HIV cases rising in Alberta, sparking need for broad outreach, experts say

Doctors and front-line workers are watching closely as HIV rates increase significantlyin Alberta.

An annual Alberta Health report reveals the number of new HIV cases jumped by 73 per cent last year, from293 in2022 to 507in 2023.

Reported cases have nearly doubled since 2019.

"It's significant. It's the opposite direction that we hope HIV rates and infections are happening," said Dr. Caley Shukalek, a Calgary physician working in HIV and STI(sexually transmitted infection) prevention and treatment.

There are likely a number of factors contributing to this trend, including changing demographics, according to Shukalek.

While HIV stillaffects gay, bisexual,trans and other people who have sex with men, he's seeing increasing cases in the heterosexual community and among those who use injection drugs, particularly in Manitoba and Saskatchewan.

Andimmigration is likely playing a role as well, he said.

Provincially, 54.8 per cent per cent of casesidentified last yearwere acquired out of the country, compared to 43 per cent in 2022, the September 2024 report shows.

"As we see a larger influx of people into Canada we might see increases here. We also see people who are Canadians who travel abroad and come back," saidShukalek.

Sometimes HIV is discovered through testing during the immigration process, he noted.

"In particular, refugee claimants who come here and may not have had screening prior to arrival end up having screening and new infections are found and subsequently treatment is started," said Shukalek.

Dr. Ameeta Singh said many of the newcomers she sees in her Edmonton practice are already being treated, regardless of where they come from.

"Oftentimes they're already suppressed with undetectable viral loads," said Singh, a clinical professor in the division of infectious diseases at the University of Alberta.

"So it is really just a matter of trying to incorporate them into our system and transition them to sometimes newer medications and then provide other wraparound supports," she said.

Medical advancements over the decades mean HIV is treatable andseen as a "chronic manageable disease," according to Singh.

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"Having a diagnosis of HIV today no longer means you should be excluded from anything, including immigration."

Front-line strain

Front-line agencies are feeling the impacts as the HIV case numbers rise.

"We've seen a huge uptick in demand for our services over the last year," said Finn St. Dennis, research and evaluation manager at the Edmonton-basedQueer and Trans Health Collective (QTHC).

"Our team is doing our best to keep up. But the demand outstrips our capacity."

Through their work, St. Dennis sees newer infections amongyounger people in the queer and trans community and worries that awareness may be waning among Albertans generally.

St. Dennis would like to see more provincial and federal government funding for front-line agencies, such as QTHC, which offers supportsincluding safer sex supplies and short-term counselling.

"Even from an economic sense, [it] makes sense to invest earlier on in prevention than it does treatment," they said.

St. Dennis also believes more detailed data collection (including transmission rates among trans people,queer women and non-binary people, for example) would help front-line staff design effective programming.

Katie Ayres, with SafeLink Alberta, said they too are trying to sort out why the numbers are rising.

Theagency is working to raise awareness and has targeted outreach programsto connect with people from countries or regions where HIV is endemic.

"Sometimes, within certain communities, talking about sexual health and sexual activity and condom use and prevention of HIV is not culturally appropriate." she said.

There is a need, she said, to broaden outreach.

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"I think we need to probably be diversifying the education and awareness of HIV beyond the traditional populations that we've targeted as health-care providers, which are often the queer communities."

Targeting younger Albertans is also important, she said, pointing to studies that show a decline in condom use among teens and young adults.

And services such as supervised consumption sites and needle exchange programs are also key, she said.

Government response

According to the Alberta government, while numbers for this year are not finalized, cases are on track tobe similar to 2023.

"Alberta, like many other jurisdictions in Canada and around the world, has experienced a rapid increase of STIduring the last decade, including HIV," an Alberta Health spokesperson said in an email.

The province pointed to a variety of factors, including"an increase in population, more effective contact tracing, increased availability of HIV testing at community-based organizations, and the expansion of rapid point-of-care testing in Alberta."

The spokesperson said $7 million annually is provided to organizations for sexually transmitted and blood-borne infectionprevention, testing, treatment and other supports.

Other programs targeting syphilis are also in place.

Meanwhile,with no sign of a downturn,Shukalekworries about the health system's capacity to keep up.

"Do we have enough health services to provide that access to all of these patients?" he asked.

"I also worry ... if we're finding this many, how many more have we not found?"