The provincial health officer’s most recent annual report, called HIV, Stigma and Society is intended to inform and explain the current status of HIV in British Columbia.
In particular, the report explains that while the incidence of HIV dropped significantly through the 1990s, there is a new trend where infections are occurring in younger gay and bisexual men.
While there are many reasons for this trend, they are complex and interwoven so that no specific cause or link can be identified to explain why this is happening. The variables that impact the HIV epidemic, as well as, drivers, can be classified into three types: societal and structural, community and relationships, and behavioural and biological. These categories are neither exclusive, nor independent as each influences the others.
The drivers furthest from the individual are societal and structural. These work broadly within society, but influence drivers at the other two levels. Examples include experiences of marginalization and stigma, access to appropriate health care and racism. All have an effect on rates of HIV yet are least controllable by the individual.
At the intermediate level are factors such as mental health, the prevalence of HIV in gay communities and the composition of sexual networks. Drivers with the most immediate relationship to the HIV epidemic are behavioural and biological; they most directly affect the rate of HIV transmission and infection within a population. For example, whether a partner is HIV positive and whether a condom is used both have direct impact on the likelihood of transmission.
Stigma is a societal driver and among the most influential as it permeates the social and cultural experiences of gay and bisexual men. HIV infection carries a powerful stigma, but so, too does sexual orientation. Stigma, prejudice, and discrimination on the basis of sexual orientation continue to be experienced by gay and bisexual men in B.C., and include violence, verbal harassment, and suicide, and all have profound consequences for the health of this group.
Sexual behaviours are factors at the most personal level and include the single most effective strategy to reduce the transmission of HIV: high levels of condom use. However, despite high levels of condom use by gay and bisexual men during the 1990s and later, HIV prevalence has become entrenched in the population of gay and bisexual men in B.C.
Another driver is awareness of HIV status, and getting tested for HIV. About half of all gay and bisexual men in B.C. reported being tested for HIV in the past year. Among the newly diagnosed from 2006 to 2011, the median time between their last negative test and first positive test was 15 months. That means potentially being infected for up to 15 months without knowing, and while spreading the infection.
Individual drivers interact among and between each other at all three levels, making the picture very complex. There are important relationships between drivers across all three levels which means attacking any one driver must also include other related factors, no easy task.
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.
