The stigma and complexity of HIV

Health Matters

Paul Martiquet / Health Columnist
August 25, 2014 02:31 PM

Since the Human Immunodeficiency Virus (HIV) epidemic was first identified in the early 1980s, there has been a considerable decrease in the annual number of new HIV infections in B.C. and Canada.

Unfortunately, there is a new trend that reverses some of those gains.

The Provincial Health Office (PHO) has the responsibility of monitoring the health 0f British Columbians and to provide independent advice on public health issues. The PHO produces an annual report on some aspect of significant public health issues, bringing together the data and analysis to better understand the implications. Recent annual reports have focussed on injection drug use, Aboriginal health, women’s health, and gambling. The most recent examines the incidence of HIV in BC: HIV, Stigma and Society.

During the period until the late 1990s, there was a substantial decrease in the proportion of HIV diagnoses attributable to men who have sex with men. Unfortunately, that trend subsequently subsided and even increased in some years: the number of new diagnoses per year among gay and bisexual men has been stable or decreasing only slightly in comparison to other exposure groups.

Reducing the incidence and prevalence of HIV in BC thus requires reducing the number of new HIV infections among gay and bisexual men. The PHO’s report examines the epidemic in BC among gay and bisexual men and makes recommendations for renewing HIV prevention in this population.

HIV is a virus that attacks the immune system resulting in an inability to fight off usually harmless infections. Transmission most commonly occurs through sex and through sharing of used needles or other drug paraphernalia. The highest estimated risk from sexual transmission is through receptive anal sex.

In British Columbia, the majority of all new HIV diagnoses among gay and bisexual men has consistently been in the Vancouver Coastal Health region while Northern and Interior Health regions have had the lowest numbers. The age distribution for these new cases has been decreasing among those older 30 years, and increasing among younger men born after 1980. Ethnically, about 70 percent of new HIV infections self-identify as Caucasian, followed by Asian (11 percent), Latino and Aboriginal.

Especially concerning is the fact of an increase in the number of new infections diagnosed in the acute (first) stage of HIV infection. The proportion of gay and bisexual men diagnosed during this period when transmission risk is highest increased from six percent in 2006 to 19 percent in 2012.

There are many reasons for the new challenges of HIV infection among gay and bisexual men and any reduction of infection rates must take this group into account. Solutions must address many factors, or ‘drivers’ of HIV infection. We will examine drivers and some proposed actions to reduce the incidence of HIV in British Columbia in a future article.

Editor’s note: Dr. Paul Martiquet is the medical health officer for Rural Vancouver Coastal Health including Powell River, the Sunshine Coast, Sea-to-Sky, Bella Bella and Bella Coola.

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