HIV/AIDS Communiqué - Volume 4 Number 1 - Spring 2005

Table of content

• General
  • The Launch of the Federal Initiative to Address HIV/AIDS in Canada
  • The HIV/AIDS Policy, Coordination and Programs Division alignment process
  Events
  • International AIDS Conference 2006
  Funding
  • HIV/AIDS Community-Based Research Program, Canadian Institutes of Health Research
  • National Program Reviews
  • National HIV/AIDS Capacity Building Fund
  • HIV/AIDS and Hepatitis C Joint Initiative
  Science
  • Rapidly Progressing, Multiple-Class Drug-Resistant HIV: Reality Check on the New York City Case Report
  • 2nd Canadian Microbicides Symposium: Advancing HIV Prevention
  Report
  • HIV and AIDS in Canada : Surveillance Report to December 31, 2004
  Work in progress
  • Dialogue on Leading Together: Canada Takes Action on HIV/AIDS - 2005-2010

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General

The Launch of the Federal Initiative to Address HIV/AIDS in Canada

In January 2005, the Government of Canada launched the Federal Initiative to Address HIV/AIDS in Canada and committed to pursuing a Government of Canada-wide approach to addressing HIV/AIDS. This followed the announcement in May 2004 that ongoing federal HIV/AIDS funding would increase from $42.2 million annually in 2003-2004 to $84.4 million annually by 2008-2009.

The Federal Initiative, which replaces the Canadian Strategy on HIV/AIDS, is the response to calls for renewed and strengthened federal leadership. It builds on the lessons learned through previous federal strategies, on evidence from several sources, including the Report of the Standing Committee on Health and the Five-Year Review of the Federal Role in the Canadian Strategy on HIV/AIDS, and consultations with stakeholders.

The goals of the Federal Initiative are to

• prevent the acquisition and transmission of new infections;
• slow the progression of the disease and improve quality of life
• reduce the social and economic impact of HIV/AIDS;
• contribute to the global effort to reduce the spread of HIV and mitigate the impact of the disease. The Federal Initiative signals both a new focus on interdepartmental collaboration to address the determinants of health and increased coordination of HIV/AIDS activities among federal government departments and with provinces, territories and municipalities.

The Public Health Agency of Canada, Health Canada, Correctional Service Canada and the Canadian Institutes of Health Research receive funding under the Federal Initiative. The Public Health Agency of Canada is responsible for the overall coordination of this renewed federal initiative, awareness initiatives and social marketing, national and regional programs, policy development, surveillance, laboratory science and global engagement focussing on technical assistance and policy advice. Health Canada provides community-based HIV/AIDS education, prevention and related health services to First Nations on-reserve and some Inuit communities and coordinates global engagement and evaluation in partnership with the Public Health Agency of Canada. The Canadian Institutes of Health Research sets priorities for and administers the extramural research program in partnership with the Public Health Agency of Canada. Correctional Service Canada provides health services, including services related to the prevention, care and treatment of HIV/AIDS, to offenders sentenced to imprisonment of two years or more.

Activities under the Federal Initiative will be implemented in collaboration with other key federal departments and agencies, such as Social Development Canada (disability, homelessness and income support), Citizenship and Immigration Canada (medical screening of immigrants), Foreign Affairs Canada (foreign policy), Department of Justice Canada  (drug policy) and the Canadian International Development Agency (international assistance), as well as with provinces and territories, non-governmental organizations, researchers, health care professionals and people living with and vulnerable to HIV/AIDS.

For more information on the Federal Initiative, please visit the Public Health Agency of Canada Web site.

The HIV/AIDS Policy, Coordination and Programs Division Alignment Process

Over the past few months, the HIV/AIDS Policy, Coordination and Programs Division, Centre for Infectious Disease Prevention and Control (CIDPC), Public Health Agency of Canada, has been undergoing a process to better align the Division with the Federal Initiative to Address HIV/AIDS in Canada and increase the Division's capacity to respond quickly and efficiently to issues, requests and commitments. On April 1, 2005, a new structure was implemented as follow:

Accountability and Evaluation Section

Responsible for:

• carrying out commitments for evaluation, monitoring, reporting and auditing, as outlined in the Federal Initiative's Results-Based Management and Accountability Framework and the Risk-Based Audit Framework;
• ensuring quality assurance for grants and contributions;
• ensuring that departmental reporting requirements are met; and
• providing evaluation support to increase effectiveness of interventions. For more information, please write to Marsha Hay-Snyder (Marsha_Hay-Snyder@phac-aspc.gc.ca) or telephone (613) 946-3565.

