HIV/AIDS Communiqué - Volume 2 Number 1 - Winter 2003

Table of content

In This Issue:

1. Surveys
   Public Attitudes Towards HIV/AIDS in Canada Survey
   CIHR HIV/AIDS Researchers Survey
2. Science
   HIV and AIDS in Canada: Surveillance Report to June 30, 2002
   Developing a National Risk Behaviour Surveillance System
3. Issues
   First Canadian Harm Reduction Conference
   CSC Expands Methadone Maintenance Treatment Program
4. Evaluation
   Five-Year Review of the Federal Role in the CSHA
   Stakeholder Support for International HIV/AIDS Program
   Direction 10 - Strategic Plan
5. Resources
   Report on Infectious Diseases in Canadian Federal Penitentiaries
   CSC's Focus on Infectious Diseases Newsletter
6. Funding
   Request for Proposals - HIV/AIDS Research Program
   Recent Funding News

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1. SURVEYS

Public Attitudes Towards HIV/AIDS in Canada Survey

HIV/AIDS represents one of the most challenging and complex public health issues facing the world today. In Canada, despite decades of public education and prevention programming the number people living with HIV continues to rise.

One aspect of the epidemic in Canada is an apparent change in public perceptions about HIV/AIDS. To help gauge public attitudes, Health Canada commissioned Decima Research to add five HIV/AIDS related questions to its August, 2002 omnibus survey. The survey was conducted via telephone with 2008 Canadians (18 and older) and is considered accurate within +- 2.2%, 19 times out of 20.

The survey results provide some room for optimism but also some cause for concern. On the positive side, when asked about HIV transmission, most Canadians seem fairly knowledgeable about how the virus is transmitted and are able to identify unsafe sexual practices and sharing needles as key modes of transmission.

An area of concern are respondent's perceptions of the seriousness of HIV/AIDS as a problem in Canada with 54% rating HIV/AIDS as a very serious problem. At first glance this seems to indicate that Canadians are aware that HIV/AIDS remains a significant issue in Canada. However, when this same question was asked in 1989 and again in 1998, the percentage of Canadians who rated HIV/AIDS as very serious was significantly higher. In 1989, 83% of respondents rated HIV/AIDS as a very serious issue. In 1998, the figure was 69%. This decline would appear to indicate that public perceptions about the seriousness of HIV/AIDS is waning.

Other survey results included:

• 36% of respondents felt that the risk was of acquiring HIV/AIDS now versus 5 years ago is greater or much greater as opposed to 27% who felt the risk was somewhat lower or much lower. Those who felt the risk is now greater sited the increasing number of people living with HIV/AIDS and people paying less attention to risks as their main reasons for feeling this way. Those who felt the risk is now lower sited a greater awareness of risks as their primary rational.
• The majority of Canadians believe that current HIV/AIDS treatments are very (6%) or somewhat (50%) effective.

While the results of the omnibus questions are quite interesting, the HIV/AIDS Policy, Coordination and Programs Division is currently evaluating the need for conducting a more comprehensive survey to provide an ongoing assessment of the Canadian public's awareness, knowledge and level of concern about HIV/AIDS issues. For more information please contact Neil Burke at (613) 941-1313 or by e-mail at Neil_Burke@hc-sc.gc.ca.

CIHR HIV/AIDS Researchers Survey

In the fall of 2002, the Canadian Institute for HIV Research (CIHR) commissioned a survey of HIV/AIDS researchers who were funded by CIHR in 2001-2002. The survey was designed to collect information about the research they were conducting, their collaborations, their training initiatives, their knowledge dissemination activities and the impact of their research. The response was excellent with 58 of 64 researchers completing the telephone portion of the survey.

CIHR administers the majority of the CSHA funding for extramural research. The results of the survey provide CIHR with information which is helpful in both measuring the performance of the CIHR HIV/AIDS program and in preparing CIHR's input into Canada's annual report on HIV/AIDS.

CIHR-funded HIV/AIDS researchers are distributed across the country with the majority of researchers residing in Quebec and Ontario. The survey indicates that researchers are collaborating extensively with scientists in other departments, institutions, provinces and countries. Not only are researchers collaborating with other scientists but many are also involving health practitioners, community groups and people living with or at risk of HIV/AIDS in the design and implementation of their research.

