HIV/AIDS

Research Highlights

• There has been a 20% rise in the number of positive HIV test reports in Canada in the last five years (from 2,111 in 2000 to 2,529 in 2004).
• Central West Health Region represents 5.3% (1,311) of the total positive HIV test reports (23,523) in Ontario (2003).
• The three greatest social service issues affecting individuals living with HIV/AIDS in Guelph-Wellington are:
  • An increased risk of living in poverty, which results in challenges in meeting basic needs (food and housing).
  • Difficulties acquiring nutritional supplements, which have been proven to help manage side effects, due to lack of money.
  • Stigma and discrimination associated with HIV/AIDS, particularly within ethnic communities and among older adults.

Research Profile on Health & Independent Living

What is HIV/AIDS?
The Human Immunodeficiency Virus (HIV) is the virus that causes Acquired Immunodeficiency Syndrome (AIDS).  HIV attacks the immune system, resulting in a chronic, progressive illness. It leaves infected people vulnerable to opportunistic infections and cancers. Opportunistic infections rarely cause harm to healthy people, but for people with AIDS these infections are often severe and sometimes fatal because the immune system is so ravaged by HIV that the body cannot fight off certain bacteria, viruses and other microbes. According to Health Canada, the median time from infection to AIDS diagnosis exceeds ten years. AIDS is fatal and to this day there is no cure.
 
How is HIV Transmitted?
HIV is transmitted through unprotected sexual intercourse, needle sharing, and pregnancy both through delivery and breast feeding (from an infected mother to her infant).
 
The Changing Face of HIV/AIDS ^[i]
Men who have sex with men (MSM) continue to account for the largest number and proportion of positive HIV test reports. In 2005, they accounted for 43.5% of all reported positive HIV diagnoses in Canada, up from about 37% in the mid-to-late-nineties.

Women represent a growing proportion of positive HIV test reports in Canada. They accounted for over one quarter of the positive HIV test reports in 2004, which is a notable change from the years prior to 1995, where they represented less than 10%. The largest rise in this proportion is seen among the 15-29 year age group, where females represented 13.2% of reports in 1985-1994 and 35% in 2005. Similarly, the AIDS Committee of Guelph and Wellington County (ACGWC) reports an alarming increase in Sexually Transmitted Infections among young women in this region.
 
Heterosexual contact accounted for close to one third of all reported positive HIV test reports in 2005. This exposure category has steadily increased from 7.5% of all infections in 1995.

Within these exposure categories, Canadians from countries with high rates of HIV/AIDS (so called 'HIV-endemic countries') make up an increasing proportion of HIV infections in Canada. An estimated 3,700 to 5,700 individuals from HIV-endemic countries were living with HIV/AIDS in 2002, and accounted for an estimated 6-12% of new HIV infections in Canada in 2002. Likewise, the ACGWC has seen an increase in the number of service users from HIV-endemic countries. 
 
HIV/AIDS and Older Canadians 
HIV/AIDS is generally believed to be a younger person’s disease and therefore, little focus has been given to the issue of HIV/AIDS among older ^[ii] Canadians. Of the 18,332 AIDS cases reported to the Centre for Infectious Disease Prevention and Control, 2,123 (11.6%) were among persons 50 years of age or older ^[iii]. Approximately 10% (3,858) of the positive HIV test reports in Canada each year (since 1982) have been among those age 50 years or older.  Men accounted for 88.2% of those positive reports. ^[iv]
 
Sexual contact is the major risk factor for HIV infection in older Canadians.

Special Considerations

• HIV/AIDS educational campaigns and programs are not targeted at/to older individuals.
• Older people with HIV/AIDS face a double stigma: ageism and infection with a sexually-or-IV drug transmitted disease.
• Because of the stigma, it can be difficult for seniors – women, in particular – to disclose their HIV status to family, friends, and their community.
• As HIV symptoms often are similar to those associated with aging (fatigue, dementia, skin rashes, and swollen lymph nodes), misdiagnosis is frequent in older people who are, in fact, infected. 
  

