My interest is always piqued as soon as a news report refers to rates of some disease being “on the rise”. I’m usually disappointed as I wait to hear the details since often no actual numbers are provided.
Last week a CKOM news brief declared “Heterosexual sex HIV transmission on rise in Sask“. Really? No details are provided, just quotes from an AIDS Saskatoon coordinator.
What are the actual numbers?* 2009 2010 2011 2012 2013
Total HIV cases 94 74 66 55 43
Heterosexual sex transmission 12 11 12 13 9
Injection drug use transmission** 76 56 49 34 28
The total number of new HIV cases in the health region is falling and this decrease is primarily among injection drug users. When the percent of cases associated with one cause decreases, the other causes increase as a percent of the total. In 2009, 81% of HIV transmission was via IDU and 12% from heterosexual sex compared to 65% and 21% respectively in 2013.
Conclusion? Heterosexual HIV transmission in the Saskatoon Health Region is not increasing. A larger percentage of cases are the result of heterosexual sexual contact but there are a smaller number of cases.
I also noted that 68% of cases had heterosexual contact with an injection drug user and 30% of cases had sexual contact with a confirmed or suspected HIV+ person.
*Information from the Saskatoon Health Region’s “HIV Strategy Report 2012-2013” and “Better Health for All Series 5: Rates of HIV declining but more needs to be done“.
** Could be +/- 1 since I used a graph to estimate the percentage in each category.
Note: This is a somewhat old topic but it is part of what made me want to get back to blogging rather than just scribbling on paper at my computer.
Did you know that the Saskatoon Health Region now has an “opt out” policy for HIV testing? Had a blood test recently? Did your doctor tell you about the HIV test?
The Saskatoon Health Region does almost 2000 HIV tests every month. Last year they identified 55 new cases and over 72% of those cases were intravenous drug users. Why would the health region decide to test every patient aged 13 to 64 regardless of risk factors? In 2012, they found one new HIV case for every 393 tests that were performed. In 2009, they did 26% fewer tests in 2009 but identified 50% more cases. I wonder if they were more accurately targeting patients for testing.
I also remember a 2012 article about the 186 new cases in 2011. (Of course, I can’t find it online. Why do StarPhoenix articles seem to disappear?) The article emphasized the increase in new cases and discussed expanding testing for everyone. However, if you look closer at the numbers, 81% of the new cases were among Aboriginals. Using rough population numbers, the incidence rate among non-Aboriginals was 4 per 100,000. Among Aboriginals, it was 90 per 100,000. Effort should be focused on reducing the spread of HIV in the populations most at risk.
In general, screening tests are most effective when the at risk population to be screened is correctly identified. Testing every patient in SHR is not a well-designed screening program. Testing people with no risk factors and no symptoms is a waste of resources. Who benefits from this?
In 2012, we heard that cases in Saskatchewan were up 8% in 2011. In 2013, we heard that cases were down 5% in 2012. Saskatchewan has been aggressively increasing testing since 2010 and now it looks to me like rates have leveled off. This also suggests that condom distribution and needle exchanges are not reducing the number of new cases.
Data from cbc.ca and LeaderPost.