HIV rates continue to rise in Manitoba: new report

Manitoba has the second highest rate of new HIV cases in the country, behind Saskatchewan, according to the province's latest figures.

In its recently released annual statistical update for 2016 Manitoba Health found 128 new cases of HIV, the human immunodeficiency virus that can lead to acquired immunodeficiency syndrome (AIDS) the potentially life-threatening condition. 

Cases of HIV are up 47 per cent compared with 2014.

"That's quite a concern," said Keith Fowke, head of medical microbiology and infectious diseases at the University of Manitoba. "These numbers are too high. It's unacceptable."

While Manitoba's HIV rates continue to rise, only one case of AIDS was reported in 2016 — the lowest level since 2006 apart from in 2014 when not a single case was reported. 

According to the report, a third of the new HIV cases in 2016 were found in people arriving from countries where rates of the illness are already high. Unprotected sex between men and women and between just men follow as risk factors for the spread of HIV.

Better testing possible factor in HIV rates

The bulk of new cases — almost 40 per cent — had no identifiable risk factor, meaning there was no information provided on how the person might have contracted the virus. The province says this could be because patients did not wish to disclose how they may have acquired the virus, or did not know a behaviour they were engaged could spread the disease.

Along with unprotected sex, sharing needles and sex toys, breast feeding and child birth can all put a person at risk of contracting HIV, according to Health Canada.

Dr. Joss Reimer, medical officer of health for sexually transmitted and blood-borne infections in Manitoba, says Manitoba's relatively low population makes it harder to draw concrete conclusions from fluctuations in HIV rates.

"Certainly there is the worry that this means that we have more HIV and that things are getting worse but it could also mean that we're testing more and that we're being successful in reaching people who already had HIV and we didn't know about them," she said.

More than half of HIV patients who self-reported their ethnicity identified as either black or Indigenous (55 per cent), which Reimer says means Manitoba needs to consider a wide range of factors that can lead people to developing the disease. Those of Caucasian descent comprised 20 per cent.

Poverty, racism, colonization and historical trauma all contribute to these higher rates, Reimer says.

"Instead of just focusing on the infection itself, we need to look even further back than that and make sure that we are providing safe and healthy environments for people," Reimer said. 

"How do we change things so if you're on reserve you get the same access to safe and healthy housing and good education as if you were off reserve? We know that those are not equal right now."

Fowke says Manitoba has a "fairly good" program finding and identifying HIV cases, but there are likely cases that aren't being caught. 

Stigma continues 

HIV rates have risen and fallen over the last decade, though new cases have steadily increased since 2014, provincial records show.

"I think as a province we need to pay more attention to this because it's the tip of the iceberg," Fowke said. "There's probably many other cases that have yet to be identified."

Stigma surrounding an HIV and AIDS diagnosis continues to be a factor blocking patients from seeking out treatment and getting tested, Reimer says.

"It comes from this fear that was set up when AIDS first appeared on the scene and people were dying, but now we know that hepatitis C is a more dangerous infection," she said. 

"Most people with HIV are going to live are going to have the same life expectancy as people who don't have HIV."

Fowke says Manitoba needs to watch whether an increase in injection drug use causes HIV rates to rise as well, as has happened in Saskatchewan. 

Data from 2017 and the start of 2018 is not yet available, but Reimer says the 2016 data is encouraging, showing a decrease in the number of people infected with HIV who use dirty needles to inject drugs.