Recently, Health Canada released its annual report on trends in human immunodeficiency virus (HIV) infection in Canada in 2023.
The report has garnered widespread attention, with media outlets focusing on a 35 per cent increase in newly diagnosed HIV cases compared to 2022. This statistic — juxtaposed with a global trend of declining new cases — has sparked concerns about the effectiveness of Canada’s public health system.
But this discourse is too simplistic. While the increase is real and poses a significant challenge to our health-care system, context is needed to evaluate the magnitude of the HIV burden in Canada.
In 2023, Canada recorded nearly 2,500 new HIV cases — a 35 per cent increase from the approximately 1,800 cases reported in 2022.
This trend followed significant increases in the two prior years as well. The number of newly diagnosed HIV cases increased by 25 per cent from 2021 to 2022 and by 11 per cent from 2020 to 2021.
These increases may make it seem like HIV is spiralling out of control. But comparing absolute case numbers between years is like comparing apples to oranges, as the nature of the population changes each year.
In the past three years, Canada has experienced significant population growth, driven largely by immigration. It is natural that the absolute number of HIV diagnoses would rise as our population increases.
To properly assess trends over time, we need to consider the rate of new cases relative to the population at risk.
When normalized to the population, the incidence rate of newly diagnosed HIV cases in 2023 was 6.1 cases per 100,000 people. The rates in 2022 and 2021 were 4.7 and 3.8, respectively. The 2023 rate was comparable with the historical average: it matches the 2011 rate and is well within the range observed between 2011 and 2019, when rates fluctuated between 5.3 and 6.2 cases per 100,000 individuals.
The fall in the incidence rate between 2020 and 2023 can be attributed to the Covid pandemic. During this period, HIV surveillance was limited as resources were redirected toward combatting Covid. People were also discouraged from making non-urgent health-care visits.
As the pandemic eased in 2022, so too did restrictions on accessing health care. HIV testing increased, capturing infections that would not have been detected during the pandemic. In this context, the increase from 3.8 to 6.1 cases per 100,000 between 2021 and 2023 was not a true increase in infection but a post-pandemic rebound.
In fact, Canada’s rate of newly diagnosed HIV cases has been significantly lower than that of countries with equally developed health care and HIV surveillance systems.
For example, between 2011 and 2022, while Canada’s incidence rate fluctuated between 3.8 and 6.2, France and the UK both reported rates in the range of 5 to 10 cases per 100,000 individuals. In the US, the rate fluctuated between 12.6 and 14.1 during 2013 and 2019.
Numerous countries — including France, the UK, Sweden and Norway — also saw a decrease in newly diagnosed HIV cases at the beginning of the pandemic followed by a rebound to pre-pandemic levels.
Canada’s public health system deserves recognition for its consistent efforts in HIV prevention. These efforts have kept incidence rates stable over the past decade and lower than peer countries.
Of course, there is no room for complacency. While the rate of new diagnoses has remained relatively consistent, the absolute number of people living with HIV continues to grow due to improved treatment options that allow individuals to live longer, healthier lives.
This poses a significant challenge for Canada’s health-care system, which is already struggling with staff shortages, long wait times and resource constraints.
The increasing number of individuals requiring lifelong management for a chronic condition like HIV underscores the need for thoughtful planning and investment in health-care infrastructure by the federal and provincial governments.
