What’s the current state of HIV in Ontario?

Ontario is close to reaching the UNAIDS 90-90-90 targets, and seeing shifting demographics in HIV transmission. While Ontario surpasses the UN target for supressed viral loads in people living with HIV on treatment, there’s more room for improvement when it comes to HIV positive folks in Ontario knowing their status, and getting on antiretroviral therapy. All data discussed here are findings from the Ontario HIV Epidemiology and Surveillance Initiative (OHSEI). 

In 2020 in Ontario, 97.8% of people on HIV medication are virally suppressed. That’s an extremely encouraging figure, which indicates that Ontarians with HIV who are on medication are able to practice strong adherence to their pill regimes. 

89% of people living with HIV in Ontario know their status. That’s just 1% shy of the UN’s 90% goal. Of course, we’d love to meet and surpass 90%, but where we are is still promising. Ontario falls shorter when it comes to getting those diagnosed with HIV onto treatment, reaching 86.7%. 

These two figures mean we have more work to do getting people who are at risk for HIV tested, and on retaining those who get a positive diagnosis in care. Some ways to retain HIV positive folks in the care system have to do with psychology. Despite the medical strides made in the field of HIV, being diagnosed with HIV is still a scary scenario for a patient. We need to make sure patients feel emotionally supported, we need to provide them with mental health resources, and we need to make sure they understand the benefits of treatment by teaching them about U=U. 

World events and healthcare trends also contributed to other changes in HIV epidemiology for 2020. The COVID-19 pandemic led to both less testing and less actual transmission. People were having less sex, and travelling and migrating less. While OHESI hasn’t released the full updates for these three primary figures yet for 2021, there is some initial data from that year available. For example, in 2021 HIV testing went up by 22% from 2020, so it seems people started to get closer to their normal testing routines. 

Some 2021 data around positive HIV tests by race, gender, and age is available. While gay men still make up the vast majority of new HIV diagnoses, their numbers fell again in 2021, which OHESI think has to do with the 7.5x increase in PrEP users in Ontario since 2016.  

In 2021 Black men have seen falling HIV diagnoses for a second year in a row. This is excellent news, but they’re still overrepresented relative to the size of their population. AIDS service organizations, testing and treatment clinics, and family doctors alike need to hire members of communities of colour, increase anti-racism training, and ensure their programming meets the cultural needs of queer black men and other queer and trans people of colour. Studies show when queer black men feel welcome, valued, included, and respected, they’re much more likely to engage with sexual health care. 

In 2020, white men and Black women saw the most decreased diagnoses. While non-white GBMSM are overrepresented in HIV transmission compared to the sizes of their populations, and diagnoses among white men who have sex with men (GBMSM) have been falling since 2015, gay white men still have the highest numbers of new cases by sheer volume. 

Abigail Kroch from the Ontario HIV Treatment Network and Sean Colyer from the OHESI had more to say on the topic during our conference last year. Check it out here: 

Intro to Epi & an update on HIV among gay, bi, & other men who have sex with men (GBMSM) in Ontario