An estimated 2.5 million people became newly infected with HIV worldwide in 2007, providing further evidence that HIV transmission knows no boundaries - geographic, socio-economic, gender, age, or otherwise. Although HIV/AIDS is most entrenched among vulnerable Canadians, it also reaches into the most privileged groups in society.
HIV/AIDS related stigma and discrimination still persist in Canada, and continue to fuel the spread of HIV. As is the case in other parts of the world, populations at risk of HIV infection in Canada include some of the most vulnerable groups in society.
Gay men and other men who have sex with men is the group most affected by the epidemic, accounting for 51 per cent of the estimated 58 000 individuals living with HIV infections in Canada at the end of 2005 (Public Health Agency of Canada estimates). People who use injection drugs comprised a further 17 per cent of the total, and women represented 20 per cent of individuals living with HIV. Aboriginal persons account for a disproportionately high percentage of the individuals living with HIV infections in Canada. Similarly, people from countries where HIV is endemic also represent a disproportionate number of these infections.
The Government of Canada is committed through the Federal Initiative to Address HIV/AIDS in Canada to develop discrete approaches to address HIV/AIDS among eight key populations:
Population-specific approaches result in evidence-based, culturally appropriate responses that are better able to address the realities and vulnerabilities that contribute to infection and poor health outcomes for the target groups. These approaches also allow people at risk of infection and those living with HIV/AIDS to directly shape policies and programs that affect them.
Under the Federal Initiative to Address HIV/AIDS in Canada (Federal Initiative), the Government of Canada is committed to developing, in concert with those affected or at risk, population-specific approaches to address HIV/AIDS.
While anyone - from all ages, walks of life and socio-economic strata of society - can be affected by HIV or AIDS, the reality is that in Canada (as in most high resource countries) key populations are disproportionately represented among those living with HIV/AIDS.
Advances in treatments available to people living with HIV/AIDS (PLWHA) have significantly increased life expectancy. However, PLWHA have increasingly complex needs as HIV/AIDS and the associated stigma and discrimination may affect their emotional and physical health, quality of life, finances and independence.
The Public Health Agency of Canada (PHAC) is developing a Population-Specific HIV/AIDS Status Report for PLWHA to guide future policy, program and research priorities. The report will include up-to-date information on the population's demographic profile, on the state of HIV infections, on the factors that increase vulnerability to HIV/AIDS, on currently funded research, on the lived experience of people affected by HIV/AIDS and will conclude with an analysis of the response. This report is being developed with the support of an external working group comprised of representatives of the population, the organizations involved in the response and the research community. The final report is expected to be released in 2009.
The Federal Initiative strives to ensure the direct involvement of PLWHA. For instance, PLWHA play an important role on the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada. They comprise one third of members of the Council and one of the co-chairs must be a PLWHA.
PHAC is establishing a second generation surveillance system called P-Track that will monitor attitudes, behaviours and access to prevention services among PLWHA in Canada. This will be achieved with the central and active involvement of PLWHA and through collaboration with provincial, regional, and local health authorities, community-based organizations, and researchers.
These three initiatives are examples of how the government of Canada values the greater involvement of PLWHA (GIPA principle) and ensures their meaningful involvement in its activities.
Through its community programming, including the AIDS Community Action Program (ACAP) and its National HIV/AIDS Funds, PHAC provides support for community-based organizations to deliver prevention, care and support services to PLWHA and those vulnerable to HIV infection.
The following are just a few examples of projects and programs for PLWHA being supported through PHAC:
Under the Federal Initiative to Address HIV/AIDS in Canada (Federal Initiative), the Government of Canada is committed to developing, in concert with those affected or at risk, population-specific approaches to address HIV/AIDS.
While the impact of HIV/AIDS on the gay community has diminished since the mid-1980s, the group of men who have sex with men (MSM), an epidemiological term describing a behaviour, which encompasses a broad range of people, continues to represent the majority of reported HIV and AIDS diagnoses. This group spans all social categories and overlaps with other key populations and factors, such as age, ethnicity, sexual and drug use practices, that may inform prevention, care, treatment and support approaches.
