It's not the death sentence it was once thought to be, but a sudden spike in HIV cases in the Maritimes is concerning health officials.

“Any time we see a spike in any type of sexually transmitted or blood-borne infection, that's certainly something we take notice too,” said Matthew Smith of AIDS NB.

That spike is dramatic.

The five-year average of new HIV cases in New Brunswick is seven.

In 2018 there were 21, and of those, 11 people acquired the virus outside of Canada and 10 within.

In Nova Scotia, there's an average of 16 new HIV cases per year, but in 2018, there were 25. That's up from 15 in 2017.

On Prince Edward Island, there were seven new cases in 2018. The average is three.

Sometimes, the biggest risk is not knowing.

“We know that in Canada there's about 63,000 people living positive, and about 14 per cent of people living positive are unaware of their HIV infection,” Smith said. “So, a person who doesn't know that they're living positive may not be taking the steps necessary to prevent an infection from spreading.”

And the only way to know if you're HIV positive is to get tested.

“We want people to get tested,” said Dr. Jennifer Russell, New Brunswick’s Chief Medical Officer of Health. “We want people to get treated. If you don't get tested you don't know you have HIV. So the people who are most at risk obviously are the people who are engaging in behaviours such as, multiple partners, hooking up, using apps.”

Russell says reducing the stigma can help.

“We're not in the setting of 30 years ago where this was a death sentence,” she said. “We can treat this.”

And she says people need to know their status so they can get treated and won't be perpetuating it.

It's difficult to know exactly why there is an increase -- and why we're seeing it across all three provinces.

But last year, New Brunswick and Nova Scotia started covering a relatively new drug that can reduce the risk of HIV before transmission.

Known as "prep" or pre-exposure prophylaxis, AIDS NB says it's 92 per cent successful. It is covered in Nova Scotia and New Brunswick but not P.E.I.

With files from CTV Atlantic’s Laura Brown.