HIV affects some communities more than others. Examples include men who have sex with men, trans women, people who inject drugs, and Black and Indigenous communities.
In 2020, the Public Health Agency of Canada (PHAC) estimated that around 62,800 people in Canada were living with HIV. Assuming that new HIV cases grew at a steady rate, we can estimate this number in 2024 to be about 68,000.
The number of new HIV cases in Canada appears to be stable. The average for over a decade has been around 1,800 new cases per year, and in 2022 there were 1,833 cases. There was a drop in 2020 (1,322 cases) and 2021 (1,466 cases). This is likely because people had less access to HIV testing during lockdowns.
PHAC measures the annual rate of new HIV diagnoses per 100,000 people. In 2022, Canada’s rate was 4.7 new cases per 100,000 people.
The provinces with the highest rates of new cases are Saskatchewan (19) and Manitoba (13.9). These are also the only provinces where most new HIV cases diagnosed are among people who inject drugs.
The major cities with the highest HIV rates are Winnipeg (16.5), Saskatoon (15.3), Regina (15.7) and Montreal (12.4). Prince Albert in Saskatchewan has the highest recorded HIV rate of all cities at 56.4 cases per 100,000.
To understand how common HIV is in Canada, we need to get into some statistics. We know nobody likes math, but bear with us!
If you watched the news during the COVID-19 pandemic, you’ll know that tracking a disease is complicated. This difficulty is because diseases don’t always affect all communities equally.
For example, the overall percentage of people with COVID-19 who are hospitalized is low. But if we look at the number of older people who are hospitalized with COVID-19, the rate is higher. Discrepancies like this are how we can tell that COVID-19 is more serious for elderly people.
We know that HIV impacts some communities more than others: men who have sex with men, trans women, people who inject drugs, and Black and Indigenous people. If someone is outside these groups, they might never meet someone with HIV.
If you’re in a community affected by HIV, though, you could know more people living with it. This is what we call a “burden” - it’s where one group of people faces higher rates of a disease than everyone else.
“Burden” is a term from epidemiology, the study of diseases and how they spread. We’ve all become more aware of science-y concepts like “flatten the curve” during COVID-19 – some of these terms can also help us understand HIV in Canada.
Prevalence means how many people have a disease in a time period, which shows us its overall impact. So, Canada’s HIV prevalence in 2020 was 62,800.
Incidence means the number of new cases in a time period, showing how fast a disease is spreading. So, Canada’s HIV incidence in 2022 was 4.7 new cases per 100,000 people. (We have different years for prevalence and incidence because these come from separate data sources)
In Canada, we can break prevalence & incidence down by province and city. We can also break them down by population to see how HIV affects some communities more than others.
Not everyone who has HIV knows their status, so the Public Health Agency of Canada uses the data they have to estimate prevalence. In 2020 they estimated that 62,800 people in Canada were living with HIV.
The HIV incidence in Canada has remained stable since 2012, with an average of 1,800 new diagnoses per year. This does not include 2020 and 2021, when new HIV cases dropped. Lower numbers in these years are likely because less people had access to HIV testing during lockdowns. The most recent data is from 2022, which showed 1,833 new cases.
If HIV transmissions continued through 2023 at the same rate, we could estimate that there are now 68,000 people in Canada living with HIV.
The Public Health Agency of Canada measures the annual rate of new HIV diagnoses per 100,000 people. It provides a rate for the country and provinces/territories, and it’s important to look at both. This is because there are considerable differences in HIV incidence between regions.
In 2022 this national rate was 4.7 people diagnosed with HIV per 100,000.
Five regions were below this average: Northwest Territories (1.5), Atlantic Canada (1.6), B.C. (2.5), Ontario (4.1) and Alberta (4.2). Quebec is close to average (4.9). All of these have decreased since before COVID.
HIV rates are highest in Manitoba (13.9) and Saskatchewan (19), which have increased since before COVID. Indigenous people in these provinces face a huge burden of HIV. These are also the only provinces where most new diagnoses are among people who inject drugs.
HIV rates can vary by city, and these numbers tend to be higher than in rural areas. The available data is usually for new HIV cases per year out of 100,000 (incidence). The following numbers come from 2017 to 2022. This is because some provinces have more recent public data compared to others.
Cities tend to have an incidence above their provincial average and the national average (4.7 per 100,000).
The major cities with the highest HIV rates are Winnipeg (16.5), Saskatoon (16.3) and Montreal (12.4).
These are followed by Toronto (9.6), Edmonton (7.3) and Calgary (6.2). Ottawa (4.2) and Vancouver (3.8) are below the national average.
Prince Albert has the highest recorded HIV rate of all Canadian cities at 56.4 per 100,000.
The HIV data that we have in Canada is broken down by population. This groups people together by “exposure category,” meaning the way they probably acquired HIV. The main categories are through sex between men, injecting drugs and heterosexual sex.
We know that trans women are particularly affected by HIV, but researchers have historically neglected this group regarding data collection. This has a real-world impact because a lack of data can make it harder to tailor HIV prevention to trans women in Canada. Things are slowly improving, though, and HIV research is becoming more inclusive.
Around half of people living with HIV in Canada are gay, bisexual and other men who have sex with men (MSM). Transmission rates among this group are trending down. On the other hand, new cases among women, people who inject drugs and Indigenous people are going up.
In 2022, transmission from heterosexual sex was the biggest group of new HIV cases for the first time. MSM had previously been the largest group of new HIV cases each year.
One quarter of people living with HIV in Canada are cis women, and in 2022 they were 33% of new cases. 36% of these women were exposed to HIV by injecting drugs, and 60% were exposed by heterosexual sex.
Some communities have a much higher HIV burden than others.
The data we have can sometimes be limiting. For example, data on race and ethnicity was only collected for 45% of new HIV cases in 2021. This means that data on HIV cases among Indigenous people are likely to be an under-count. PHAC data on sex does also not include people who were categorized as transgender.
When we don’t have an accurate picture of how HIV affects these and other groups, it can make it harder to respond to their needs and achieve health equity.
Yes! Until 2018, people living with HIV faced challenges when immigrating to Canada because their HIV treatment was deemed an “excessive demand” on the healthcare system.
Potential immigrants are required to take a medical examination and tests (including HIV); the results are then used to calculate how much someone’s healthcare will cost the government each year.
In 2018, Immigration, Refugees and Citizenship Canada raised the cut-off from $6,604 to $19,812 per year. This now covers many HIV treatments, which come under this maximum.
References
“Estimates of HIV incidence, prevalence and Canada’s progress on meeting the 90-90-90 HIV targets, 2020”, Public Health Agency of Canada (2022)
"HIV & AIDS in Saskatchewan", Government of Saskatchewan (2019)
“HIV in Canada: 2022 surveillance highlights”, Public Health Agency of Canada (2023)
"HIV in Canada, Surveillance Report to December 31, 2021", Public Health Agency of Canada (2024
“HIV in Manitoba 2022: Annual Surveillance Update”, Government of Manitoba (2023)
“Indigenous peoples and communities”, Government of Canada (2024)
“New Vancouver-area HIV cases fall by more than half”, CBC News (2019)
“Prevalence of Injecting Drug Use and Coverage of Interventions to Prevent HIV and Hepatitis C Virus Infection Among People Who Inject Drugs in Canada”, American Journal of Public Health (2020)
“The Epidemiology of HIV in Canada”, CATIE (2024)
“Trends in HIV testing, diagnoses and the care cascade in Ontario in 2022”, Ontario HIV Epidemiology and Surveillance Initiative (2023)
