Who Is at Risk?

If you think you are not at risk, think again. What was once considered a "gay" disease affects people of any sex, of all ages and from all backgrounds. In fact, women and youth are two of the groups with the fastest growing rates of infection in Canada and around the world.

HIV/AIDS does not discriminate. Anyone can contract the virus, and many people who look and feel healthy may have HIV without knowing it. Health Canada estimates that in Canada, 27% of people living with HIV do not know they are infected.

Awareness is the key to making the choices that will protect you and keep you healthy.

(Source: HIV and AIDS in Canada: Surveillance Report to December 31, 2007. Public Health Agency of Canada. 2008)

Community Involvement

MEN
Throughout North America, HIV/AIDS first appeared in the gay community. But HIV/AIDS is not and never has been restricted to gay men. Today, it is estimated that 80% of HIV infections around the world have been transmitted through sexual contact, and the majority are heterosexual contact. In Canada, of new HIV infections among men in 2007, the risk categories were 14% injection drug use, 22% heterosexual and 56% men who have sex with men.

(Source: HIV and AIDS in Canada. Selected Surveillance Tables to June 30, 2008. Surveillance and Risk Assessment Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, 2009.)

A number of factors place men at particularly high risk of contracting HIV. For example, men tend to have more sex partners than women, including extramarital partners. They are less likely than women to seek health care. There are also more men in prisons, where high risk sexual and drug-related activities are common, and harm reduction tools are not available or easily accessible.

Since the penis is the most likely area of transmission of HIV/AIDS for males, the consistent use of condoms is vital to prevention.

WOMEN
The number of women infected with HIV is climbing rapidly. Worldwide, women account for half of all people living with HIV. In Canada, women account for a growing proportion of new HIV infections: from 11.3% of test reports in the 1985-1996 period, to 27.8% of positive HIV test reports in 2006.

(Source: HIV/AIDS Epi Updates, November 2007, Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, 2007.)

Women are biologically more vulnerable than men to HIV infection because of the greater exposed surface area of the female genital tract. Studies show that male to female transmission appears to be 2 to 4 times more likely than female to male transmission. Young girls are especially vulnerable, since their immature cervixes and low vaginal mucus production present less of a barrier to HIV.

Women who are HIV positive can transmit the virus to their unborn babies during pregnancy, birth or breastfeeding. If a pregnant woman is found to be HIV positive, medication can be taken by the mother and by the newborn to reduce the likelihood of mother-to-child transmission.

Women who have sex with men can protect themselves against HIV/AIDS by using female condoms or convincing their sexual partners to wear male condoms. This means women must play an active role in discussing and practicing safer sex and being responsible for their health.

YOUTH
Young people are at particular risk of HIV infection. Worldwide, almost half of the 2.7 million new HIV infections in 2007 occurred among people between 15-24 years of age. (Source: 2008 Report on the Global AIDS Epidemic, UNAIDS, 2008) In Canada, youth are also one of the groups with the fastest increasing proportion of new HIV infections.

The vulnerability of young people may be due to a tendency to experiment with sex, sometimes with many different partners, as well as with recreational drugs and alcohol which can impair judgment about practicing safer sex.

Some studies show that many young people mistakenly believe that there is a vaccine or cure for HIV. Young people may rarely see someone their own age visibly sick with AIDS because HIV infection can take years to develop into AIDS. Consequently, many young people do not understand the very real and present risk of HIV/AIDS.

ABORIGINAL PEOPLE
In Canada, Aboriginal people continue to be over-represented among populations at risk for, and living with, HIV/AIDS. Although Aboriginal people represent only 3.4% of Canada’s population, in 2005 they accounted for 7.5% of all people living with HIV/AIDS in Canada.

In 2006 the proportion of positive HIV test reports attributed to Aboriginal persons was 27.3% (among the provinces and territories that include ethnicity information with their HIV reports). Among Aboriginal people, HIV affects more women and young people than in non-Aboriginal groups.

There are number of social and economic reasons why Aboriginals populations can be at higher risk of HIV/AIDS. Discrimination, poverty, and other destructive effects of the residential school system play a part in the vulnerability to HIV/AIDS among Aboriginal people.

(Source: HIV/AIDS Epi Updates, November 2007, Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, 2007.)

ELDERLY
In Canada, persons over the age of 50 have been experiencing increasing rates of HIV infection. The proportion of positive HIV test reports for people 50 and older has risen from 7.6% between 1985 and 1998 to a high of 13.8% in 2006.

(Source: HIV/AIDS Epi Updates, November 2007, Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, 2007.)

People often think that just because a person is over 50 years old that they are no longer sexually active. We know from studies and speaking with people that this is certainly not the case. People have active and healthy sex lives well into their 60's, 70's, and 80's.

Older people may lose their partners and be entering the dating scene after many years. They may enter the scene with little or no knowledge of HIV/AIDS and other STI's. Many grew up in a time when HIV was unheard of, and there are few, if any, HIV prevention campaigns targeted towards older people.

Many seniors view condoms as a form of birth control. Because of their age, most no longer worry about pregnancy. This means they are often not practicing safer sex. As well, post-menopausal women are at greater risk of HIV infection through sexual activity due to thinning vaginal walls and reduced lubrication.

Symptoms such as dementia, lung problems, and unexplained weight loss may be attributed to the aging process instead of being investigated as HIV related, and health care professionals may not consider HIV testing for people over 50.

The number of older persons living with HIV/AIDS is also increasing, due in part to more effective medications that are helping HIV+ people live longer.

SEX TRADE WORKERS
The term "sex trade" can be used to describe a variety of individuals who have different levels of contact with clients. Workers in the sex trade can include people working in exotic dancing or adult film, massage parlour workers, escorts, S/M dominants and submissives, out-call and in-call (indoor) workers, and street-level workers. With these variations in client contact come varying risks for HIV.

Canadian studies indicate that sex trade workers use condoms more consistently than other populations. However, sex trade workers are at increased risk for HIV when they have unprotected sex for higher fees than would be paid for sex with a condom. Factors which increase the likelihood of a sex trade worker following this practice are inexperience on the streets, threats of violence, economic need and drug use.

INJECTION DRUG USERS
The use of drugs and alcohol can be related to high risk behaviors. For injection drug users, high risk of HIV transmission is related to the use of unsterilized, shared needles or syringes. In addition, the altered mental state resulting from the use of alcohol and drugs can lead to increased risk due to unsafe sexual practices. Substance use or abuse may further jeopardize the health of an individual who is HIV positive.

In Canada, injection drug use accounted for 17.3% of new HIV infections during 2007.

(Source: HIV and AIDS in Canada. Selected Surveillance Tables to June 30, 2008. Surveillance and Risk Assessment Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, 2009.)

PRISONERS
Inmates are at exceptional risk for infection with HIV/AIDS. Basic HIV prevention measures are often not available to inmates or are not easily accessible. Safer sex tools such as condoms and lubricant may be difficult to access, and needle exchange programs have not been implemented in all Canadian prisons. High risk activities including unprotected sex, tattooing with shared equipment, and injection drug use are sometimes more common in prisons.

Even before entering correctional institutions, inmates could be more susceptible to infection than the general population. Inmates may come from economic and social backgrounds where effective education, prevention and treatment are lacking.

HIV Edmonton would like to thank AIDS Calgary Awareness Association for providing the information on this page. To read more, check out their briefing documents at
http://www.aidscalgary.org/resources/publications.cfm