Background: Human immunodeficiency virus (HIV) is a global public health issue with an estimated 1.8 million people newly infected in 2017. Objective: To provide a descriptive overview of reported cases of HIV in Canada by geographic location, sex, age group, exposure category and race/ethnicity, from 1985-2017, with a focus on the most recent data. Methods: The Public Health Agency of Canada (PHAC) monitors HIV through the national HIV/ AIDS Surveillance System, which is a passive, case-based system that collates non-nominal data voluntarily submitted and validated by all Canadian provinces and territories. Additional data sources presented here include data on immigration-related medical screening for HIV by Immigration, Refugees and Citizenship Canada and data on infants perinatally-exposed to HIV submitted by the Canadian Perinatal HIV Surveillance Program. Data were collated, tables and figures were prepared and descriptive statistics were applied by PHAC and validated by each province and territory. Results: A total of 2,402 new HIV diagnoses were reported in 2017 in Canada; an increase of 3% compared with 2016 and an increase of 17.1% since 2014. The national diagnosis rate increased slightly, from 6.4 per 100,000 population in 2016 to 6.5 per 100,000 population in 2017. In 2017, while Ontario continued to account for the highest number (n=935) and proportion (38.9%) of reported HIV cases, Saskatchewan reported the highest provincial diagnosis rate (15.5 per 100,000 population). In 2017, the diagnostic rate for males at 9.9 per 100,000 population was higher than for females at 3.2 per 100,000 population. As in 2016, the 30-39 year age group had the highest HIV diagnosis rate at 14.8 per 100,000 population. The "gay, bisexual and other men who have sex with men" exposure category continued to represent almost half (46.4%) of all reported HIV cases in adults. In 2017, the absolute number of HIV-positive migrants entering Canada increased to a total number of 835 migrants. One mother-to-child HIV transmission was confirmed in a mother who did not receive any perinatal antiretroviral therapy and two transmissions were confirmed in mothers who did receive perinatal antiretroviral therapy. Conclusion: Similar to the annual changes that have been reported since 2014, the number and rate of reported HIV cases in Canada in 2017 increased slightly compared with 2016. Additional data and analysis are needed to determine the extent to which these findings reflect an increase in HIV transmission, an increase in HIV testing, changes in reporting practices and an increase in the number of HIV-positive people migrating to Canada.

OBJECTIVES:Men who have sex with men (MSM) report challenges to accessing appropriate health care. We sought to understand the relationship between disclosure of same-sex sexual activity to a health care practitioner (HCP), sexual behaviour and measures of sexual health care. METHODS:Participants recruited through community venues and events completed a questionnaire and provided a blood sample. This analysis includes only individuals with self-reported HIV negative or unknown serostatus. We compared participants who had disclosed having same-sex partners with those who had not using chi-square, Wilcoxon Rank Sum and Fisher's exact tests and used logistic regression to examine those variables associated with receiving an HIV test. RESULTS:Participants who had disclosed were more likely to have a higher level of education (p<0.001) and higher income (p<0.001), and to define themselves as "gay" or "queer" (p<0.001). Those who had not disclosed were less likely to report having risky sex (p=0.023) and to have been tested for HIV in the previous two years (adjusted odds ratio 0.23, 95% confidence interval: 0.16-0.34). There was no difference in undiagnosed HIV infection (3.9% versus 2.6%, p=0.34). Individuals who had disclosed were also more likely to have been tested for gonorrhea and syphilis, and more likely to have ever been vaccinated against hepatitis A and hepatitis B (p<0.001 for all).CONCLUSIONS: While generally reporting lower risk behaviour, MSM who did not disclose same-sex sexual activity to their HCP did have undiagnosed HIV infections and were less likely to have been tested or vaccinated. Strategies to improve access to appropriate sexual health care for MSM are needed.

