Human Immunodeficiency Virus (HIV)

Human Immunodeficiency Virus (HIV) is a sexually transmitted and bloodborne infection. People can live with HIV for years without developing symptoms, while the virus attacks and weakens their immune system, making them more vulnerable to preventable health complications and premature death. With proper treatment and care, a person with HIV can live a long full life and HIV treatments are highly effective at preventing onward transmission.

HIV is primarily passed on through unprotected sex or through sharing injection or other drug use equipment. HIV can also be passed on during pregnancy, labour and delivery or breastfeeding, though these are rare in Ontario.

There are many highly effective ways to prevent HIV from being passed on. Prevention, testing and treatment are key pillars to an effective response to HIV.

Acquired Immune Deficiency Syndrome (AIDS)

Acquired Immune Deficiency Syndrome (AIDS) is the name used to describe the most advanced stage of HIV infection, where the immune system has been severely damaged by HIV and a number of potentially life-threatening infections and illnesses can happen. This is most likely when HIV is left untreated and can take many years to develop.

Who is at risk

In some regions of the world, HIV is well-established within the general heterosexual population, which is called a generalized epidemic. In Ontario, HIV has primarily remained within a number of smaller identified populations, which is called a concentrated epidemic. Early in the HIV epidemic, before the virus had been identified, HIV established itself in a small number of populations, which now have higher prevalence of HIV than the general population. Despite the significant progress these populations have made preventing and treating HIV over almost 4 decades, new HIV diagnoses in Ontario are still concentrated in:

  • gay, bisexual and other men who have sex with men, including trans men
  • African, Caribbean and Black populations
  • Indigenous Peoples
  • cis and trans women, including those from the communities above, who face systemic and social inequities, and are more likely to be exposed to HIV through a sexual or drug using partner
  • people who use drugs

Members of these populations also face stigma, discrimination and other barriers related to the social determinants of health, such as poverty, housing instability, intimate partner violence, and trauma associated with homophobia, racism and colonization, that may make them more vulnerable to HIV infection and affect their ability to access services.

Find more information on the epidemiology of HIV in Ontario.

HIV prevention, testing, treatment and care

HIV risk requires all of the following:

  • a sexual or drug use partner that has transmittable HIV (such as, an unsuppressed or detectable viral load)
  • a sexual or drug use practice (for example, sharing drug use equipment, having vaginal or anal sex) that makes HIV transmission possible
  • effective tools to protect against HIV (for example, condoms, pre-exposure prophylaxis) that are either not accessible or are not used consistently and correctly

HIV transmission can be prevented through the following highly effective prevention strategies.

Condoms

Use every time, don’t delay application, and watch for leakage or breakage.

HIV pre-exposure prophylaxis (PrEP)

If you engage in frequent high risk activities, take a pill a day to prevent acquiring HIV.

Post-exposure prophylaxis (PEP)

If you think you’ve been exposed to HIV, seek HIV PEP medication within 72hours - PEP can rid your body of the virus before it takes hold.

Safer drug use equipment

Do not share drug use equipment; unused supplies are available in Ontario. Learn more about the use of safer drug equipment.

Maintaining an undetectable HIV viral load

If you test HIV positive and start treatment, you can reduce your viral load to undetectable and untransmittable levels.

With today’s testing technology, people can be diagnosed as early as 3 weeks after they get HIV. People with HIV have the best opportunity at a long full life when they are diagnosed early in the infection and start HIV treatment right away. This also prevents onward transmission because HIV treatment can suppress the amount of HIV in the body to such a low level that it cannot be passed on during sex. This is called a suppressed or undetectable viral load.

How to get tested for HIV

With today’s HIV treatments, people with HIV can lead long, full lives with fewer health complications. The key is to start HIV treatments as soon as possible after becoming infected with HIV.

HIV treatments are also highly effective at preventing HIV from being passed on. When people with HIV are on HIV treatment and have a suppressed viral load, they cannot pass HIV on sexually.

Yet, too many people with HIV in Ontario today are not diagnosed. They do not know they have HIV, and HIV is harming their health and they may be unknowingly passing HIV on to others.  An HIV test can tell you if you have HIV, and with that knowledge you can act to protect your health.

Ways to get tested in Ontario include:

  • standard HIV test: a sample of your blood is taken and sent to a public health laboratory. This can be done by a doctor, nurse practitioner, midwife or other licensed health care provider, including at a sexual health clinic. Results are generally available within 72 hours.
  • anonymous test: the test is ordered for you and your results are provided using a code known only to you. You do not have to provide your name or an OHIP number. Anonymous HIV testing is offered at more than 50 locations in communities across Ontario. For more information on anonymous testing, including where to find an anonymous testing site: sexualhealthontario.ca
  • rapid/point of care (POC) test: your blood is tested while you wait and can be done in less than 10 minutes. If you test negative for HIV, you will learn your results immediately. If you test reactive or ’preliminary positive’, your blood sample will be sent for standard testing in order to confirm that you have HIV.  Find a site in Ontario where you can get a POC HIV test.
  • self-test:  you can order (for free) or purchase your own HIV test, do the test yourself, and get a result right away without having to go to a clinic or doctor’s office Like rapid/point-of-care testing (above), if your test is reactive or ‘preliminary positive’, you will need to obtain a standard HIV test in order to confirm that you have HIV. Find more information on self-testing, including where to obtain a test kit.

