Epidemiological Profile

HIV and Hepatitis C Disease

HIV infection results in a gradual destruction of the body’s immune system
and its ability to combat infection. People living with HIV are prone to a host
of opportunistic infections, cancers and severe weight loss that can lead to
serious illness or death. With recent treatment advances, many people who previously
experienced ill-health as a result of HIV infection can now lead relatively
health lives, provided they have access to appropriate treatment and healthy
living conditions.

The most common modes of HIV transmission are unprotected sexual intercourse,
including vaginal and anal intercourse, and needle-sharing.

The HIV epidemic can be conceptualized as a series of epidemics moving through
different populations at different times and at different rates. In Canada,
the first epidemic was identified in the early 1980’s, and primarily affected
gay men and other men who have sex with men.

A second epidemic became apparent in 1994, as HIV rates soared among people
who injected drugs, and to a lesser extent among heterosexuals. Since then,
the HIV epidemic and other blood borne pathogens, such as Hepatitis C, have
moved increasing into marginalized populations, taking advantage of the transmission
opportunities made possible by poverty, homelessness, addiction, cultural dislocation
and mental illness.

Hepatitis C is a disease of the liver caused by the Hepatitis C virus (HCV).
People at highest risk for HCV infection are people who use drugs by injection
and people who received a blood transfusion, blood product or organ or tissue
transplant before 1990. The most common mode of HCV transmission is the sharing
of needles and other drug using equipment.

HIV and Hepatitis C Incidence

The epidemiological data reported here is HIV and HCV testing data for the
Vancouver Island Health Authority which consists of three health service areas:
Southern Vancouver Island, formerly the Capital Region, Central Vancouver Island,
and Upper Vancouver Island. The Gulf Islands are included in the Southern Vancouver
and Central Vancouver Island health service areas. The HIV data is supplied
by the Vancouver Island Health Authority and the HCV data is supplied by the
BC Centre for Disease Control.

It should be noted that testing data captures only those individuals who voluntarily
sought testing on Vancouver Island. It does not capture people who were tested
elsewhere and now reside in one of the three Vancouver Island health service
areas. It does not capture the prevalence, or extent, of HIV and HCV infection
in the general and target populations. Testing data also does not capture those
people who have not been tested and who may be positive for HIV and/or HCV.

The overwhelming proportion of people who do get tested for HIV and/or HCV
are the “worried well” who test negative for the infections. In
contrast, most of the positive test results for HIV and/or HCV tend to cluster
in high risk populations.

The HCV testing data also does not differentiate between acute and chronic
infection. Given that most acute Hepatitis C is asymptomatic or has non-specific
clinical presentation, most reported cases represent chronic infection. As a
result, the true prevalence of HCV in the population may be underestimated.

The epidemiological data most relevant to AIDS Vancouver Island are from the
Southern and Central Island health service areas. However, from a planning perspective,
HIV and Hepatitis C trends in the Upper Island should be monitored as newly
diagnosed people are likely to migrate to larger urban centres, such as Nanaimo
and Victoria, in search of treatment, care and support services.

Southern Vancouver Island

In 2001, 36 people tested newly positive for HIV in the Southern Vancouver
Island health service area, compared to 27 people in 2000. This represents an
increase of 33% in actual cases—the only health region in BC where such
an increase has occurred. The rate of HIV infection per 100,000 population in
2001 was 10.74, the second highest rate among the health regions and the same
as the overall rate for BC.

It should be noted, however, that the BC rate is skewed by the very large numbers
of HIV cases reported in the Vancouver health service area (253 cases in 2001
for a rate of 43.2 per 100,000 population). This means that the rate of HIV
infection in southern Vancouver Island is unacceptably high.

To date, 445 people have tested positive for HIV infection in Southern Vancouver
Island since testing began. Just over 80% of HIV infections occurred in men.
Of these cases, 33% occurred in men who inject drugs and 36% occurred in men
who have sex with men. For women, who comprise 18% of total HIV infections,
an overwhelming 58% of these cases occurred in women who inject drugs and/or
are involved in the sex trade. Of the total 445 cases of HIV infection, just
under 10% self-identified as Aboriginal people and/or First Nations. Ninety
eight percent (98%) of the total HIV cases occurred among people 20 years of
age or over, with the majority of cases among people 30 years of age or over,
regardless of gender.

