HIV cases rise sharply in region

Health unit reports 46 new cases this year, up from 32 in 2010

A "significantly higher" number of Ottawans contracted HIV in the first half of this year than in the same period in 2010, says a report from the city's public-health unit.

The report, summarizing all the communicable diseases reported to the public health unit so far this year, says that 46 new HIV cases were reported between January and June 2011, compared with 32 new cases in the same period the year before. "This one clearly crosses a threshold of statistical significance," said Dr. Isra Levy, Ottawa's chief public-health doctor. "It's an increase of nearly 50 per cent."

Although it doesn't break down the demographics of the new cases in detail, the report observes that "year-todate rates of HIV among 20-29 year old men are the highest they have been in the last decade" and that noticeably higher rates are being seen in men between ages 30 and 39 as well. In all, nine out of 10 new cases are in men, and two-thirds are in men who have sex with men. "Some people continue to practise what we would regard as less-safe sex," Levy said, and ironically it hasn't helped that science has devised ever-better treatments for HIV and AIDS. The illness can't be cured, but drugs can keep it from destroying a person's immune system for years - even decades, with diligent care and a little luck.

"The term that's applied is 'treatment optimism,' " Levy said. "The behaviour of some individuals has become less cautious as a result."

A further theory among epidemiologists, Levy said, is that technology has made sexual trysts among strangers and near-strangers easier to organize, so the cost in time and effort of finding a partner willing to engage in unsafe sex is lower now than it used to be.

In January, the public-health unit opened an expanded treatment clinic for sexually transmitted infections, to try to deal with overwhelming demand. That was a mixed blessing: it enabled the clinic to see more than the 1,500 people a month it had previously been seeing, but it meant that during the renovations at the clinic on Clarence Street, which lasted nearly two months, only the most urgent cases were seen there. (Staff went to other community health centres so the system didn't shut down entirely.)

It's also true, of course, that if more people can been seen by doctors, it likely means more people will be diagnosed with infections even if no more people are actually sick. In that sense, the numbers may be a sort of good news. There's a saying in medicine, 'If you take a temperature, you'll find a fever,' " Levy said. "That's probably some of what's going on here." He said the sexual-health clinic tests about 300 people for HIV each month, and the more HIV-positive people who know they're HIV-positive, the better off everyone is.

The report also notes that more people caught chlamydia, another sexually transmitted infection, in the first part of this year in particular; 1,189 new cases were reported, compared with 1,161 in the same period in 2010. Reported cases of gonorrhea are also down (to 117 from 126) and so are cases of syphilis (to 54 from 77).

But, said Levy, the increase in chlamydia cases is part of a long steady march upward. And even where the numbers have dipped, they're still up dramatically from a few years ago: Ottawa used to have maybe two to four cases of syphilis a year, for instance.

His department is always working on reminding people that sexually transmitted diseases haven't gone away, even as the cultural panic over AIDS has receded, Levy said. The health unit's outreach efforts include work in schools and on college and university campuses, supplying free condoms to people who can't afford them, and teaching people how to "negotiate condom use" in difficult situations.

Although the figures for HIV show that most of the new Ottawa cases are in younger men who have sex with men, Levy said it remains a disease that spreads through heterosexual sex and through activities like sharing drug needles, and the other sexually transmitted illnesses don't show that profile at all. "This is not a downtown problem. It's everywhere in the city, it doesn't respect boundaries of socio-economic status or anything else," Levy said.