The Public Health Agency of Canada (PHAC) is developing a Population-Specific HIV/AIDS Status Report for Gay, 2 Spirit, Bisexual and Other Men who have Sex with Men to guide future policy, program and research priorities. The report will include up-to-date information on the population's demographic profile, the state of HIV infections, the factors that increase its vulnerability to HIV/AIDS, currently funded research, the lived experience of gay men affected by HIV/AIDS and will conclude with an analysis of the response. This report is being developed with the support of an external working group comprised of representatives of the population, the organizations involved in the response and the research community. The final report is expected to be released in 2009.
In 2005, PHAC implemented a second-generation HIV surveillance system called M-Track. The goal of M-Track is to monitor trends in the prevalence of HIV, viral hepatitis, sexually transmitted infections (STI) and associated risk behaviours among MSM. This was achieved through collaboration with provincial, regional, and local health authorities, community-based organizations, and researchers. There are now six M-Track sites across Canada: Montreal, Ottawa, Toronto, Winnipeg, Vancouver and Victoria. Over 4500 men participated in an M-Track survey from 2005 to 2007.
Through its community programming, including the AIDS Community Action Program (ACAP) and the Specific Populations HIV/AIDS Fund (Populations Fund), PHAC provides support for community-based organizations to deliver local prevention, care and support services to all people living with HIV/AIDS, including gay men, and those vulnerable to HIV infection. The following are examples of projects and programs for gay men being supported:
Under the Federal Initiative to Address HIV/AIDS in Canada (Federal Initiative), the Government of Canada is committed to developing, in concert with those affected or at risk, population-specific approaches to address HIV/AIDS.
According to the Canadian Addiction Survey, of those Canadians reporting use of an injectable drug at some point in their life, 6.5% (269,000) reported injecting drugs in 20041. Although the number of new HIV infections among people who inject drugs (IDU) appears to be decreasing overall, challenges remain for HIV prevention among women who inject drugs in Canada.
* Information on ethnicity is not available for all provinces and territories. Ethnicity information was reported for 79.1% of all AIDS cases reported between 1979 and December 31, 2006, while this information was reported for 29.2% of HIV positive test reports from 1998 to the end of 2006.
The Public Health Agency of Canada (PHAC) is developing a Population-Specific HIV/AIDS Status Report for People Who Inject Drugs to guide future policy, program and research priorities. The report will include up-to-date information on the population's demographic profile, the state of HIV infections, the factors that increase vulnerability to HIV/AIDS, currently funded research, the lived experience of people affected by HIV/AIDS and will conclude with an analysis of the response. This report is being developed with the support of an external working group comprised of representatives of the population, the organizations involved in the response and the research community. The final report is expected to be released in 2009.
To better understand HIV risk behaviours among people who inject drugs, PHAC has established I-Track: an enhanced surveillance system of HIV-associated risk behaviours at sentinel sites across Canada. This has been achieved through collaboration with provincial, regional, and local health authorities, community-based organizations, and researchers.
Through its community programming, including the AIDS Community Action Program (ACAP) and National HIV/AIDS Funds, PHAC provides support for community-based organizations to deliver prevention, care and support services to all people living with HIV/AIDS and those vulnerable to HIV infection, including people who inject drugs.
The following are examples of projects and programs for people who inject drugs being supported through PHAC:
The Labrador Friendship Centre has implemented its HIV/AIDS Labrador Project for Aboriginal women and youth, inmates and people who inject drugs who are vulnerable to HIV, hepatitis C and sexually transmitted infections, as well as for Aboriginal people living with HIV/AIDS. Education, training and support to individuals, communities, correctional facility inmates and staff, service providers, parents and educators improve knowledge and capacity to prevent transmission of infections and increase access and use of diagnosis, care, treatment and social supports (Non-Reserve First Nations, Inuit and Métis Communities Project Fund).
