure categoryWomen in Ontario, December 2003Women in Ontario, December 2003

100%1%18%30%51%Ontario

100%0%12%15%73%Southwest

100%0%16%16%68%Central West

100%2%14%21%63%Central East Other

100%1%12%40%47%Toronto

100%0%35%12%53%Eastern Other

100%1%29%29%40%Ottawa

100%0%35%12%53%Northern

TotalOtherIDUEndemicHetero


Overview: Women / heterosexualOverview: Women / heterosexual

•1,780 HIV-infected women (51% of Ontario 1,780 HIV-infected women (51% of Ontario infections), 55% diagnosedinfections), 55% diagnosed

•Toronto (45%); rest throughout OntarioToronto (45%); rest throughout OntarioBoth sexes:Both sexes:•1998-2003 HIV prevalence up 64% (annual 10%)1998-2003 HIV prevalence up 64% (annual 10%)•2000 to 2004, HIV diagnoses increased 70%; 2000 to 2004, HIV diagnoses increased 70%; increased in most regions but especially Central West increased in most regions but especially Central West (+202%), Southwest (+160%) and Toronto (+74%) (+202%), Southwest (+160%) and Toronto (+74%)

•320 new HIV infections in 2003320 new HIV infections in 2003



Overview: Women / HIV-endemicOverview: Women / HIV-endemic

•1,040 HIV-infected (30% of infections); 75% diagnosed 1,040 HIV-infected (30% of infections); 75% diagnosed •HIV prevalence approximately 0.8%HIV prevalence approximately 0.8%•Most HIV-infected women in Toronto (64%) and Most HIV-infected women in Toronto (64%) and Ottawa (18%)Ottawa (18%)

Both sexes:Both sexes:•1998-2003 prevalence up 86% (annual 13%)1998-2003 prevalence up 86% (annual 13%)•New HIV diagnoses increased 1999 (160) to 2002 New HIV diagnoses increased 1999 (160) to 2002 (280) then decreased somewhat (230 in 2004)(280) then decreased somewhat (230 in 2004)

•330 new HIV infections in 2003 (imported & Canada)330 new HIV infections in 2003 (imported & Canada)



Overview: Women / IDUOverview: Women / IDU

•630 HIV-infected (18% of Ontario infections), 69% diagnosed630 HIV-infected (18% of Ontario infections), 69% diagnosed•HIV-infected women in Toronto (33%) and Ottawa (30%)HIV-infected women in Toronto (33%) and Ottawa (30%)Both sexes:Both sexes:•New HIV diagnoses stable overall past five years, though New HIV diagnoses stable overall past five years, though increase in 2004 in Southwest and Northern regionsincrease 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 reassuringRelatively reassuring



AcknowledgementsAcknowledgements

•Frank McGee, AIDS Bureau, Frank McGee, AIDS Bureau, Ontario Ministry of Health Ontario Ministry of Health and Long Term Care (MOHLTC)and Long Term Care (MOHLTC)

•Maraki Fikre Merid, University of TorontoMaraki Fikre Merid, University of Toronto•Aida Rita Santiago, University of TorontoAida Rita Santiago, University of Toronto•Carol Swantee, HIV Laboratory, MOHLTC Carol Swantee, HIV Laboratory, MOHLTC • Jane Njihia, FSO, PHAC / MOHLTCJane Njihia, FSO, PHAC / MOHLTC•Lorraine Schiedel, Public Health Branch, Lorraine Schiedel, Public Health Branch, MOHLTCMOHLTC •CIDPC, Public Health Agency of Canada and Ontario CIDPC, Public Health Agency of Canada and Ontario HIV Treatment Network (OHTN) for funding the HIV Treatment Network (OHTN) for funding the Laboratory Enhancement StudyLaboratory Enhancement Study

Documents

EPIDEMIOLOGIC CHARACTERISTICS OF HIV INFECTION AND AIDS AMONG WOMEN ONTARIO, 1981-2004