In 2001, there were 403 cases of Hepatitis C reported in Southern Vancouver
Island, down from 426 cases in 1999. The rate of infection per 100,000 population
was 120.2 in 2001, higher than the BC rate of 107.5 for the same year. In 1999,
the regional rate of Hepatitis C infection was 126.9 per 100,000 population,
quite a bit lower than the BC rate of 134.4 for the same year.

Central Vancouver Island

In Central Vancouver Island, 12 people tested newly positive for HIV infection
in 2001, compared to 13 in 2000. The rate of HIV infection in 2001 was 4.85
per 100,00 population, just under half of the provincial rate. There have been
a total of 172 HIV infections to date. Women account for 23% of the total HIV
infections and the two biggest risk factors for women are heterosexual contact
(47%) and injection drug use and/or involvement in the sex trade (43%). Men
account for 77% of the total HIV infections and the biggest risk factors for
men are injection drug use (37%) and men who have sex with men (27%).

Of the 172 HIV cases in Central Vancouver Island, 35% self-identified as Aboriginal
people and/or First Nations. The age distribution is the same as in Southern
Vancouver Island (nearly everyone over 20 years and the majority over 30 years
of age).

In 2001, there were 315 cases of Hepatitis C reported in Central Vancouver
Island, down from 390 cases in 1999. The rate of infection per 100,000 population
was 127.4 in 2001, higher than the BC rate of 107.5 for the same year. In 1999,
the regional Hepatitis C rate was 160 per 100,000 population, considerably higher
than the BC rate of 134.4 for the same year.

Upper Vancouver Island

Very few people tested newly positive for HIV in the Upper Vancouver Island
health service area over the past two years: only 2 cases in 2001 and 3 cases
in 2000. There have been a total of 47 HIV infections to date and nearly 40%
of these infections occurred among women. The biggest risk factor for women
from the Upper Island is injection drug use and/or involvement in the sex trade
(36%). A surprising 36% of HIV infections among women cannot be linked conclusively
to either heterosexual contact, injection drug use or sex trade involvement.

In 2001, there were 142 cases of Hepatitis C reported in Upper Vancouver Island,
down from 170 in 1999. The rate of infection was 116.1 per 100,000 population
in 2001, higher than the BC rate of 107.5 for the same year. In 1999, the regional
rate of Hepatitis C infection was 138.4 per 100,000 population, slightly higher
than the BC rate of 134.4 for the same year.

Other Relevant Data

One indicator of access to treatment for HIV-positive individuals is the number
of people receiving antiretroviral (ARV) therapy. The BC Centre for Excellence
HIV/AIDS Drug Treatment Program tracks participants by health region and several
key variables, including age, gender, ethnicity, social status, income, housing
status, health care utilization and risk group.

It should be noted, however, that without knowing the prevalence of HIV infection
in the general and target populations, it is hard to estimate the proportion
of HIV-positive individuals who are accessing ARV treatment.

As of August 2002, a total of 334 people on Vancouver Island were receiving
antiretroviral therapy: 224 people in southern Vancouver Island, 79 people in
central Vancouver Island, and 34 people in upper Vancouver island.

A survey of drug treatment program participants who are on any form of anti-HIV
treatment revealed the following breakdown by risk factor: on Vancouver Island,
12% of survey participants are injection drug users, 58% are gay or bisexual,
and 12% are First Nations.

In southern Vancouver Island, 11% of survey participants are injection drug
users, 64% are gay/bisexual and 10% are First Nations. In central Vancouver
Island, 12% are injections drug users, 52% are gay/bisexual and 21% are First
Nations. In upper Vancouver Island, 22% are injection drug users, 39% are gay/bisexual
and 17% are First Nations.