Under the Federal Initiative to Address HIV/AIDS in Canada (Federal Initiative), the Government of Canada is committed to developing, in concert with those affected or at risk, population-specific approaches to address HIV/AIDS.
Correctional Service of Canada (CSC) is the federal government agency responsible for administering sentences of a term of two years or more, as imposed by the courts. Prison inmates in correctional facilities experience higher rates of infectious diseases than the general population2. Many enter the correctional system already infected, often as a result of their history of high-risk behaviours. Those who continue to engage in high-risk behaviours, while incarcerated, put others at risk of infection, including placing themselves at risk of further infection.
* Prevalence of infection is based on results of tests. Not all inmates undergo testing, therefore, prevalence of infection may be greater than reported.
The Public Health Agency of Canada (PHAC) will be developing a Population-Specific HIV/AIDS Status Report for Prison Inmates to guide future policy, program and research priorities. The report will include up-to-date information on the population's demographic profile, the state of HIV infections, the factors that increase vulnerability to HIV/AIDS, currently funded research, the lived experience of people affected by HIV/AIDS and will conclude with an analysis of the response. This report is being developed with the support of an external working group comprised of representatives of the population, the organizations involved in the response and the research community. The final report is expected to be released in 2010.
As a partner in the Federal Initiative, CSC is engaging with other federal departments, agencies and non-governmental organizations in addressing the need for prevention, diagnosis, care, treatment and support services. A comprehensive public health program for infectious diseases is provided within CSC with the support of an interdepartmental Letter of Agreement between this agency and PHAC. PHAC has also partnered with CSC in an inmate infectious diseases and risk behaviours survey with both agencies now analyzing the results.
CSC offers confidential voluntary testing to inmates for infectious diseases upon admission and throughout incarceration, as well as access to HIV specialists and treatment. Pre- and post-testing counselling is offered to all those undergoing HIV testing. Educational programs on infectious disease transmission and prevention, discreet access to condoms, dental dams and water-based lubricant, bleach for cleaning injecting, tattooing and piercing equipment, and methadone treatment are available in all CSC correctional facilities.
Through PHAC National HIV/AIDS funding, Prisoners with HIV/AIDS Support Action Network (PASAN), in partnership with the Canadian HIV/AIDS Legal Network, published Hard Time: Promoting HIV and Hepatitis C Prevention Programming for Prisoners in Canada in December 2007 that documents best practice prison-based programming to prevent infectious disease transmission.
Through its community programming, including the AIDS Community Action Program (ACAP), PHAC provides support for community-based organizations to deliver prevention, care and support services to all people living with HIV/AIDS and those vulnerable to HIV infection, including prison inmates.
The following are examples of projects and programs for prison inmates being supported through PHAC:
The BC Persons with AIDS Society (BCPWA) provides the Entry to Exit: Prison Outreach Program (POP) that seeks to educate prisoners and prison staff about HIV, its transmission, treatment and associated risk management practices. For HIV-positive prisoners, POP also provides support services for both face-to-face sessions and through a 1-800 telephone number; access to complementary health products through BCPWA's Complementary Health Fund; individual advocacy services, as appropriate; and assistance with pre-release planning.
In Ontario, PASAN offers the Prison In-Reach Program to reduce the transmission of HIV/AIDS among prisoners/ex-prisoners; increase health promotion and health services for prisoners and ex-prisoners living with, and affected by, HIV/AIDS in Ontario; and increase skills-building opportunities for AIDS service organizations and community-based organizations working with prisoners and ex-prisoners. PASAN is the only organization in Canada exclusively providing HIV/AIDS education and support to prisoners, ex-prisoners, young offenders and their families.
Stella l'amie de Maimie, a community-based organization in Montreal has implemented the "Wings for Our Future" project for female inmates and/or infected women, as well as workers in the field of parole eligibility and labour force reintegration. Through educational sessions, the inmates gain greater understanding of modes of infection and prevention techniques and social workers become more familiar with resources in providing appropriate referrals.