Knowledge and Awareness Section

Responsible for:

• planning and priority setting for the pan-Canadian research plan, federal research priorities, vaccines, and surveillance plans;
• Legal, Ethical and Human Rights Fund;
• National HIV/AIDS Community-Based Social Marketing Fund;
• HIV/AIDS Information Service Initiative Fund;
• National Awareness Strategy; and
• Communications. For more information, please write to Steven Sternthal (Steven_Sternthal@phac-aspc.gc.ca) or telephone (613) 946-3635.

External and Government Relations Section

Responsible for:

• providing policy advice and meeting coordination for existing committees (Ministerial Council on HIV/AIDS, Federal/Provincial/Territorial Advisory Committee on AIDS, National Aboriginal Council on HIV/AIDS), new committees (Associate Deputy Ministers Interdepartmental Committee, multi-sectoral steering body of Leading Together) and the national non-governmental organizations / HIV/AIDS Policy, Coordination and Programs Division joint meetings;
• monitoring annual reporting on UNGASS and Leading Together;
• monitoring government-wide approach to HIV/AIDS; and
• monitoring relations with provinces and territories and other government departments. For more information, please write to Grafton Spooner (Grafton_Spooner@phac-aspc.gc.ca) or telephone (613) 941-2673.

Program Development and Evidence-Based Interventions Section

Responsible for:

• National Non-Governmental Organizations Operational Fund;
• National HIV/AIDS Capacity Building Fund;
• National HIV/AIDS Demonstration Fund;
• Non-Reserve First Nations, Inuit and Métis Communities HIV/AIDS Project Fund;
• development of guidelines, standards, and tools for voluntary and health care sectors;
• development of collaborative funding models with other levels of government;
• interdepartmental pilot projects; and
• program development coordination and support to responsibility centres. For more information, please write to Neil Burke (Neil_Burke@phac-aspc.gc.ca) or telephone (613) 941-1313.

Population-Specific Approaches Section

Responsible for:

• developing approaches and providing public health and policy advice/expertise on issues affecting people living with HIV/AIDS, gay men, injection drug users, Aboriginal people, federal inmates, youth and women at risk for HIV, and people coming from countries where HIV is endemic; and
• coordinating global activities and the role of the Public Health Agency of Canada in the XVI International AIDS Conference, which will be held in Toronto in August 2006. For more information, please write to Susan Tolton (Susan_Tolton@phac-aspc.gc.ca) or telephone (613) 952-7199.

For more information about the Division's alignment process, please write to Nina Arron, Director, HIV/AIDS Policy, Coordination and Programs Division (Nina_Arron@phac-aspc.gc.ca) or telephone (613) 957-1345.

Events

International AIDS Conference 2006

The Public Health Agency of Canada, along with at least nine other federal government departments, is supporting the XVI International AIDS Conference, which is being organized by the International AIDS Society. The conference will be held in Toronto from August 13 to 18, 2006. Federal engagement will include both financial support and various forms of organizational involvement. To date, Health Canada has contributed $1.5 million to the conference through a grant to the International AIDS Society. The Honourable Aileen Carroll, Minister for International Cooperation, has been named Canadian Co-chair of the Leadership Program Committee. Dr. Frank Plummer, Director General of the Public Health Agency's Centre for Infectious Disease Prevention and Control, is the Canadian Co-chair of the Basic Science Track.

A federal AIDS 2006 secretariat has been established to coordinate the involvement of the federal government and to provide a central point of contact. The Secretariat is being chaired by Carla Gilders, Director General of Health Canada's International Affairs Directorate. Bersabel Ephram, Associate Director General of the Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, is the alternate chair.

For more information on the Government of Canada's participation in the conference, please telephone Michael McCulloch at (613) 946-8110 or write to Michael_McCulloch@phac-aspc.gc.ca.

Funding

HIV/AIDS Community-Based Research Program, Canadian Institutes of Health Research

Following a successful transfer from Health Canada, the first Request for Applications for the HIV/AIDS Community-Based Research (CBR) Program at Canadian Institutes of Health Research (CIHR) was launched in November 2004. The program is managed by the Institute of Infection and Immunity in partnership with the Institute of Aboriginal Peoples' Health. CIHR worked hard to maintain the principles of the program and consulted with the community to ensure that the valuable contributions of this program would not be lost. CBR funds capacity-building initiatives and projects in two streams: Aboriginal research and non-Aboriginal research. Within each of these streams, applications were sought for development grants, operating grants, capacity-building workshops and research technical assistants. Masters and doctoral awards to contribute to the capacity-building goals of the initiative were also requested.

