Sexual Health and Harm Reduction Services

Ontario’s HIV support services: Activities and Impact 2018-19

The AIDS and Hepatitis C Programs, Provincial Programs Branch, Ministry of Health funds and oversees community-based HIV and hepatitis C services as well as the distribution of naloxone and harm reduction supplies to populations at risk of HIV, hepatitis C, and opioid overdose.

$44.94M invested in 84 front-line organizations that deliver programs along the HIV care cascade, including programs that deliver HIV support services. These organizations aim to:

• Reduce new HIV transmissions by providing education, support, and linking people to other prevention services
• Increase the number of people on treatment by providing support services that help them stay in care and manage other health and social issues
• Minimize the burden of HIV on the health care system

The 84 funded organizations include: 

• 5 programs that deliver community-based HIV clinical care and supports to people living with and at-risk for HIV:
  • saw 2,268 clients
  • 1,779 (78%) were people living with HIV
  • 532 (23%) were new clients
  • services provided include blood work, primary care, health promotion, HIV specialty care and treatment information
• 36 harm reduction programs that deliver supports to people who use drugs
  • provided 455,428 service sessions
  • focused on brief counselling (45%), harm reduction teaching (30%), and practical support (25%)
  • had 242,600 interactions with over 60,000 people who use drugs

The good news

HIV is a chronic manageable illness. HIV treatments can suppress the virus to the point where it is no longer detectable and people with HIV can lead long healthy lives. Being on treatment and virally suppressed also means they can’t pass HIV to their sexual partners1.

The challenge

To achieve these health outcomes – better health and no HIV transmission - people living with HIV have to stay on treatment for the rest of their lives until there is a cure. Staying in care year after year isn’t easy for anyone, but it is harder when people face other systemic barriers and challenges in their lives, such as poverty, unstable housing, immigration or settlement issues, mental health issues (e.g. depression, anxiety), substance use and other co-morbidities.

This OCHART fact sheet focuses on the support services provided by Ontario’s AIDS service organizations and other community-based HIV programs and how they help people with or at risk of HIV manage those challenges.

Who Uses Support Services?

In 2018-19, ministry-funded community-based HIV programs reported delivering support services to:

• 16,638 clients
• Up 7% from 2017-18
• Of those, 3,384 (20%) were new clients

3 out of 5 clients (10,185; 61%) were living with HIV

3 in10 (4,795; 29%) were at risk of HIV

In terms of ethnicity, clients living with HIV were:

• Black (39%)
• White (35%)
• Latin America (13%)
• Southeast Asian (5%)
• Indigenous (4%)
• South Asian (3%)
• Arab & West Asian (2%)

Community-based HIV programs focus their services on populations most affected by HIV. In 2018-19, of new clients living with HIV:

• 49% were gay, bisexual and other men who have sex with men.
• 36% were members of African, Caribbean and Black communities

More Black women living with HIV receiving support

In 2018-19,

• The number of Black women living with HIV receiving support services increased 21% from the previous year
• Among women living with HIV who accessed support services Black women made up 61% (1,769 out of 2,892)

More at-risk clients who use drugs received support services

In 2018-19, there was a 23% increase in at-risk clients who use drugs accessing support services compared to 2017-18.

Among clients living with HIV: Percent of clients living with HIV by gender 

• Female (33%)
• Male (65%)
• Client identified as trans and other genders

Among the 1,691 new clients living with HIV,

• 1124 (66%) were male
• 533 (32%) were female
• 30 (2%) were trans and other genders

What services do clients use?

Organizations delivered 202,411 service sessions in 2018-19 – up 13% from previous year; 92% (186,636) of those service sessions were delivered to people living with HIV.

Almost 1 in 4 services for all clients (23%) provided general support.

Almost 1 in every 3 service sessions for all clients (29%) provided practical assistance.

72% of all female clients received practical support services compared to 53% of all male clients.