Prenatal HIV testing

All pregnant people in Ontario are offered an HIV test as part of their pre-natal care.

When a person with HIV starts HIV treatment before they are pregnant and maintains a suppressed virus throughout the pregnancy, they will not transmit the virus to their baby during pregnancy or delivery.

If you have more questions, contact your doctor or local public health unit.

Learn more about HIV testing:

If you have HIV

People living with HIV today can live long, full lives. It is important to get tested and diagnosed as soon as possible after acquiring HIV and to start HIV treatment right away. HIV treatment can help you to stay healthy and can prevent passing HIV on to others. Newer HIV medications are easier to take and usually cause few side effects. With ongoing treatment, care and support, HIV can be managed.  

Accessing HIV clinical care and treatment

HIV treatments are covered through private insurance plans and are publicly funded by the Government of Ontario through the Ontario Drug Benefit Program.

While the clinical management of HIV has become increasingly simplified, people with HIV have the best health outcomes when they are cared for by HIV experienced clinicians. There are experienced HIV primary care clinicians and specialist physicians in community-based and hospital-based HIV clinics across Ontario.

There are also supports in Ontario for clinicians to ensure they provide optimal HIV clinical care. These include:

  • Ontario’s eConsult Service allows primary care providers to ask for advice and receive support from specialists in many fields, including HIV, and may be particularly valuable for primary care providers with smaller numbers of people with HIV in their practice.
  • Clinical Care Guidelines for Adults and Adolescents Living with HIV in Ontario provide evidence-based practices to ensure people with HIV are engaged in timely and sustained HIV care and treatment. The use of comprehensive HIV care guidelines can improve health outcomes.

To find an HIV clinical care provider:

Accessing community-based HIV support services

The Ontario Government funds more than 80 HIV organizations and programs across Ontario which aim to reduce transmission of HIV and linkage to treatment and care. Programs deliver a range of services to people living with and at risk for HIV. These services include HIV prevention and harm reduction, connections with other people living with HIV, counselling and support, and referrals to mental health, addiction, housing, and other health, community and social services, as well as HIV and STI (sexually transmitted infections) testing.

To find a community-based HIV service organization near you: 

If you use drugs

People who use drugs may need a wide range of health care and social services to have the best health possible.

People who use drugs are at higher risk of acquiring blood-borne infections (such as HIV, hepatitis C and hepatitis B) if they share equipment to inject drugs. However, other (non-injecting) drug use (including smoking crack and using alcohol, cannabis and drugs like crystal methamphetamine to enhance sex) can also increase risk by affecting judgement and increasing higher risk behaviour, such as more sexual risk taking or lower chances of taking medications such as PrEP and antiretroviral therapy as directed.

Harm reduction services and supports work to reduce the transmission of blood-borne infections, (such as HIV, hepatitis C and hepatitis B), injury from high risk behaviour and save lives. Provided through community-based organizations, needle syringe programs and harm reduction programs offer a wide range of evidence-based, accessible and non-judgmental supports and services, as well as connect people who use drugs with important health and social services. Harm reduction programs benefit the individual and community.

Accessing needle syringe and harm reduction programs

If you, a family member or friend uses drugs, you can get free harm reduction supplies at over 34 needle syringe programs and over 700 access points across Ontario, including:

  • sterile, single use injection equipment
  • sterile, single use inhalation equipment

Through these programs, you can also:

  • safely dispose of both injection and inhalation equipment
  • get free take-home naloxone
  • get free condoms
  • get prevention, education and information
  • get referrals and counseling, including mental health care and addictions treatment for those who are ready
  • meet with a prevention worker and get help with HIV and hepatitis C testing and treatment

To find needle syringe and harm reduction programs

To find the closest needle syringe and harm reduction program near you:

To meet with a prevention worker, contact the nearest outreach agency to you. If you need urgent help, call the Sexual Health Infoline Ontario toll free at 1-800-668-2437.

Related information

Sexual Health Ontario
Ontario Harm Reduction Distribution Program
CATIE - Canada’s source for HIV and hepatitis C information Gay Men’s Sexual Health Alliance (GMSH)
African and Caribbean Council on HIV/AIDS in Ontario (ACCHO)
Women and HIV/AIDS Initiative (WHAI)
Oahas (Ontario Aboriginal HIV/AIDS Strategy)