Background Tuberculosis (TB) is a major global health problem that affected an estimated 10 million people worldwide in 2017. The Public Health Agency of Canada monitors active TB disease through a national surveillance system, which is a collaborative effort with the provinces and territories. Objective To present an epidemiological summary of active TB cases reported in 2017. Results are discussed in the context of the previous year’s data. Treatment outcomes for cases diagnosed in 2016 are also presented. Methods The Canadian Tuberculosis Reporting System is a case-based surveillance system that maintains non-nominal data on people diagnosed with active TB disease in Canada. Data are collected annually from the provinces and territories, analyzed by the Public Health Agency of Canada and validated by each province and territory. Results There were 1,796 cases of active TB reported in Canada in 2017 compared with 1,750 cases in 2016, representing a 2.6% increase. There was a corresponding increase in the incidence rate from 4.8 to 4.9 per 100,000 population. Foreign born individuals continued to make up the majority of cases (71.8%) and the incidence rate remained highest among Canadian born Indigenous people (21.5 per 100,000 population), in particular, among the Inuit population (205.8 per 100,000 population). Consistent with the previous decade, TB incidence rates in 2017 continued to be higher among males (5.5 per 100,000) compared with females (4.3 per 100,000), and the majority of cases (45.6%) were between the ages of 15 and 44 years. The incidence rate was highest among adults over 75 years of age (13.8 cases per 100,000 for males and 7.2 for females). Of the TB cases diagnosed in 2016 where outcomes were reported, 80.4% were treated successfully. Conclusion Although the incidence rate of TB in Canada in 2017 remained low in the global context and has been relatively stable over the last decade, both the case count and rate have been gradually increasing since 2014. Indigenous and foreign born Canadians continued to be disproportionately represented among TB cases. Canadian TB surveillance data are an important source of information for monitoring progress and informing public health action related to reducing the burden of TB in Canada, with the ultimate goal of TB elimination.

G ay, bisexual and other men who have sex with men (MSM) remain the population most heavily affected by HIV in Canada and British Columbia (BC). 1,2 MSM are thought to comprise 45% or more of the estimated 9,300-13,500 individuals infected with HIV in BC. 3,4 The number of new diagnoses of HIV among MSM in BC has remained largely unchanged since 2003, with approximately 150-180 new diagnoses each year. 4 We conducted an analysis from an HIV serobehavioural survey of MSM who attend community venues that cater to gay, bisexual and other MSM in Vancouver in order to determine the current state of HIV knowledge and HIV risk and preventive behaviours among this population. METHODS The Public Health Agency of Canada (PHAC) has developed a national enhanced surveillance system for HIV among MSM called M-Track. In Vancouver, M-track was called "The ManCount Survey" and was jointly designed and implemented by PHAC and local partner organizations. The study protocol was approved by the Research Ethics Boards of the University of British Columbia and Health Canada. Participants were recruited from August 1, 2008 to February 28, 2009 through venues that cater to gay, bisexual and other MSM. We used a time-space sampling recruitment methodology based on a two-stage sampling plan. This entailed the construction of a sampling frame of potential recruitment events at participating venues followed by developing a standardized process for sampling these events and venues. Men ≥18 years of age who reported ever having had sex with other men were offered enrolment in the study. Participants were excluded if they had previously completed the survey or were

Prenatal/preconceptional and newborn screening programs have been a focus of recent policy debates that have included attention to ethical, legal, and social issues (ELSIs). In parallel, there has been an ongoing discussion about whether and how ELSIs may be addressed in health technology assessment (HTA). We conducted a knowledge synthesis study to explore both guidance and current practice regarding the consideration of ELSIs in HTA for prenatal/preconceptional and newborn screening. As the concluding activity for this project, we held a Canadian workshop to discuss the issues with a diverse group of stakeholders. Based on key workshop themes integrated with our study results, we suggest that population-based genetic screening programs may present particular types of ELSIs and that a public health ethics perspective is potentially highly relevant when considering them. We also suggest that approaches to addressing ELSIs in HTA for prenatal/preconceptional and newborn screening may need to be flexible enough to respond to diversity in HTA organizations, cultural values, stakeholder communities, and contextual factors. Finally, we highlight a need for transparency in the way that HTA producers move from evidence to conclusions and the ways in which screening policy decisions are made.