A total of 47 applications were received for research projects as a result of this call: 17 in the Aboriginal stream and 30 in the General stream.

To ensure continuity and maintain the spirit in which the CBR program was developed, two distinct Merit Review panels were established. The panels were composed of researchers and community members who brought their expertise in CBR, knowledge of CIHR, experience with the Health Canada program and unique cultural representation to the panels. The panels met in early March to review the projects.

Of the 17 projects received in the Aboriginal stream, seven were approved for funding, which represents a success rate of 41%. In the General stream, 30 projects were received, and a total of 14 projects were funded for a success rate of 47%. An additional four applications were received for personnel training awards. These applications will be reviewed in the coming weeks.

For full results of this competition, please visit the CIHR Web site.

We are very pleased with the final results of this first launch. The large number of applications received speaks to the need for community-driven initiatives and the increasingly valuable role that community contributions make.

The new Federal Initiative to Address HIV/AIDS in Canada further supports CBR by increasing the funding available over the next four years. The funding available to CBR will increase from its current $1.8 million annually to $3.3 million annually by 2008-2009. This dedicated funding will be sustained at that level. CIHR will continue to develop and support initiatives that engage the community and enable control of health issues that have an impact on their lives.

The next Request for Applications in CBR will be launched in June 2005. For more details on this program and other HIV/AIDS initiatives, please visit the CIHR Web site.

For more information, please write to Paula Kirton (pkirton@cihr-irsc.gc.ca) or telephone (613) 941-4483.

National Program Reviews

The launch of the Federal Initiative to Address HIV/AIDS in Canada signals a renewed and strengthened federal role in the Canadian response to HIV/AIDS. To ensure that the work of the Public Health Agency of Canada is aligned with the new goals and policy directions of the Federal Initiative, reviews will be conducted of all of its programs and coordination mechanisms.

One aspect of this work is to conduct a review of the national grants and contributions funding streams. This review is based on the fundamental principle that grants and contributions are a vital mechanism to ensure that measurable progress can be made in addressing the epidemic. The following two reviews are under way.

1) National Grants and Contributions Review

The National Grants and Contributions Review is focussing on four national grants and contributions funds: the HIV/AIDS Information Services Initiative (HISI) Fund, the National Non-Governmental Organizations Operational Fund, the National HIV/AIDS Capacity Building Fund, and the Legal, Ethical and Human Rights Fund. The purpose of the review is to assess whether or not these funds are appropriately positioned to best contribute to the policy directions and goals of the Federal Initiative. The result of the review process will be an alignment of the Division's national funding streams with these new directions. To date, a project file review has been completed, and consultative advice is being sought and considered from key stakeholders inside and outside the federal government; from various sectors, including national non-governmental organizations; and from regions across the country. The fund review is expected to be completed by late spring 2005 in preparation for the next call for proposals.

For more information, please write to Neil Burke (Neil_Burke@phac-aspc.gc.ca) or telephone (613) 941-1313.

2) Examination of the Non-Reserve First Nations, Inuit and Métis Communities HIV/AIDS Project Fund

The Non-Reserve First Nations, Inuit and Métis Communities HIV/AIDS Project Fund (the Non-Reserve Fund) has three main priorities: 1) to build on existing work being done in the community; 2) to enhance partnerships and sustainability; 3) to work to make HIV/AIDS a part of the work done by existing Aboriginal services/agencies that may not presently do this type of work. All projects funded by the Non-Reserve Fund benefit non-reserve Aboriginal communities.

Over the next three months, Native Management Services will be examining the Non-Reserve Fund. This examination will be a key component in helping the Public Health Agency of Canada to share the history of this funding program and to continue to ensure that the Non-Reserve Fund remains responsive to the changing nature of the HIV/AIDS epidemic in Canada, particularly in Canada's non-reserve Aboriginal communities. This examination will share the stories of the funding program's successes and challenges and help to lay a course for the funding program's future.

For more information on the examination of the Non-Reserve Fund, please write to Shane Rhodes (Shane_Rhodes@phac-aspc.gc.ca) or telephone (613) 946-3636.

National HIV/AIDS Capacity Building Fund

Twelve organizations have been approved for funding in response to the National HIV/AIDS Capacity Building Fund Request for Proposals, which was issued in 2004. A list of the successful applicants and a synopsis of their projects is available on the Public Health Agency of Canada Web site.

For more information on the National HIV/AIDS Capacity Building Fund, please write to Carolyn Moffatt (Carolyn_Moffatt@phac-aspc.gc.ca) or telephone (613) 957-7736.

