HIV/AIDS not in “free fall”

Several inaccuracies in Patrick Sullivan's recent news article about HIV/AIDS1 might lead readers to falsely conclude that the battle against HIV/AIDS is nearly won. In fact, both national surveillance and targeted research data indicate that HIV/AIDS remains a serious problem in Canada.

First, trends in reported cases of AIDS can be accurately assessed only by examining numbers adjusted for reporting delay. We perform this adjustment in our year-end reports, and from the 2001 report it is clear that although there was a steep decline in reported AIDS cases between 1995 and 1998 (from 1713 to 701 cases, a 59% decrease), this rate of decline slowed over the next period (from 701 cases in 1998 to 452 in 2001, a 36% decrease) (Fig. 1).2

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Fig. 1: Reported cases of AIDS by year of diagnosis in Canada, to Dec. 31, 2001, adjusted for reporting delay.

Second, although the number of reports of positive HIV test results decreased from 2987 in 1995 to 2119 in 2000, the number increased to 2180 in 2001 and continued to increase in the first half of 2002 (1193 v. 1088 reported in the first half of 2001) (Fig. 2).3 Furthermore, positive HIV test reports represent only those who came forward for testing and whose diagnosis of HIV infection was subsequently reported; they do not represent the annual number of new HIV infections (incidence). We estimate national HIV incidence through a separate process, and our most recent estimate is that 4190 new infections occurred in 1999, a number essentially unchanged from our estimate of 4200 in 1996.4

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Fig. 2: Number of reports of positive HIV tests in Canada by year of test. The 2002 value is an estimate that represents twice the number of reports to June 30, 2002.

Third, of positive test results reported for adult females during the first half of 2002, the proportion for those 15 to 29 years of age was 35.4% (104/294), not 42.6% as reported by Sullivan. The figure of 42.6% refers to the proportion of females among all positive HIV test results reported for the 15- to 29-year age category during the first half of 2002.3

National HIV and AIDS surveillance data and other available evidence5 indicate that HIV infection continues to be a significant public health problem in Canada, one that is increasingly affecting women and socially and economically disadvantaged groups such as Aboriginal people.

Dana C. Reid Acting Head HIV and AIDS Surveillance Unit Chris P. Archibald Director Division of HIV/AIDS Epidemiology and Surveillance Centre for Infectious Disease Prevention and Control Health Canada Ottawa, Ont.