HIV in Canada: A primer for service providers

Heterosexual transmission

Key Points

  • Heterosexual transmission accounted for an estimated 33% of new HIV infections in 2016.
  • Heterosexual transmission accounted for an estimated 33% of all Canadians with HIV in 2016 (prevalence).
  • People from countries where HIV is endemic are over-represented in the Canadian HIV epidemic.

Heterosexual transmission occurs in people from both HIV-endemic countries and non-HIV-endemic countries in Canada. For the purpose of HIV surveillance, HIV-endemic countries are generally defined as those that have an adult prevalence of HIV that is 1% or greater and one of the following:

  • 50% or more of HIV diagnoses are attributed to heterosexual transmission;
  • the male-to-female ratio of people with HIV is 2:1 or less; or
  • the HIV prevalence is 2% or greater among females receiving prenatal care.

Examples of regions where HIV is considered endemic include sub-Saharan Africa and the Caribbean.

The 2016 estimates of HIV prevalence and incidence indicate that heterosexual exposure to HIV represents a substantial proportion of the HIV epidemic in Canada.

An estimated 719 new HIV infections (33% of all new infections in Canada) were attributed to heterosexual contact in 2016. This estimate includes an estimated 294 new infections (14%) attributed to heterosexual sex in people from a country where HIV is endemic and 425 (20%) new infections attributed to heterosexual sex in people from a country where HIV is not endemic. HIV incidence has increased in the heterosexual population in Canada since 2014. In 2014, the estimated number of new HIV infections attributed to heterosexual contact was 641.

People from HIV-endemic countries (residing in Canada) are over-represented in the HIV epidemic. This group accounted for an estimated 14% of new HIV infections in 2016 but only comprised 2.5% of Canada’s population in 2011.

Heterosexual transmission accounted for an estimated 33% of all Canadians with HIV in 2016 (20,543 people). Of these, 9,438 people (15% of all people with HIV) were from a country where HIV is endemic (primarily countries in sub-Saharan Africa and the Caribbean).

The epidemiological picture for people from countries where HIV is endemic includes transmission through heterosexual contact only and does not include people exposed to HIV through injection drug use or men who have sex with men who are from an HIV-endemic country.

The communities of people from countries where HIV is endemic are diverse, reflecting variations in historical backgrounds, language and cultural traditions. These communities are disproportionately affected by many social, economic and behavioural factors (determinants of health) that not only increase their vulnerability to HIV but may also act as barriers to accessing prevention, testing, treatment, and care and support programs.

Resources

The epidemiology of HIV in Canada – CATIE fact sheet

Summary: Estimates of HIV incidence, prevalence and Canada’s progress on meeting the 90-90-90 HIV targets, 2016 – Public Health Agency of Canada

Where is HIV hitting hardest? – CATIE infographic

HIV/AIDS in Canada – CATIE infographic

HIV in Canada – PHAC infographic

People living with HIV in Canada – CATIE infographic

New HIV infections in Canada – CATIE infographic

Sources

Public Health Agency of Canada. Summary: Estimates of HIV Incidence, Prevalence and Canada’s Progress on Meeting the 90-90-90 HIV targets, 2016. Public Health Agency of Canada, 2018. Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/summary-estimates-hiv-incidence-prevalence-canadas-progress-90-90-90.html