On a day meant to bring international awareness of HIV/AIDS, Torontonians learn we need not look any further than our own city. A new report says 1 in 120 adults in Toronto are HIV-positive. "Facing the Future: An Innovative Response to the Urgent HIV/ADIS Crisis in Toronto" was authored by Dr. Kevin Gough, Director of Infectious Diseases at St. Michael’s Hospital and Stephanie Karapita, CEO of Casey House, a specialty hospital for people with HIV/AIDS. I spoke with Karapita yesterday on this new report, what it means for Torontonians and our local capacity to serve people with HIV/AIDS.
When the study was released a few days ago, the numbers certainly caught peoples’ attention. One in 120 people in Toronto ‑ really?
We’ve been living with all the statistics in this document for years. But we felt it was time people in Ontario knew about it too and to highlight the need for treatment.
There are two reasons for these numbers: People are living longer with HIV, given anti-retroviral treatment regimens. Between 2003 and 2008 in Ontario, the number of people with HIV rose by 31% ‑ because people are living longer and also because new infections keep occurring. There are 1,000 new diagnoses in Ontario every year. Of course, one-third of people who have HIV don’t know they do, so those numbers are based on actual reporting and statistical modelling.
What these numbers mean is the demands on the health care system continue to grow and immediate response is needed.
We’re now discussing working towards an AIDS-free generation, and yet the HIV numbers are increasing in Ontario. Do we know more about why these new cases are happening?
In general, there’s a misconception that HIV is a manageable chronic disease and you can take medication and go on the cocktail and you’ll be okay. There’s another misconception out there that there is a cure for HIV. CANFAR (The Canadian Foundation for AIDS Research) did some polling last year amongst Grade 9 students and [found that result.] It’s very alarming that a quarter of the new diagnoses in Toronto are in people under the age of 30. There’s a false sense of security. And for my board of directors here at Casey House ‑ a lot of gay people who lived through the early years of the crisis – they’re seeing another generation being infected when it was never supposed to be this way. It’s sad to see.
I’m pleased to see Hillary Clinton taking a leadership position by saying let’s create an AIDS-free generation. There are a number of strategies which will be put into place. The stigma of HIV is a big challenge so when leaders like Clinton speak out, it also helps reduce the stigma. Clinton has always preached “Treatment as Prevention.” What that means is if you are HIV-positive and are on meds, the less likely you are to spread the virus. Taking medication makes you less infectious. Yes, condoms are necessary but it’s difficult to get people to use them when there are other factors such as mental health issues or homelessness to deal with. So anti-viral programs go a long way in treating people, reducing infection rates and contributing to public health ‑ and this reduces health care costs.
Where are the new cases coming from?
A quarter of new infections are in young people. Aboriginal people proportionally have higher new infections than the rest of the population, with aboriginal women being hardest hit. The reason for this is poverty. This is related to mental illness and substance abuse. It makes them vulnerable to HIV infection.
What are we dealing with in treating this population now and in the years ahead?
We’re dealing with higher numbers and a more complex population with multiple diseases and all made more complicated by the greying of AIDS. By 2015, across North America and including Ontario, over 50% of people with HIV will be over the age of 50. This is already the case at Casey House today and has been for some time. Older patients have increased and complex healthcare needs. A 55 year-old person with HIV/AIDS has the body of a 75 year-old. Patients at Casey House deal with five diseases layered on top of their HIV – cancer, high blood pressure, nerve pain, mental illness and heart disease. And so it’s a complex disease for the health system to treat.