Dr. Perry Kendall said the infection rate among gay and bisexual men has remained steady for the past decade.
The group made up 57 per cent of new infections in B.C. in 2011 and accounted for 45 per cent of the provincial population living with HIV.
"If we look at incident and prevalence infections, gay and bisexual men continue to bear a disproportionate burden of HIV illness," Kendall said.
Overall, there has been a drastic drop in the number of new infections annually in the province. In 2012, there were 238 new cases diagnosed in B.C. — the lowest on record. In comparison, there were 788 in 1992 and 418 in 2002.
Gay and bisexual men aged 30 to 44 years represent the highest proportion of new diagnoses, the report said.
"We have a confluence of factors working together to make this a challenging epidemic," Kendall said.
"Health outcomes do not happen in a vacuum. They're the result of a complex interaction of a number of factors, most of which may be determined by the environment in which boys and men live, work and play."
There are many theories about the worrying trend, Kendall said: that gay and bisexual men are suffering "condom fatigue," less vigilance because HIV is now a treatable disease, less testing, or lower perception of risk.
But the answers are more complex, he said.
Broader societal issues like marginalization of the community, stigma and racism play a role, as well as access to appropriate health care, sexual behaviour and other factors, said the report by Kendall and Dr. Mark Gilbert of the B.C. Centre for Disease Control.
The report also pointed out that while gay and bisexual men now represent nearly half of the HIV population, less than 10 per cent of Canadian health research grants in 2011 were for prevention targeting that group.
The report included 15 recommendations from an advisory group and six priorities from the public health officer, including a provincewide strategy.
"The report does signal the need to be now really focusing on gay and bisexual men," he said.
"It's not to say we can stop what we've been doing for people using injection drugs. There's still a need to support that community but we do need to really prioritize our efforts."
B.C. is the only province that has had a consistent decline in new HIV infections. Most provinces have seen static or slightly increasing rates, with the exception of Saskatchewan, where the disease is still on the rise, Kendall said.
Though antiretroviral medications have changed HIV from a fatal disease to a chronic, manageable illness, an estimated 35 million of the 70 million people infected worldwide have died.
Jesse Brown was 20 when he was diagnosed with HIV. Now the executive director of Youth Co. HIV and Hep C Society, he gave the report and recommendations a ringing endorsement.
"The great news is that we live in British Columbia, and have the resources and know what it is to prevent HIV and support our community," he said.
"... Changing some of the larger social determinants of health, like homophobia and stigma, will continue to challenge us for a long time to come."