Frequently Asked Questions

Our FAQ covers how the Public Health system is organized, how HIV testing is conducted, along with information about your rights, privacy, and the issue of HIV criminalization.

Understanding HIV in Ontario

Number of HIV tests per year (2022)

Based on the most recent data available from 2022, 641,745 HIV diagnostic and routine tests and 128,824 prenatal HIV tests were performed in Ontario.

(Via: Ontario HIV Epidemiology and Surveillance Initiative (OHESI))

Number of people living with HIV in Ontario (2022)

Based on the most recent data available from 2022, it is estimated that the number of people living with HIV across Ontario is 20,885. Additionally, in 2022, there were 623 first-time HIV diagnoses across the province.

(Via: Ontario HIV Epidemiology and Surveillance Initiative (OHESI))

About Public Health

Public health focuses on protecting and improving community health through prevention and promotion and is managed by all three levels of government.

What is Public Health?

Public health focuses on protecting and improving community health through prevention and promotion rather than individual treatment. It is a collective, government-led responsibility grounded in accessibility, equity, and social justice. Public health interventions range from voluntary education and testing to more coercive measures like incentives, disincentives, and enforcement to improve population health.

In Canada, all three levels of government are responsible for public health. At the federal level there is the Public Health Agency of Canada, and provincially there is Ontario Public Health, and locally, at the regional level there are public health units.

How is Public Health different from Healthcare?

Your healthcare practitioner (such as a physician, general practitioner, nurse practitioner, or specialist) has a duty to offer services to you as an individual, for example, health prevention, diagnosis, treatment, and monitoring, and to work with you to provide those services according to your consent.

Public health has a duty to promote the health of the public as a whole through education, case management, intervention, and surveillance.

The differences can be confusing, and sometimes public health and healthcare can overlap, such as during vaccination programs, disease outbreak responses, and sexually transmitted infection screenings. Additionally, healthcare providers also must report certain infections, such as HIV, to public health authorities, linking individual care with public health.

What is Public Health Ontario and what are local Public Health Units?

Public Health Ontario (PHO), created under the Ontario Agency for Health Protection and Promotion Act, 2007 (HPPA), operates under the Ministry of Health. PHO oversees public health across the province.

Across Ontario there are 29 local public health units, each led by a Medical Officer of Health and a municipal board of health. These units deliver local prevention programs, enforce public health rules, and conduct investigations into reportable diseases.

Each public health unit has different policies and approaches to address public health in their local region. To find your local public health unit, click here.

What is an Electronic Health Record?

An Electronic Health Record (EHR) is a digital record of your health information.

Clinicians (physicians, specialists, nurses, and other healthcare providers and workers) and laboratory technicians and workers (the people who do various tests) will add people's health care information such as lab results, medications, digital images, hospital discharge summaries, demographics, mental health and addiction information, medical history, and emergency department visits (among others) into a person’s EHR.

There is now a provincial EHR system, created by eHealth Ontario and maintained by Ontario Health (an agency of Ontario’s Ministry of Health), known as the Ontario EHR that differs from local electronic medical records or regional hospital information systems.

Public Health workers at the provincial and municipal level can access your EHR directly without your consent, but not all currently do. Practices and policies relating to accessing EHR’s vary among local public health units.

Currently, people do not have access to their own Electronic Health Record (EHR) in Ontario.

What information does Public Health Ontario and local Public Health Units collect and have access to?

In Ontario, HIV is a reportable disease under the regulations of the Health Protection and Promotion Act, 2007 (HPPA). A positive HIV test performed where a person receives care, needs to be verifed with a confirmatory test, is then reportable to the Medical Officer of Health of the local public health unit.

For HIV tests, public health gathers information on risk behaviours, demographics (for example, your age, sex, race, location, and information about sex and/or drug taking practices).

Public health will not have your name, contact information or other identifying details if you have only tested for HIV anonymously. Tell your physician or health care professional that you wish to have anonymous viral load testing. This is a viral load test ordered without your name. To get one, you need a test code from the anonymous testing site. The test code can be used to order viral load tests on an ongoing basis.

If you wish to exercise this exception, please contact HALCO - HIV & AIDS Legal Clinic Ontario for further information and assistance. It is important to remember that even if you have an anonymous viral load test, Public Health authorities might still find out that you are living with HIV.

