Chapter 7: Population-Specific HIV/AIDS Status Report: People living with HIV/AIDS - Conclusion

Chapter 7 - Conclusion

This is the first time the Public Health Agency of Canada has synthesized evidence from a variety of sources in one document to better understand the lives of people living with HIV/AIDS (PHA) in Canada. It is hoped that the evidence provided in this report will be useful to governments, non-governmental organizations, public health officials, researchers, communities and others in informing the development of programs and policies addressing PHA in Canada.

Surveillance data presented in this report show that the burden of HIV in Canada has shifted. In the early stages of the HIV epidemic, most PHA in Canada were gay men. Now, transmission routes are varied. Transmission in the men who have sex with men (MSM) exposure category still accounted for an estimated 46.6% of new infections in 2011; but transmission through heterosexual sex and injection drug usage also represent a significant proportion of new infections, accounting for 37.2% and 13.7% of estimated new infections respectively. Aboriginal peoples and people from HIV-endemic countries are disproportionately affected by HIV in Canada. (1)

A key theme that emerged in the writing of this report is the diversity of PHA - the lived experiences prior to infection of a gay youth, a street-involved person who uses drugs, and a refugee woman from West Africa are very different. These different experiences and life paths continue once someone is infected. The majority of studies that look at PHA focus on one of the sub-populations affected, and it is sometimes difficult to compare studies and findings on one population with another.

Despite this diversity, most PHA come from marginalized populations. The health and quality of life of PHA are affected by multiple determinants of health, including early childhood experiences, poverty, social and physical environments, culture, gender, and social support. These multiple determinants affect their vulnerability to HIV infection, and continue to influence their health status and quality of life once infected.

Stigma and discrimination is a shared experience for most PHA, affecting all aspects of people's lives, from their relationship with intimate partners, family, and friends, to their community, their workplace, and society at large. For many, this stigma is compounded by other forms of discrimination targeted towards the group they identify with - i.e., racism, sexism, and homophobia.

Due to the advances made in HIV treatment, living with HIV is now an issue that extends across the life course. PHA are becoming parents, and children and adolescents are growing up with HIV. At the other end of the continuum, PHA are living long enough to encounter the challenges of aging. Despite this progress in treatment, HIV remains a significant health burden. PHA experience higher rates of non-AIDS-defining diseases; and some have to manage complex co-infections and co-morbidities. For some, HIV is an episodic disability, with periods of health being interrupted by unpredictable periods of ill health and disability. People continue to die from complications due to AIDS, some without ever having accessed health treatment. Although treatment is widely available in Canada, treatment access and adherence continue to present challenges, particularly for certain marginalized populations.

Community involvement continues to be key, both to the prevention response and to the care, treatment, and support of PHA. Community engagement and social support networks help develop positive coping skills, help PHA with appropriate information and emotional support, and are key sources to helping build resilience.

The Canadian response to HIV/AIDS involves a wide array of organizations and communities, with people at risk of HIV infection and PHA significantly engaged. This report identifies numerous strategies, networks and organizations, both nationally and in provinces and territories across Canada, and over 150 community-based projects specifically addressing the needs of PHA. Researchers across the country are also active in addressing many issues that affect PHA, ranging from treatment to determinants of health.

Partnerships exist at all levels - between service providers and PHA, community-based organizations, national non-governmental organizations, governments at all levels, researchers, and healthcare providers. There is a widespread recognition that PHA must be involved in developing and implementing the policies, programs, and research that affects them, in order that these approaches are effective and address the realities of PHA experience.

This report acknowledges the crucial role that PHA play in HIV/AIDS leadership, research, policy and programs, prevention, and support. All stakeholders, with the central engagement of PHA, must continue to build on our past successes to prevent new infections and to improve the quality of life of those living with HIV.

7.1 References

(1) Public Health Agency of Canada. Summary: Estimates of HIV prevalence and incidence in Canada, 2011. Ottawa: Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada; 2012.