Over the past decade we have observed a substantial decrease in new HIV cases in British Columbia. A similar decrease has not, however, occurred among gay, bisexual, and other men having sex with men (MSM). We used provincial surveillance data to evaluate this trend in more detail.
Methods: We examined demographic characteristics of individuals having a new positive HIV test (i.e., cases, or new diagnoses) in BC, focusing on men who report having sex with other men. HIV became a reportable disease in BC in 2003, resulting in measurable improvements in data quality. For this reason analysis was restricted to 2004-2011.
Findings: While the total number of new HIV cases decreased by 35%, from 442 in 2004 to 289 in 2011, the number of MSM cases decreased by only 11% (187 in 2004 versus 167 in 2011). Consequently, the proportion of new HIV cases in BC who are gay/bisexual or other MSM increased to 58% in the most recent year.
When trends in new MSM HIV cases are examined by year of birth, we see the largest increase for those born between 1980 and 1989. By contrast, new HIV cases among older cohorts were generally stable or declining during this eight-year period.
There has been a small shift in the ethnicity distribution of MSM HIV cases over the past seven years: the percentage of (non-white) ethnic minorities has increased from 20% (142 cases) in 2004-2007 to 33% (215 cases) in 2008-2011. In particular, increases in new HIV cases were apparent among Asian and Hispanic men.
Implications: Gay men and other MSM continue to be disproportionately represented among new HIV cases in BC. While decreases in HIV case reports have been observed for some other populations affected by the HIV epidemic such as people who use injection drugs, the epidemic continues unabated in gay men.
The largest increase in HIV cases among MSM was observed for those born during the 1980s (these men were in their late teens and twenties during the period of analysis). Notably this birth cohort constitutes the first to enter adolescence/adulthood in the post-HAART HIV era and hence the first to not witness first-hand the high burden of AIDS—and its related mortality—experienced by the gay community in the 1980s and early 1990s. There is furthermore some indication that the profile of new MSM HIV cases is shifting, with more ethnic minorities represented in cases during the past four years. Novel, increased, and intensive efforts to better understand and address the HIV epidemic among gay men in BC, especially those under 30 and members of ethnic minority communities, are critical to controlling the provincial burden of disease.
Further information: The provincial annual surveillance reports for HIV and other sexually transmitted infections can be found on the BCCDC website. Health Initiative for Men is a community-based organization dedicated to strengthening the health and well-being of gay men in BC.
Acknowledgements: Dr. Mark Gilbert, Physician Epidemiologist