Ontario nearing ambitious UN targets for ending AIDS epidemics

St. Michael's HospitalAug 14 2015

A new study suggests Ontario is nearing ambitious United Nations targets for ending the AIDS epidemics: By 2020, 90 per cent of all people living with HIV should know their HIV status, 90 per cent of all people diagnosed with HIV are receiving sustained antiretroviral drug therapy and 90 per cent of people on ART have a very low or undetectable levels of the virus.

In a study published today in the Journal of Acquired Immune Deficiency Syndrome, Dr. Sean B. Rourke found that in 2011, 87.3 per cent of people in the Ontario study were receiving care (defined as having had one viral load test measuring amount of HIV virus in the blood in the previous year), 77 per cent were on antiretroviral treatment and 76 per cent had a suppressed viral load.

Ensuring that people living with HIV are accessing and staying in health care is vital to achieving optimal health outcomes, said Dr. Rourke, a scientist with the Li Ka Shing Knowledge Institute of St. Michael's Hospital and executive director of the Ontario HIV Treatment Network.

Dr. Rourke is also principal investigator of the OHTN Cohort Study, which tracks thousands of people in Ontario with HIV who are receiving care in the province's HIV clinics and which provided the data for this research paper.

"The good news is that people with HIV who are in care are doing well," said Dr. Rourke. "The bad news is that there still are some gaps. Younger adults with HIV were consistently less likely to be receiving health care or taking antiretroviral drugs. This is especially true for younger gay men, who are being infected at a higher rate than others, and people who have a history of substance use and heterosexual men."

He also noted that the study looked specifically at people who are in care and does not capture people with HIV who have not yet been diagnosed or those who are not engaged in care.

These differences may be due to challenges such as substance abuse, stigma, concerns about confidentiality, lack of transportation, feelings of invincibility or poor connections with the health-care system in general.

The study also noted that continuous HIV care was also less common among heterosexual men, a trend that has also been observed in the United States and sub-Saharan Africa. A 2012 study by Tony Antoniou, a pharmacist and research scholar in the Department of Family Medicine at St. Michael's found that many heterosexual men feel existing HIV-related programs and services don't meet their needs and are geared primarily or exclusively toward gay men and heterosexual women who are living with the virus.

More work needs to be done to ensure that young people, especially younger gay men and people with a history of drug use, are getting tested and going to medical appointments. According to Dr. Rourke, innovative and practical solutions are needed to engage groups falling between the cracks more closely in their health care, such as:

• educating physicians and other health care workers to talk more openly and routinely to patients about sexual orientation to find out who may be at risk of acquiring HIV. He said half of gay men are not open with their physicians about their sexual orientation.

• peer navigation programs, where people with HIV receive training to support those who are newly diagnosed