Otherwise, any physician or other health care professional, laboratory worker, hospital administrator, school principal who comes to know a person’s positive HIV status has a duty to report this to the local public health unit. Additionally, even with anonymous viral load testing, there is the risk of name reporting by hospital administrator and superintendents

If you are taking a nominal test (where the test is connected to your name), your name, health insurance, and contact information will be connected to this information, and if the test is anonymous, your name, health insurance, and contact information will not be connected to this information, See a list of the information collected, click here.

If you are living with HIV, and were not tested anonymously, public health will have your name, contact information, health insurance information, and information on risk behaviours, demographics (for example, your age, sex, race, location, and information about sex and/or drug taking practices).

In certain instances, such as if public health are conducting an investigation into a new HIV transmission, or looking into allegations that someone is not following public health guidance, public health workers may also access other health information about you, including from your Electronic Health Record (EHR).

For more information about anonymous viral load testing and reducing the chances that your name will be reported to Public Health, please contact HALCO - HIV & AIDS Legal Clinic Ontario for further information and assistance. For more information, see also HALCO’s HIV testing and reporting to Public Health in Ontario guide.

You must give your consent to be tested

Informed consent is required for HIV testing, meaning it is your choice whether to be tested. Before the test, a healthcare provider must explain the available testing options, possible outcomes, and whether your name or personal information will be shared with Public Health authorities in Ontario. You should also be offered pre- and post-test counselling. If you are tested without your informed consent, it may be important to seek legal advice via the HALCO - HIV & AIDS Legal Clinic Ontario.

For more information, see our resources section.

Ontario's HIV Testing Infrastructure

Public Health Laboratories and Units Across Ontario

11 Public Health Ontario provincial laboratories and 29 local Public Health Units across the province are responsible for HIV-related test and data collection, reporting, and investigations.

(Public Health Ontario Laboratory Services, and Local Public Health Unit Locations)

Anonymous Testing Sites Across Ontario

Across Ontario, there are 46 locations where people can get anonymous HIV tests.

(Ontario Health Promotion and Protection Act, Schedule 1)

About HIV Testing

In Ontario, people can get tested for HIV anonymously, and also nominally (using their name). There is also the option to self-test, which still needs to be confirmed by a clinic-based test if it tests positive.

What is an anonymous HIV test?

HIV testing can be done without your name. Anonymous HIV testing is only done through anonymous testing clinics. For a map of anonymous HIV testing sites across Ontario, click here. Additionally this information is part of Schedule 1 of the Health Promotion and Protection Act.

For anonymous HIV tests, your name, address, and healthcard, or insurance information is not connected to other demographic information about you.You do not need an OHIP card or number to get an anonymous test.

If you are being tested for HIV and you are pregnant, you may not have the option to do an anonymous test, and other details about your pregnancy may be collected.

If you are being tested during an immigration medical exam, you do not have the option to do an anonymous test, and details about your country of origin will also be collected.

For more information, see our resources section.

What is a nominal (uses your name) HIV test?

HIV testing can be nominal, where your name is collected and shared with your local public health unit if there is a reactive HIV test (positive). For nominal HIV tests, you may need an Ontario Health Insurance Plan (OHIP) card or number, and your name, address, and health card, or insurance information is connected, along with other demographic information about you.

For more information, see our resources page here.

What is an HIV self-test?

HIV self testing means that a person can order or purchase their own HIV test, do the test themselves, and get initial results without having to go to a clinic or doctor’s office (similar to a home pregnancy test). HIV self-tests, similar to the HIV point-of-care test, are considered just a screening test. This means that any reactive (positive) self test results must be confirmed by a test that is then done in a clinic and where a lab-based result is provided. A confirmatory test can be done nominally or anonymously.

See HALCO - HIV & AIDS Legal Clinic Ontario's information on self-testing.

See the statement on self testing and human rights.

For more information, see our resources here.

HIV Clincial Care

If you are living with HIV, there are a variety of ongoing clincial care tests your physician, specialist, or other healthcare provider will conduct - with your consent - these include viral load, CD4/CD8, and drug resistance tests.

What is a HIV viral load test?

Your viral load test measures the amount of HIV that is in your blood. The lower your viral load, the better for your overall health.

HIV viral load testing measures HIV levels in a person’s blood (known as plasma) to monitor treatment and prognosis. Viral load tests are used at diagnosis before therapy, to assess effectiveness and adherence to treatment, and to guide resistance testing or regimen changes. The test is also used on a regular basis to confirm that someone has achieved viral suppression.

If you are on HIV treatment and the treatment is working, your viral load will fall to a level too low for a test to detect (this is called an undetectable viral load). Being virally undetectable while taking HIV treatment means you cannot sexually transmit the virus to other, which is known as U=U (Undetectable=Untransmittable).