As our society ages and persons with HIV/AIDS live longer due to improved medical treatment, it is likely that HIV/AIDS among older adults will become a greater issue. 
 
 
HIV and Ethno-cultural Groups
Increasingly, Guelph-Wellington is becoming home to a more culturally diverse community.  While the total number of Canadians diagnosed with AIDS from 1994 to 2004 has decreased from 1,776 to 237, there has been an increase in the proportion attributed to Black Canadians from 8.3% to 15.5% and to Aboriginal persons from 2.3% to 14.8% ¹.
 
Cultural taboos linked to sex and Sexually Transmitted Diseases can impact people’s access to HIV prevention and education, and thus, directly increase the vulnerability to HIV infection of those who are not infected. 
 
The local HIV physician reports seeing a substantial increase in the number of late-stage AIDS diagnoses among ethnic minorities and seniors, an indication that people are not being tested early and not recognizing their risk factors.
 
Prevalence and Incidence Rate
A total of 60,160 positive HIV tests have been reported to the Public Health Agency of Canada, from November 1985 (when reporting began) to December 31, 2005.  There has been a 20% rise in the number of positive HIV test reports in the last five years (from 2,111 in 2000 to 2,529 in 2004). Ontario has the highest number of positive HIV test reports in Canada (as of December 31, 2004) with a total of 24,479 (44.5%) ². 
 
In 2004, 2,529 Canadians were diagnosed with HIV, 47 more cases than in 2003. In Ontario alone, 1,176 new cases were reported in 2004, representing 46.5% of all new reported cases across Canada ³.

Source: Report on HIV/AIDS in Ontario, 2002, Health Canada

• Central West represents 1,311 (5.3%) of the total 23,523 positive HIV test reports in 2003
• Central West Health Region includes Halton, Peel, Waterloo, and Wellington-Dufferin-Guelph

Community Supports & Services (non-medical)

The AIDS Committee of Guelph and Wellington County (ACGWC) administers a Support Program for People Living with HIV/AIDS, providing compassionate support and accurate information to individuals with HIV/AIDS to assist them in making informed choices and attain greater control over their health. The program offers nutritional supplements, free food and vitamins, emergency funds for medication, counselling, advocacy, a free naturopath clinic, an on-line chat room, and referrals to community programs. In addition, the ACGWC has recently developed the Masai Centre, a community-based outpatient clinic offering holistic and compassionate care and treatment for those living with HIV/AIDS in Wellington-Dufferin, Grey-Bruce and Waterloo Region.

The Wellington Dufferin Guelph Health Unit administers a Harm Reduction service providing needle exchange services and other harm reduction, educational, and counselling services to the community. In addition, they provide education, and counselling to promote positive messages about sexual orientation, healthy relationships, and prevention of sexually transmitted infections including HIV/AIDS. Free confidential HIV antibody testing is also provided.

Hospice Wellington provides compassionate care to individuals and their families facing a life-threatening illness, extending through bereavement. They offer weekly Day Hospice Wellness Programs in Guelph and Fergus. Programs vary from relaxation and support to walking, working with clay art and horticulture therapy, scrap booking, watercolour painting, and monthly luncheons. Within the next two years Hospice Wellington will be opening up a residential palliative facility to better serve their clients.
 
Of the above mentioned services, the United Way of Guelph and Wellington County funds the AIDS Committee of Guelph and Wellington County (Support Program for People Living with HIV/AIDS) and Hospice Wellington’s and its two programs; Palliative & Bereavement Support and the Wellness Program.

What are the Social Service Issues in Guelph-Wellington?
Acquiring Basic Needs
One of the main challenges facing individuals living with HIV/AIDS is financial difficulty resulting from their illness. Individuals living with HIV/AIDS are at an increased risk of living below the poverty line⁴ and as a result are often unable to acquire basic needs (i.e. food, housing, clothing, etc.). According to the 1998 Canadian AIDS Society survey⁵, 74% of the respondents had a gross annual income of less than $29,000 and 45% had less than $12,000, indicating that a very large number of people living with HIV/AIDS in Canada are living below the poverty line. Approximately 42% received income from public benefits, while only 11% received income from private insurance companies. Likewise, only 33% of respondents reported receiving income from wages, savings or salaries. Extrapolating from this survey, it can be assumed that people living with HIV/AIDS in the Guelph-Wellington not only face financial difficulties, but are also at an increased risk of living below the poverty line and not meeting their basic needs.
 