Other counselling and support services include supports to:

• Manage medications
• HIV pre/post test counselling
•  Indigenous traditional services 
• financial and employment services

Top 3 services accessed by all existing clients (by # of clients) 

• General support 3,604 (27%)
• Transportation 1,200 (9%) 
• Food programs 3,039 (23%) 

Top 3 services accessed by existing clients living with HIV (by # of clients)

• General support 2,320 (27%)
• Transportation 1,044 (12%) 
• Food programs 2,677 (32%) 

Top 3 services accessed by all new clients (by # of service sessions) 

• General support 3,431
• Case management 1,969 
• Food programs 2,333

References

¹Montaner, J.S., Lima, V.D., Barrios, R., Yip, B., Wood, E., Kerr, T., … Kendall, P. (2010). Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study. Lancet, 376(9740): 532–399.

²Mateo-Urdiales, A., Johnson, S., Smith, R., Nachega, J. B., & Eshun-Wilson, I. (2019). Rapid initiation of antiretroviral therapy for people living with HIV.

The Cochrane database of systematic reviews, 6(6), CD012962. doi:10.1002/14651858.CD012962.pub2.

³Ontario HIV Epidemiology and Surveillance Initiative. HIV care cascade in Ontario by sex, age and health region: Linkage to care, in care, on antiretroviral treatment and virally suppressed, 2015. February 2018.
 

OCHART Ontario’s Linkage to HIV Care:

Activities and Impact 2018-19

The AIDS and Hepatitis C Programs, Provincial Programs Branch, Ministry of Health funds and oversees community-based HIV and hepatitis C services as well as the distribution of naloxone and harm reduction supplies to populations at risk of HIV, hepatitis C, and opioid overdose.

$44.94 M invested in 84 front-line organizations that deliver programs along the HIV care cascade: prevention, harm reduction outreach, health teaching, testing, linkage to care, and treatment.

The 84 organizations include:

• More than 50 community-based HIV programs and AIDS service organization
• 5 community-based HIV clinics
• 8 anonymous testing sites
• 36 harm reduction programs

*Some organizations provide more than one of these services. Total number of funded organizations that report in OCHART: 93.

These organizations actively work to link people with or at risk of HIV to care and other health, prevention, and community-based social services. Their aims are to:

• Reduce new HIV transmissions by connecting people to care
• Increase the number of people on treatment and accessing support services
• Minimize the burden of HIV on the health care system.

Why does linkage to care matter?

Early linkage to care – that is, connecting someone to HIV care within 14 days of diagnosis or someone at risk to prevention programs and pre-exposure prophylaxis (PrEP) – helps people engage in care.

People who are linked to care early are more likely to stay in care and to take treatments that will protect their health. When that happens, they have better health outcomes and they can’t pass the virus to their sexual partners.234 For people living with HIV, rapid linkage to treatment means the virus can be suppressed within just a few weeks to the point where it’s undetectable. For people at risk, rapid linkage to PrEP can help them protect their health and avoid HIV infection.

Effective linkage services also develop referral pathways that connect people to other health and social services they need, such as housing programs, income support programs, settlement services, mental health, substance use and harm reduction services.

Ontario’s Clinical Care Guidelines for Adults and Adolescents Living with HIV recommend newly diagnosed people see a physician within 2 weeks of receiving a positive HIV test result, or within 1 to 2 days when test providers suspect a person has been diagnosed in the very early stages of infection.1

Linking people to testing, care and other services

Being tested is a critical first step in the HIV care cascade. Before people can be connected to HIV treatment or PrEP, they need to be tested and assessed for risk. Effective testing strategies can help identify previously undiagnosed cases of HIV and get people into care.

In 2018-19, the eight anonymous HIV testing clinics in Ontario funded by the AIDS & Hepatitis C Programs:

• Conducted 11,800 tests
  • 11,552 anonymous rapid point-of-care tests
  • 248 standard blood draw HIV tests (non-confirmatory)
• Connected127 people newly diagnosed with HIV to care

In 2018-19, a total of 16,638 people accessed support services through AIDS service organizations and other community-based HIV programs. Of those:

• 4,795 were people at risk
• 1,658 were people affected by HIV (e.g. family members)
• 10,185 were people living with HIV

The dedicated AIDS service organizations reported serving a total of 6,489 clients living with HIV. Of those:

• 5,248 were existing clients and1,241 were new clients
• 2 out of 3 new clients with HIV (66%) reported facing barriers connecting to HIV care, accessing and adhering to medications, managing symptoms, disclosure, and stigma or discrimination – barriers the province’s HIV services help them overcome.