HIV/AIDS and Hepatitis C Joint Initiative

The HIV/AIDS Policy, Coordination and Programs Division and the Community Acquired Infections Division (Hepatitis C Prevention Support and Research Program), both with the Public Health Agency of Canada, have been exploring new models for increased mutual collaboration on issues related to HIV/AIDS and hepatitis C. One of the new approaches is the integration of funding agreements for the Canadian HIV/AIDS Information Centre and the Canadian Hepatitis C Information Centre, both of which are housed at the Canadian Public Health Association. The information centres collect and distribute HIV/AIDS and hepatitis C information, produce new resources, and house a library and archives.

A memorandum of understanding has been signed between the HIV/AIDS Policy, Coordination and Programs Division and the Community Acquired Infections Division to outline how the joint initiative will be managed and monitored.

For more information on this joint initiative, please write to Jo-Anne Stead (Jo-Anne_Stead@phac-aspc.gc.ca) or telephone (613) 941-9766.

Science

Rapidly Progressing, Multiple-Class Drug-Resistant HIV: Reality Check on the New York City Case Report

On February 11, 2005, the New York City Department of Health and Mental Hygiene released results of a preliminary investigation of a New York City resident infected with a strain of HIV that was resistant to all but two anti-HIV drugs. This high level of drug resistance was present before the individual was treated with any anti-HIV drugs. In addition, the individual in question was apparently infected with HIV in 2003 and yet had rapidly progressed to AIDS by early 2005, with a CD4 count of <200 cells/mm3. Further investigation revealed that this individual was likely infected when he engaged in unprotected anal sex with multiple male partners while on crystal methamphetamine.

Some have suggested that this case may represent a new strain or type of HIV that is both multi-drug resistant and very pathogenic (causes rapid disease progression). However, the available data do not support this conclusion. First, although rapid progression to AIDS after infection with HIV is unusual, it is not unprecedented. Data from several studies in the U.S. show that approximately 1% of infected individuals progress rapidly to AIDS. While characteristics of the virus itself can affect the rate at which an individual progresses to AIDS, rapid progression may also be the result of characteristics of the individual who is infected, such as a weakened immune system. Therefore, the rapid progression to HIV in this New York case may be due to characteristics of the infected person rather than to any specific characteristic of the virus. Further investigation is under way to clarify reasons for rapid progression in this New York City case.

Furthermore, it is important to note that cases of multi-drug resistance are not rare, since resistance to more than one class of HIV drugs among newly diagnosed, untreated HIV infections has been previously reported from Canada, the U.S. and Europe. These studies indicate that the prevalence of multiple-class antiretroviral drug resistance (MDR) among newly diagnosed, untreated HIV infections is between 1.2-4.8%. Since 1998, Health Canada (and now since 2004, the Public Health Agency of Canada), in partnership with provincial and territorial ministries of Health, has been conducting a national surveillance program to monitor HIV drug resistance among newly diagnosed, untreated, HIV-infected individuals (Canadian HIV Strain and Drug Resistance Surveillance Program). Data from this program show that the overall prevalence of MDR HIV among newly diagnosed, untreated individuals in Canada is 1.3%. The clear lesson here is that the transmission of MDR HIV is occurring, and this will create significant clinical challenges for prescribing effective treatment. Nonetheless, the vast majority of HIV infections are due to non-resistant strains, and therefore treatment with antiretroviral drugs remains an effective way to delay progression of HIV disease and improve quality of life for HIV-infected persons.

The New York City case highlights the importance of safer drug use and safer sexual behaviours to prevent HIV infection in the first place. Furthermore, knowledge of one's HIV status, by getting tested for HIV infection, enables infected individuals to take advantage of appropriate treatments and to prevent further transmission. The monitoring of drug resistance among newly diagnosed individuals can support the development of optimum prevention and treatment strategies by helping to assess the effectiveness of prevention counselling for HIV-infected persons and to develop initial treatment regimens for HIV.

For more information on the Canadian HIV Strain and Drug Resistance Surveillance Program, please contact Gayatri Jayaraman by e-mail at Gayatri_Jayaraman@phac-aspc.gc.ca or by telephone at (613) 954-4442.

2nd Canadian Microbicides Symposium: Advancing HIV Prevention

The 2nd Canadian Microbicides Symposium: Advancing HIV Prevention was held in Ottawa on March 11, 2005. Bringing together more than 40 invited participants from government departments, research bodies, the private sector and community organizations, the goal of the symposium was to engage domestic and international players in the development of an action plan outlining Canada's role in microbicide development. The Honourable Aileen Carroll, federal Minister of International Cooperation, spoke at the opening reception, reminding participants of the real life experiences of women around the world who are living with and affected by HIV/AIDS and of the difference a microbicide-a female-controlled prevention method-could make to them. She encouraged symposium participants to work together to build commitment for Canadian action on microbicides.

