Canada considering making HIV a reportable disease after an increase in new infections in immigrants

A recent report by the British Columbia Center for Disease Control (BCCDC) has warned that immigrants with HIV account for a large portion of new infections of the disease in Canada and these immigrants are slipping between the healthcare cracks.

The report titled "Trends in HIV-positive Immigrants and Reporting by Citizenship and Immigration Canada" found that estimated infection rate in 2005 was 12.6 times higher for immigrants – or those connected to them – from HIV-endemic countries than in other Canadians. As a result, about 16 per cent of all new infections in Canada are linked to people born in an HIV-endemic country, yet they make up only 1.5 per cent of the Canadian population.

This study was undertaken with an objective to connect with immigrants who are new to the country and who may not know that help is available for treatment and counseling. Therefore, it suggested that "targeted testing" of immigrants will increase the opportunity to ensure that HIV-positive immigrants are made aware of their status and support expedient counseling, prevention and treatment after they arrive in Canada.

Although Citizenship and Immigration Canada (CIC) is considering making HIV a "reportable" disease, currently it is not, meaning it is not considered a public health risk and it is not mandatory to report infections to public health officials.

In 2001, Health Canada recommended routine HIV testing of all persons applying for immigration to Canada. As of January 15, 2002, CIC requires all immigrants and certain visitors to Canada to undergo an immigration medical examination (IME). Currently a urinalysis, chest X-ray, syphilis serology and an HIV test (applicants aged 15+ and infants having received blood/blood products or born to a known HIV-positive mother) are included in the IME.

Both tuberculosis (TB) and syphilis have been designated by CIC as reportable diseases, while HIV has been designated as a "notifiable" disease. Any individual testing positive for TB and/or syphilis as part of IME must present to public health for assessment within a given period following arrival in Canada. Individuals testing positive for HIV as part of an IME are not required to present to public health upon arrival, and there are no conditions for follow-up in Canada.

From a public health perspective, if HIV were treated as a reportable infection through CIC, that would be one way of improving the timeliness of connecting with these individuals when they come to Canada.

Every province and territory in Canada, however, lists HIV as a reportable disease. As of September 1, 2004, CIC has the responsibility to notify provincial and territorial health officials about HIV-positive newcomers for statistical, educational and resource planning purposes.

Between 2002 and 2006 there were 2,567 immigration applicants who tested positive for HIV during their medical examinations among the 1.2 million immigrants to Canada accepted during the same period. Of those HIV-positive applicants, 89 per cent were determined to be medically admissible to the country.