Nov 29th, 2024

World AIDS Day 2024: New report on HIV diagnoses in Ontario in 2022

In recognition of World AIDS Day 2024 and the theme “Take the rights path”, the Ontario HIV Epidemiology and Surveillance Initiative (OHESI) is pleased to announce a new report: HIV diagnoses in Ontario, 2022. Understanding the current HIV epidemic in Ontario is crucial to informing policy and action, including HIV prevention, treatment and care services. Equitable access to HIV data empowers individuals and communities, including vulnerable and marginalized populations who may be living with, at risk for, or affected by HIV.  

This report describes trends in HIV diagnoses in Ontario over the past ten years (2013-2022), with a focus on first-time HIV diagnoses occurring in 2022. It includes overall findings presented by age, sex, HIV exposure category, race/ethnicity, and geography. It also includes trends among key populations in Ontario most affected by HIV: two-spirit, gay, bisexual and other men who have sex with men including trans men, people who inject drugs, people who are African, Caribbean, or Black (ACB), Indigenous Peoples, and cis and trans women, including those from the communities above, who face systemic and social inequities, and are more likely to be exposed to HIV through a sexual or drug using partner.

The impact of the COVID-19 pandemic on HIV testing and diagnoses in Ontario affects the trends during those years. In 2022, HIV testing almost reached pre-pandemic levels; and more testing is expected to capture more HIV diagnoses, including some that may have been missed in 2020 and 2021.

Key findings from the 2022 HIV Diagnoses Report

First-time HIV diagnoses following pre-pandemic trends

OHESI classifies HIV diagnoses in Ontario into two groups: first-time diagnoses (People learning of their HIV positive status for the first time by having an HIV test in Ontario. This includes individuals who acquired HIV in Ontario, and individuals who acquired HIV outside of Ontario who learned their status for the first time in Ontario) and previous evidence of HIV (People who have a positive HIV test in Ontario but report to their health care provider a previous diagnosis of HIV outside Ontario, or people with a history of viral load testing in Ontario).There were 900 positive HIV tests– 623 classified as first-time HIV diagnoses and 277 classified as diagnoses with previous evidence of HIV, in 2022.

Although the number of first-time HIV diagnoses in 2022 was higher than in 2020 and 2021 – the years when COVID-19 disrupted HIV services, including testing – it was 15.6% lower than its decade-high 738 in 2018 and 8.8% lower than in 2019.

The number of people with previous evidence of HIV dropped by over half in 2020 and 2021 compared to 2019 – likely due to fewer people already diagnosed with HIV moving to Ontario and entering care during the height of the COVID-19 pandemic. However, the number of people with previous evidence of HIV in 2022 (277) was comparable to 2019 (270).

When an HIV diagnosis is missing data on HIV test history, they default to being a first-time HIV diagnosis which likely overestimates first-time HIV diagnoses and underestimates people with previous evidence of HIV. Due to missing data on HIV test history, OHESI estimates between 9.7% and 11.3% of first-time HIV diagnoses overall to have an uncaptured previous HIV diagnosis (2020-2022 average).

Figure 1: Number of first-time HIV diagnoses and positive tests with previous evidence of HIV, in Ontario, 2013 to 2022

Females made up a larger proportion of diagnoses in 2022

The number of first-time HIV diagnoses decreased by 13% in males between 2019 (514) and 2022 (449) and remained unchanged in females between 2019 (167) and 2022 (165). Women made up approximately 1 in 4 (26.9%) first-time HIV diagnoses in 2022, an increase compared to the average over the previous decade (20.5% average 2013 to 2022).

Figure 2: Number of first-time HIV diagnoses among males and females, Ontario, 2013 to 2022

First-time HIV diagnoses reporting male-to-male sexual contact (where exposure category was known) saw the largest decrease in 2022 compared to 2019

In 2022, the most frequently reported HIV exposure category continued to be male-to-male sexual contact (191), followed by heterosexual contact with identified risk (66) and heterosexual contact with no identified risk (60). The number of first-time HIV diagnoses has been decreasing among male-to-male sexual contact between 2018 and 2021, with a slight increase in 2022. The number of first-time HIV diagnoses with no risk reported/unknown has been increasing over the years, with a 70.3% increase from 2021 to 2022.

Though the counts of first-time HIV diagnoses (where exposure category reported) have varied over the years, the proportional breakdowns across the exposure categories has remained fairly unchanged. Male-to-male sexual contact continued to be the most commonly reported mode of HIV transmission in 2022, accounting for 53.2% of first-time HIV diagnoses (where HIV exposure category was reported).  HIV exposure category was not reported for 32.5% of diagnoses in 2022.

Figure 3: Number of first-time HIV diagnoses by HIV exposure category, Ontario, 2018 to 2022

First-time diagnoses decreased in White males in 2022, increased among Black males, Latino/e/x males and White females

Of the 623 first-time HIV diagnoses in 2022, 409 (65.7%) reported information on race/ethnicity and 214 (34.3%) did not. Among the first-time diagnosis with a reported race/ethnicity, white males continued to account for the largest number of first-time HIV diagnoses in 2022, but there was a relative decrease of 48.0% from 2019 (175) to 2022 (91). After decreases in 2020 and 2021, first-time HIV diagnoses increased to roughly pre-pandemic values in Black females in 2022 and increased in White females.

Figure 3a. Number of first-time HIV diagnoses by race/ethnicity, males, Ontario, 2018 to 2022

Figure 3b. Number of first-time HIV diagnoses by race/ethnicity, females, Ontario, 2018 to 2022

Variations in the rate of first-time HIV diagnoses per 100,000 people by health region from 2019 to 2022

Historically, HIV has been highly concentrated in more populated cities in Ontario – particularly Toronto. In 2022, Toronto region had the largest number and highest rate per 100,000 people of first-time HIV diagnoses but saw a decrease compared to 2019. Ottawa, Eastern, Central East and Central West regions saw an increase in the rate of first-time HIV diagnoses in 2022 compared to 2019.

Figure 4: Rate of first-time HIV diagnoses per 100,000 people by health region, Ontario, 2018 to 2022

Some key populations saw a drop in the proportion of first-time HIV diagnoses between 2019 and 2022 while others remained stable or increased

With respect to the proportions of first-time HIV diagnoses attributed to each key population in 2022, more than half (204/359, 56.8%) were among GBMSM, 29.8% (125/420) among ACB people, 26.9% (166/616) among Women, 10.6% (41/385) among PWID, and 4.6% (19/409) among Indigenous Peoples.

The key populations categories are not mutually exclusive: a person can be a member of multiple key populations.

Figure 5: Number of first-time HIV diagnoses and people with previous evidence of HIV by key population, Ontario 2019 and 2022

Note: Each key population is tabulated separately and has a different denominator, depending on the proportion of missing data for each indicator that is used to create each key population.

Stay tuned for more OHESI reports coming soon!

OHESI is a collaboration involving HIV and Hepatitis C Program of the Ontario Ministry of Health, Public Health Ontario, the Public Health Agency of Canada, and the Ontario HIV Treatment Network. The objectives of OHESI are to analyze, monitor and disseminate knowledge products on the epidemiology of HIV in Ontario.