Under the Federal Initiative to Address HIV/AIDS in Canada (Federal Initiative), the Government of Canada is committed to developing, in concert with those affected or at risk, population-specific approaches to address HIV/AIDS.
While the reported incidence of HIV among young people (defined here as between 10 and 24 years), constitutes a very small proportion of the total number of HIV/AIDS cases in Canada, the data on risk behaviours, including sexual behaviour, substance abuse, and perceptions amongst youth, demonstrates the potential for HIV transmission. This increases significantly in the case of youth at risk. High-risk behaviours, such as unprotected sex, drug use, street involvement, and factors, including homelessness, mental illness, and sexual abuse, place youth at higher risk. Gay youth are more vulnerable than their heterosexual peers; and Aboriginal youth are at greater risk than non-Aboriginal populations.
The Public Health Agency of Canada (PHAC) will be developing a Population-Specific HIV/AIDS Status Report for Youth at Risk to guide future policy, program and research priorities. The report will include up-to-date information on the population's demographic profile, the state of HIV infections, the factors that increase its vulnerability to HIV/AIDS, currently funded research, the lived experience of youth at risk affected by HIV/AIDS and will conclude with an analysis of the response. This report will be developed with the support of an external working group comprised of representatives of the population, the organizations involved in the response and the research community. The final report is expected to be released in 2010.
PHAC conducts a national enhanced surveillance program of street-involved youth and has released several reports containing overviews of available data and several Quick Facts and Epi Updates, which address specific issues relating to the street-involved youth population, including more in-depth analyses on STIs, substance use and associated sexual risk behaviours, as well as hepatitis C and injection drug use.2
Through its community programming, including the AIDS Community Action Program (ACAP), PHAC provides support for community-based organizations to deliver local prevention, care and support services to all people living with HIV/AIDS, including youth at risk, and those vulnerable to HIV infection.
The following are examples of projects and programs for youth at risk being supported through ACAP:
Under the Federal Initiative to Address HIV/AIDS in Canada (Federal Initiative), the Government of Canada is committed to developing, in concert with those affected or at risk, population-specific approaches to address HIV/AIDS.
Aboriginal peoples experience poorer health and socio-economic conditions than the general population in Canada. Epidemiological data also suggest that Aboriginal peoples are over-represented in the HIV epidemic and are being infected with HIV at a younger age than the non-Aboriginal population.
* Information on ethnicity is not available for all provinces and territories. Ethnicity information was reported for 79.1% of all AIDS cases reported between 1979 and December 31, 2006, while this information was reported for 29.2% of HIV-positive test reports from 1998 to the end of 2006.
The Public Health Agency of Canada (PHAC) is developing a Population-Specific HIV/AIDS Status Report for Aboriginal Peoples to guide future policy, program and research priorities. The report will include up-to-date information on the population's demographic profile, the state of HIV infections, the factors that increase its vulnerability to HIV/AIDS, currently funded research, the lived experience of Aboriginal peoples affected by HIV/AIDS and will conclude with an analysis of the response. This report is being developed with the support of an external working group comprised of representatives of the population, organizations involved in the response and the research community. The final report is expected to be released in 2009.
The National Aboriginal Council on HIV/AIDS (NACHA) is an advisory committee to PHAC and Health Canada ensuring that the HIV-related needs of First Nations, Inuit and Métis are met. In September 2007, NACHA held its first national policy forum in Montreal. The forum focused on issues specific to First Nations, Inuit and Métis, as well as discussions on the social determinants of health, the challenges related to HIV programming in northern and rural Aboriginal communities, and strategies for increasing HIV testing among Aboriginal populations.
PHAC is working with representatives from Aboriginal community groups and others to develop A-Track -- a second-generation HIV/AIDS surveillance system among Aboriginal peoples. This surveillance system is being designed to collect self-reported information over time on HIV-related risk behaviours, HIV testing history, attitudes toward and access to health care services, as well as knowledge of HIV. To date, two sites have been identified as pilot projects for data collection.