Getting Complementary Therapies
Individuals living with HIV/AIDS who are facing financial difficulties are often unable to pay for extra nutritional supplements needed to help fight the virus, or complementary therapies to help manage side effects. Medications are expected to become less toxic in the future but so far there has been no change.  Thus, the need to supplement an individual’s diet with vitamins and supplements has become more pressing, resulting in an increased acceptance of complementary therapies by health care professionals.⁶ Although mixed opinions still exist within the literature many people with HIV/AIDS find them very helpful in coping with stress and drug induced side effects.
 
Community Awareness & Education
Another challenge facing individuals living with HIV/AIDS is feelings of isolation associated with stigma and discrimination.  According to the joint United Nations Programme on HIV/AIDS, “stigma and discrimination associated with HIV and AIDS are the greatest barriers to preventing further infections, providing adequate care, support and treatment and alleviating impact” ⁷. 
 
Why are people living with HIV/AIDS stigmatized?

• People may be afraid of "catching" HIV because they do not know how it is transmitted or they wrongly believe they can catch it through casual contact like hugging or sharing a drinking glass
• People living with HIV/AIDS may be members of already marginalized populations (e.g. injection drug users, men who have sex with men)
• Their behaviours may be seen as bad or wrong (e.g. sexual activity, injection drug use, etc.)
• People may think that it is the individual’s own fault they were infected with HIV

People living with HIV/AIDS find themselves being stigmatized by family, friends, employers, co-workers, landlords and/or service providers who fail to respect their dignity. Unfortunately, stigmas and discrimination have detrimental effects, damaging people’s lives.  These range from but are not limited to:

• Being fired, pressure to resign, having hours cut back
• Being evicted, being harassed into leaving housing
• Being denied services by doctors and dentists
• Depression, stress, isolation, fear
• Negative health impacts
• Severe poverty

According to the ACGWC, stigma and discrimination has lessened within the gay community where most of the education in the eighties was focussed, but remains particularly high in ethnic communities of Guelph-Wellington. For instance, members of the same family are often counselled in different locations. This trend is not unique to Guelph-Wellington as research indicates that many minorities living with HIV/AIDS often experience dual discrimination: discrimination on grounds of race, and discrimination on the basis of actual or imputed HIV status.

• [i] Public Health Agency of Canada (2005).  HIV and AIDS in Canada: Surveillance Report to December 31, 2005.  Ottawa, Ontario: Public Health Agency of Canada – Catalogue No. H121-1/2005-2.
• [ii] It should be noted that the age range for older is subjective, and the lower age limit in the literature varies between 40 years to 55 years of age.  For the purpose of this research report, older individuals will be defined as those age 50 years or older.
• [iii] Public Health Agency of Canada (2005). Centre for Infectious Disease Prevention and Control (CIDPC).  Ottawa, Ontario: Public Health Agency of Canada.
• [iv] Data from the provincial and territorial HIV testing programs reflect numbers up to June 30, 2002.

1. “Surveillance Report to December 31, 2005”. HIV/AIDS in Canada. Public Health Agency of Canada.
2. Ibid.
3. Ibid.
4. According to Statistics Canada, 1997 LICO was considered to be below $16,565 per family income or individual.
   
5. The only known national survey that has been conducted with the goal of collecting information about income from people living with HIV/AIDS. The Canadian AIDS Society conducted the survey in 1998, with 9,000 surveys distributed, and 1,400 completed and returned.
6. Gillet, R. (2003). “Complimentary Therapies in Health Care”.
7. United Nations Programme on HIV/AIDS (UNAIDS). http://www.unaids.org/en/default.asp