For more information on HIV viral load testing, see CATIE's page on viral load testing.

Your physician or health care provider issues a viral load requisition form for laboratory testing. Viral load testing is only conducted in Public Health Ontario laboratories. For more information on Public Health Ontario and HIV viral load testing, click here.

What is a CD4/CD8 test?

CD4 cells are the “leaders” of your immune system, and HIV attacks them. CD8 cells help fight infections.

Blood tests can measure your CD4 count (healthy is considered around 500–1,500). Tests can be done regularly on your CD4 count and also the balance between CD4 and CD8 cells known as the CD4:CD8 ratio. Low counts or a low ratio might indicate that HIV is active and your immune system is weak. These tests help your physician, specialist, or other healthcare provider check how your immune system is doing and how well treatment is working. HIV medicines usually raise CD4 counts and restore balance.

Your physician or health care provider issues a CD4/CD8 requisition form for laboratory testing. CD4 and CD8 tests are conducted in privatized clinics such as Dyncare or Lifelabs, or sometimes in a hospital.

For more information on HIV viral load testing, see CATIE's page on CD4 testing.

What is HIV genotyping/resistance testing?

Drug resistance tests monitor genetic changes in an individual’s virus that can affect how well the medication works. The outcome of the test provides the unique genetic code of each person’s mutation of HIV, like a fingerprint, and helps determine which medications to go on.

HIV genotyping/resistance testing is only done through Public Health Ontario laboratories, who then send the sample for testing to the British Columbia Center for Excellence in HIV and AIDS. The results are shared with Public Health Ontario and the health care provider who completed the requisition form.

To learn more on Public Health Ontario and HIV genotyping/resistance testing, click here.

HIV and criminalization

Canada, and the province of Ontario, have been known to be leaders in the world for criminalizing people living with HIV.

What is HIV criminalization?

Canada is a country which uses the criminal law to respond to issues of HIV non-disclosure, exposure and transmission.

Most of the time, whether someone tell others (or “disclose”) that they are living with HIV is up to them. The situation is different when it comes to sex partners. In Canada, the criminal law says that, in certain circumstances, people must tell their sex partners that they are living with HIV before they have sex. This is sometimes called the “legal duty to disclose.”

People living with HIV in Canada have faced criminal convictions and prison for allegations that they have not told a sex partner they have HIV. This has happened even when there was little to no risk of HIV transmission and the sex partner did not get HIV (or there was no HIV transmission).

People living with HIV, human rights advocates and legal experts state that this is a discriminatory misuse of the law that undermines testing and prevention, fosters stigma, creates a false security for HIV negative people by shifting responsibility away from shared sexual health, and the practice also fuels human rights violations against people living with HIV.

Kissing or other activities that have no risk of HIV being passed on. Vaginal, anal, or oral sex if your viral load is under 200 copies/ml blood for at least six months. This is the case whether or not a condom is used. Vaginal, anal, or oral sex if a condom is used properly and it does not break and your viral load is in between 200 and 1500 copies/ml blood. For more information contact HALCO - HIV & AIDS Legal Clinic Ontario and see this information sheet on HIV criminalization in Canada.

Ontario introduced guidelines for prosecutors which limit who can face criminal charges regarding HIV, excluding people who are virally suppressed and uninfectious, known as being undetectable.

Additional information on these guidelines can be found via HALCO - HIV & AIDS Legal Clinic Ontario here, and here.

To learn more, see our resources section.

How does the criminalization of HIV intersect with Public Health?

In Ontario, public health authorities manage HIV testing, surveillance, and prevention, and also have the power to enact legal orders under public health legislation against people living with HIV to mandate them to follow public health guidelines.

If someone violates a public health order, in rare instances police have been involved, who may turn to using criminal law. In rare instances the criminalization of HIV non-disclosure can turn these public health tools into potential evidence against people living with HIV. This intersection erodes trust and undermines effective collective health responses.

To learn more, see our resources section.

Who is impacted by HIV criminalization in Ontario?

In Ontario, HIV criminalization impacts people living with HIV, especially Black and Indigenous communities, migrants, women living with HIV who are facing domestic violence, and gay men and other men who have sex with men are disproportionately targeted.

HIV criminalization undermines community health by discouraging testing and disclosure, while reinforcing stigma, discrimination, and leading to human rights violations that harm both individuals and broader communities.

Additional information on these guidelines can be found via HALCO - HIV & AIDS Legal Clinic Ontario here, and here.

To learn more, see our resources section.