As an example of the level of collaboration found in the microbicides field, this year's symposium was co-organized by 10 organizations and government departments, including the Canadian AIDS Society on behalf of the Microbicides Advocacy Group Network; the Interagency Coalition on AIDS and Development; Action Canada on Population and Development; the Canadian Association for HIV Research; the HIV/AIDS Policy, Coordination and Programs Division, Public Health Agency of Canada; the International Affairs Directorate, Health Canada; the Canadian Institutes of Health Research; the Canadian International Development Agency; the International Partnership for Microbicides; and the Global Campaign for Microbicides.

The symposium began with a presentation by a panel of experts who provided an overview of the current challenges and activities related to microbicide development globally. Participating experts included Manju Chatani of the African Microbicides Advocacy Group and Dr. Lulu Oguda, Clinical/Regulatory Africa Regional Manager for the International Partnership for Microbicides, as well as Canadian community, government and research representatives. This was followed by a discussion in which the whole group sought to identify major areas of focus needed to advance microbicide development, manufacture, equitable delivery and acceptance.

In the final session, participants divided into three groups-government, community and research-to discuss specific actions to be taken over the next year with a view to establishing desired outcomes for each sector. As each group presented its actions, it was clear that a high level of support exists in all sectors for action on microbicides. It was agreed that in order to advance interest, awareness, research and development, dissemination, and communication on the microbicide front, the next step would be to establish a multisectoral steering committee. The ultimate goal of the committee would be to develop a Canadian microbicides plan.

The symposium report is available here

For more information, please contact Marita Killen by e-mail at Marita_Killen@hc-sc.gc.ca or by telephone at (613) 941-4765 or Ingrid Wellmeier by e-mail at Ingrid_Wellmeier@phac-aspc.gc.ca or by telephone at (613) 941-4765.

Report

HIV and AIDS in Canada: Surveillance Report to December 31, 2004

The latest HIV and AIDS in Canada Surveillance Report is now available. The April 2005 report presents HIV and AIDS surveillance data to December 31, 2004, as reported from Canadian provinces and territories to the Centre for Infectious Disease Prevention and Control (CIDPC), Public Health Agency of Canada.

The data presented in this report provides information on how HIV/AIDS epidemic is changing in Canada. Two of the most notable changes observed in the surveillance data are: increases in the positive HIV test reports (overall and within specific population groups), and the increase in the proportion of women among positive HIV test reports and AIDS case.

There have also been a number of changes in the distribution of exposure category over the last decade to both HIV and AIDS surveillance data. Overall trends include a slight rise among men who have sex with men, a decrease among injection drug users and an overall increase in the heterosexual exposure category. Although more years of observation are required to determine if these trends will persist, they are important surveillance findings that need further attention. The latest HIV and AIDS in Canada Surveillance Report are now posted on the Public Health Agency of Canada Web site. Meanwhile, you can get a hard copy of the report by calling the Canadian HIV/AIDS Information Centre, Canadian Public Health Association, at (613) 725-3434, or the Surveillance and Risk Assessment Division, Public Health Agency of Canada, at (613) 954-5169.

For more information about this surveillance report, please write to Jennifer Pennock (Jennifer_Pennock@phac-aspc.gc.ca).

Work In Progress

Dialogue on Leading Together: Canada Takes Action on HIV/AIDS - 2005-2010

Following the review of input and comments on the draft version of Leading Together, a final version of the document is now in the last editing stages and close to publication.

Leading Together is a blueprint for Canada-wide action on HIV/AIDS from now until 2010. It calls for consolidated action on all fronts, including governments, community, researchers, individuals and others involved in Canada's response to HIV/AIDS. It presents specifically what needs to happen to achieve its bold vision, that "the end of the epidemic is in sight."

As the writing of the document approached completion, a meeting of national stakeholders was held in Ottawa on April 14 and 15, 2005. The purpose of the meeting was twofold: 1) to build a common understanding of Leading Together, and 2) to identify initial ways of moving ahead with Leading Together. Meeting participants supported the document as being a bold and visionary approach to coordinated action on HIV/AIDS in Canada. Participants also identified the need for a multi-sectoral group to champion Leading Together and to foster its use and continued relevance over time.

It is anticipated that Leading Together will be published by the summer of 2005.

For more information, please write to Fernand Comeau at Fernand_Comeau@phac-aspc.gc.ca or telephone (613) 946-6674.