HIV infection rates on the rise

BY VERN SMITH

While experts can't agree on which North American city is hardest hit by new HIV infections, the AIDS Committee of Toronto (ACT) is backing away from two public service messages that identified Toronto's rate as the highest.

As part of ACT's public awareness campaign, the back-page ad of this year's Official Pride Guide states, "Toronto has the highest new HIV infection rate in North America." Inside, another ACT spot says, "Toronto now has the highest rate of new HIV infections in North America among gay and bisexual men, and other men who have sex with men."

While the organization refused to discuss the ads a week after their publication, by the time Toronto's public health department started making inquiries, HIV experts suggested that the copywriters were guessing.

"There was an error in that ad, and ACT is issuing a follow-up," says Sheila McEachen of Cohn & Wolfe, ACT's PR firm. "It should say 'one of the highest,' not 'the highest.'

"It was an unfortunate error that the ad got out, especially when we're launching the campaign. But the bottom line is that HIV is on the rise in this city among men who have sex with men." And ACT executive director Charles Roy also admits the information was "incorrect. We regret the error, and we're issuing 55,000 correction notices through our newsletter this week."

With a marked increase of gay and bisexual men testing positive over the past few years, experts can't pinpoint which city is hardest hit. "Incidence is the number of new infections over a period of time," says University of Toronto HIV researcher Dr. Robert Remis. "It's hard to know. We're basing it on a certain amount of estimation. You're sort of guessing, really."

But Remis says of the ads, "We can't say that. It may or may not be true. I doubt if it's true. I don't know where that came from. That's something I have never said. I'd say that we have 'among the highest' or 'a high rate.'

"In Toronto, our best estimates are [a rate of] about 1.5 per cent in gay men as a whole. As far as I can tell, it's comparable to what's going on in Vancouver, and higher than Montreal."

At a news conference at the AIDS memorial on June 18, ACT unveiled another slate of ads. Playing off Marlboro cigarette ads from manly glossies, they show good-looking cowboys below the headline "Welcome to Condom Country. " The bottom of the ads read, "HIV is on the rise in Toronto. Ride safely."

"Our focus for this is men who have sex with men [MSM]," says Roy. "This group comprises gay and bisexually identified men, as well as men who engage in same-sex sexual activity, yet self-identify as heterosexuals."

ACT will spend $400,000 this year to get its safer-sex message out. The new municipal, provincial and federal funds came on the strength of U of T studies that found HIV infection rates are rising after years of decline in the early to mid-'90s.

"We said prevalence was 22 per cent higher from '96 to '99," says Remis. "In other words, the overall number infected. This is different -- this is not incidence, this is prevalence."

According to new numbers, Remis says prevalence -- the number of living people infected at any time -- rose 30 per cent between 1996 and 2000, and MSM numbers show an increase in prevalence of 34 per cent in Toronto, where 6,800 were estimated to be infected by 1996 and 9,100 by 2000.

In July, 2000, figures released by U of T also showed an increasing number of MSM testing positive. Following four years of declining rates, researchers saw the rate rise in Ontario from 0.87 per 100 tested in 1996 to 2.07 by the end of 1999. The highest increase occurred in Toronto, where rates climbed from 1.7 in 1996 to 2.5 in 1999, although researchers qualify that result because it includes repeat testers. "It looked at when they last had their negative test and then when they had their positive test," says Dr. Liviana Calzavara, U of T's deputy director of HIV Studies. "That's different from individuals who test one time only, and we're making the assumption that people who are repeat testers are probably at higher risk."

More recently, U of T estimated Toronto's rate at about 1.5 positives per 100 first-time testers, which Remis and Calzavara say is a more reflective rate. "The thing to look at is the trend over time," says Calzavara. "It's clear there has been an increase. If you say Toronto's a North American leader, you would have to do a comparison to other cities, like San Francisco, that reported a dramatic increase, with numbers way higher. They have a larger number of infected individuals in the population to start with."

As a whole, Remis says prevalence for gay men in Ontario is about 11 per cent, and in Toronto about 15 per cent. "Overall, infection rates in New York are higher than here, in part because the epidemic hit earlier and harder in New York," he says. "That doesn't mean that's true more recently."

Remis also says prevalence advances with age. "But," he adds, "I can't tell you how that compares. There hasn't ever been a proper prevalence study on gay men in Ontario."

Calzavara is among scores of experts blaming "safer-sex fatigue" for the rise. "There's evidence to suggest that some at-risk individuals have become less vigilant about avoiding infection," she says. "There's also evidence that people are making assumptions about the HIV status of their partners. HIV-negative men are assuming that if their partner does not discuss condom use, they must be negative."