Health Canada's First Nations and Inuit Health Branch (FNIHB) supports initiatives to increase knowledge and awareness of HIV/AIDS among FNIHB health staff, youth aged 10-30 years, women, and community leaders on-reserve. FNIHB has worked to build partnerships at the national, regional and community levels to achieve a coordinated response to HIV/AIDS. Community capacity to respond to HIV/AIDS has been enhanced through awareness building, access to prevention, care and treatment, and supportive social environments for those living with, or at risk of, HIV/AIDS.
PHAC provides support for community-based organizations to deliver local prevention, care and support services to Aboriginal peoples living with HIV/AIDS and those vulnerable to HIV infection through its community programming, including the Non-Reserve First Nations, Inuit and Métis Communities HIV/AIDS Project Fund, the Specific Populations HIV/AIDS Initiative Fund and the AIDS Community Action Program.
The following are examples of projects and programs for Aboriginal peoples being supported through these funding programs:
Under the Federal Initiative to Address HIV/AIDS in Canada (Federal Initiative), the Government of Canada is committed to developing, in concert with those affected or at risk, population-specific approaches to address HIV/AIDS.
Women account for a growing proportion of positive HIV test reports. Among women (15 years and older), the primary exposure categories associated with newly diagnosed HIV infection are heterosexual contact and intravenous drug use (IDU).
The Public Health Agency of Canada (PHAC) is developing a Population-Specific HIV/AIDS Status Report for Women to guide future policy, program and research priorities. The report will include up-to-date information on the population's demographic profile, the state of HIV infections, the factors that increase its vulnerability to HIV/AIDS, currently funded research, the lived experience of women affected by HIV/AIDS and will conclude with an analysis of the response. This report is being developed with the support of an external working group comprised of representatives of the population, the organizations involved in the response and the research community. The final report is expected to be released in 2009.
Through its community programming, including the AIDS Community Action Program (ACAP), PHAC provides support for community-based organizations to deliver local prevention, care and support services to all people living with HIV/AIDS and those vulnerable to HIV infection, including women.
The following are examples of projects and programs for women being supported through ACAP:
Under the Federal Initiative to Address HIV/AIDS in Canada (Federal Initiative), the Government of Canada is committed to developing, in concert with those affected or at risk, population-specific approaches to address HIV/AIDS.
HIV-endemic countries are defined as those having an adult incidence (ages 15-49) of HIV that is 1.0% of the population or greater and one of the following:
The Public Health Agency of Canada (PHAC) is developing a Population-Specific HIV/AIDS Status Report for People from Countries where HIV is Endemic to guide future policy, program and research priorities. The report will include up-to-date information on the population's demographic profile, the state of HIV infections, the factors that increase vulnerability to HIV/AIDS, currently funded research, the lived experience of people affected by HIV/AIDS and will conclude with an analysis of the response. This report is being developed with the support of an external working group comprised of representatives of the population, organizations involved in the response and the research community. The final report is expected to be released in 2008.
To gather more detailed information on HIV-associated risk behaviours, HIV testing and exposure to certain intervention programs among individuals within ethnocultural populations in Canada and particularly among people from countries where HIV is endemic, PHAC is developing E-Track, a second-generation HIV surveillance system. It is hoped that the information collected with this system will enable a better understanding of the dynamics of HIV transmission and the potential areas for prevention programs among this vulnerable population. The initial E-Track pilot site is currently underway in Montreal. The implementation of this system is achieved through collaboration with provincial, regional, and local health authorities, community-based organizations, and researchers.
Through its community programming, including the AIDS Community Action Program (ACAP), PHAC provides support for community-based organizations to deliver prevention, care and support services to all people living with HIV/AIDS and those vulnerable to HIV infection, including people from countries where HIV is endemic.
The following are just a few examples of projects and programs for people from countries where HIV is endemic being supported through ACAP: