In September 2024, the National Institute of Public Health of Quebec (INSPQ) published the 2022 edition of its “Surveillance program for human immunodeficiency virus (HIV) infection in Quebec”. This report reveals a marked increase in new diagnoses: 422 in 2022 compared to 246 in 2021. Among these new cases, 329 (78%) concern people who have never taken an HIV screening test before.
Some figures
More specifically, among gay and bisexual men (cis and trans) and among men who have sex with men without identifying as gay or bisexual, there will be 161 new HIV diagnoses in 2022 compared to 136 in 2021. Of these new diagnoses, 98 (61%) concern men who have never had an HIV screening test before. It is also reported that around 70 men were diagnosed late; that is, at the time of receiving their positive HIV result, their CD4 count — cells of the immune system that protect against infections — was below 350 per mm3 of blood. However, such a low CD4 count means that the body cannot defend itself adequately, thus opening the door to infections.
Good and not so good news
When we analyze these figures, we can be pleased that the number of new diagnoses within the populations of gay and bisexual men has decreased considerably over the years, going from 228 new diagnoses in 2013 to 161 in 2022. Access to PrEP and multiple community awareness activities, to name just a few, have probably contributed to this success.
On the other hand, the numbers of late diagnoses (n = 70) and diagnoses involving men who have never had HIV screening tests before (n = 98) are less encouraging statistics. For years, the HIV community has been raising public awareness about getting tested regularly. More specifically, we recommend at least one screening per year for all gay and bisexual men, and three to four screenings per year when you are sexually active and have multiple partners. So, finding that around a hundred men received their diagnosis during their first lifetime HIV test can only be surprising. The same is true for the 70 men who received a late diagnosis. How is it that despite all the awareness offered, gay and bisexual men are detected late?
Barriers to accessing HIV testing
One of the hypotheses that could explain this fact would be the difficult access to HIV testing.
It is clear that in Quebec, access to HIV testing is problematic and that we must
find solutions to eliminate barriers that hinder this access. These barriers are:
• The screening offer varies from one region to another.
• The insufficient number of screening service points.
• Lack of staff which can make service points inoperable.
• The fact that screening is only offered in the health network.
• Restrictive schedules which often require missing a day of work.
• Experiences or fears of prejudice and discrimination in the health network (receptionist, doctor, nurse, etc.).
• Not being covered by RAMQ and thus having to pay the costs associated with HIV testing.
Community testing as a solution
As we can see, the barriers to access to screening are numerous. However, there are solutions which, in our opinion, would increase the number of gay and bisexual men who are screened regularly and reduce the number of men who are screened late.
In the context where the number of new infections is on the rise, the Quebec government should once again prioritize the fight against HIV and increase, sustain and diversify the screening offer throughout Quebec.
Two other possible solutions would be to make this service accessible in the evenings and weekends and to offer health professionals training on 2EGBTQ realities. Despite the apparent simplicity of these two solutions, their implementation is currently difficult, in particular because of the lack of resources and staff in the health network.
To counter this lack of staff and thus relieve congestion in the health network, one possible solution is the deployment on a larger scale of community screening. Community testing encompasses all testing services that community HIV organizations can and could offer to the populations they serve. It is a very present approach and well integrated into the health network of several countries, notably in France, Morocco, Ecuador and Burundi.
In Quebec, some community HIV organizations provide screening services, but these services are dependent on the availability of nurses in the health network. If the government allowed duly trained community workers to carry out screening tests, this would allow organizations to increase their screening offering and thereby facilitate access to all men. who have sex with men, whether they identify as gay and bisexual or not. However, it goes without saying that all populations could benefit from such a measure. And that’s what Quebec needs.
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