Ontario’s ASOs and other community-based HIV programs actively work to connect people to care. In 2018-19, they:

• Provided 13, 800 case management sessions to help clients find and connect to other services
• Made 8, 386 referrals to other health and social services.

5,379 referrals (64%) for clients living with HIV 

Top 3 referrals: 

• 722 (13%) HIV clinical care
• 946 (18%) HIV-specific community programs
• 2,748 (51%) Other community-based services

2,569 (31%) referrals for at-risk clients: 

Top 3 referrals: 

• 432 (17%) Addiction programs
• 365 (14%) Mental health services providers
• 1,029 (40%) Other community-based services

411 (5%) referrals for affected clients: 

Top 3 referrals:

• 55 (13%) Non-HIV specific clinical services
• 110 (27%)  Other community-based services
• 177 (43%) HIV/STI Testing

Other community-based services include housing, food banks, employment, legal, settlement, faith-based and other social services.

ASOs and other community-based HIV programs made 722 referrals to HIV clinical services for people living with HIV in 2018-19 – up 66% from the previous year.

provided transportation assistance 9,282 times to help clients get to other services.

In 2018-19, Ontario’s 36 harm reduction programs made:

• 4,601 referrals to Hepatitis C teams (up 76% from 2017-18)
• 8,159 referrals to mental health service providers (up nearly 250%)
• 17,146 referrals to addiction and other harm reduction services (up 6%)
• 6,089 referrals to clinical service providers (down 13%)

Warm referrals = more successful linkages

“Organizations report that warm referrals help ensure clients get the services they need. A warm referral involves a worker making a personal call or visit with the client to the referral organization to explain why they are making the referral, arranging appointments, and following up with the client to ensure they attended the appointment.

“With the client's permission, I made contact with the local legal clinic, ODSP and Legal Aid. I scheduled appointments for the client to get legal advice from a lawyer and accompanied the client to initial appointments. The client was able to identify solutions to their presenting concerns through this referral and was able to access these services without the need for support.”

• Harm reduction programs referred: 52,020
• ASOS referred: 4, 458
• Other Community-based service providers referred: 3,928
• Community-based HIV clinics referred: 4,558
• Anonymous testing sites referred: 587

Forging stronger partnerships

To help clients get the services they need, community-based HIV organizations develop partnerships with other organizations. In 2018-19, Ontario’s community-based HIV-focused services, including harm reduction programs:

• Held 4,320 meetings with community partners to strengthen their existing referral pathways and build their local service networks
• 1,313 meetings with existing coalitions/networks or advisory boards
• 2,045 meetings to plan community events, or to build new partnerships and improve services
• 962 meetings to develop educational materials, share information, and develop policies and   strategic plans
• Engaged with 37,640 individuals to improve collaborations

“Our community health workers continue to connect with multiple non-HIV funded agencies on the importance of incorporating HIV service options for their respective communities and work. Each new partnership and community contact prioritizes service provider education to

 make these partnerships sustainable and ongoing.”

1 Clinical Care Guidelines for Adults and Adolescents Living with HIV in Ontario,Canada http://occguidelines.com/guidelines/#8

2 Lundgren JD, Babiker AG, Gordin F, et al; INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795-807. doi:10.1056/NEJMoa1506816

3 Cohen, M. S., Chen, Y. Q., McCauley, M., Gamble, T., Hosseinipour, M. C., Kumarasamy,N., … HPTN 052 Study Team (2016). Antiretroviral Therapy for the Prevention of HIV-1Transmission. The New England journal of medicine, 375(9), 830–839. doi:10.1056/NEJMoa1600693

4 International Advisory Panel on HIV Care Continuum Optimization. IAPAC guidelines for optimizing the HIV continuum for adults and adolescents. Journal of the International Association of Providers of AIDS Care. 2015;14 Suppl 1:S3-S34.