The impact of scientific research is frequently measured by the number of publications in peer-reviewed journals. HIV/AIDS researchers disseminated the results of their research through this traditional means, but also extended the reach of their work by publishing and presenting their results in books, media interviews and seminars.

Overall, CIHR-funded HIV/AIDS researchers felt that the Canadian capacity to conduct HIV/AIDS research in their area of specialization is strong. The survey indicates that this capacity will likely continue to grow as a large majority of researchers are involved in training the next generation of HIV/AIDS scientists.

For further information on the CIHR survey of HIV/AIDS researchers please contact:
Jennifer Gunning, Program Officer, CIHR, at (613) 941-4483 or by e-mail at jgunning@cihr-irsc.gc.ca.

2. SCIENCE

HIV and AIDS in Canada: Surveillance Report to June 30, 2002

The latest HIV and AIDS in Canada Surveillance Report is now available. The November 2002 report presents HIV and AIDS surveillance data to June 30, 2002, as reported to the Centre for Infectious Disease Prevention and Control (CIDPC) from Canadian provinces and territories. Highlights of the main findings follow.

Positive HIV Tests

There have been 51,470 positive HIV tests reported to CIDPC since HIV testing began in Canada in November 1985. There was nearly a 30% decrease in the number of positive HIV tests reported annually between 1995 and 2000, however in 2001 there was a slight increase to 2,180 positive tests reported. There have been 1,193 positive HIV tests reported to CIDPC in the first six months of 2002, 105 (9.7%) more than at the same time in 2001.

• Women account for an increasing proportion of tests, representing 26.0% of reports among adults between January and June 2002.
• The greatest proportion of tests continues to be attributed to men who have sex with men (MSM). After a decrease in 2001 to 36.4% of adult tests, this figure increased to 40.0% in the first half of 2002.
• The proportion of adult tests attributed to injecting drug use (IDU) has been declining since 1997 (33.5%), and was 23.3% in the first six months of 2002.
• The proportion of adult tests among the heterosexual exposure category has increased steadily since HIV reporting began, changing from 9.1% in 1985-1996 to 30.6% reported between January and June 2002.

Reported AIDS Cases

Since the beginning of the epidemic in the early 1980's, there have been 18,336 AIDS cases reported to CIDPC. The number of cases reported annually peaked in 1993 at 1,766 but had declined to 297 by 2001. Seventy-five AIDS cases have been reported in the first six months of this year.

• Women also account for a growing proportion of AIDS cases representing 16.7% of reports in the first six months of 2002.
• The proportion of reported adult AIDS cases attributed to the heterosexual and IDU exposure categories have increased since reporting began. Proportions for January-June 2002 were 31.3% and 23.9% respectively.
• The proportion of adult cases among MSM has steadily declined over the last decade, and currently accounts for 40.3% of the adult AIDS cases reported in the first half of 2002.
• The proportion of AIDS cases among Black and Aboriginal populations has been increasing since reporting began while the proportion attributed to Whites has decreased. Proportions for data reported for January-June 2002 were 15.6%, 14.1% and 64.1% respectively.

Mortality Among Reported AIDS Cases

To date CIDPC has received notification of 12,655 deaths among reported AIDS cases. The number of deaths increased from the beginning of record keeping to 1995, when the number of deaths reported was 1,477. There has been a dramatic decrease in deaths since that time—136 deaths among reported AIDS cases were reported in 2001 and 36 in the first six months of 2002.

· The proportion of deaths attributed to females has increased over time, consistent with the rising proportion of females among HIV/AIDS cases.

One must be cautious when interpreting the surveillance data for the first half of the reporting year (data to June 30) because of small samples, delayed reporting and under-reporting. CIDPC will continue to monitor the surveillance data and will clarify whether these findings are sustained when data for the full year are reported.

It is also important to consider that data are only on those individuals who sought testing and/or medical care. It does not include cases not reported or not tested, and thus does not provide a complete assessment of the number of people living with HIV or AIDS in Canada (prevalence), or the number of new cases each year (incidence). For estimates of incidence and prevalence, please refer to CIDPC's latest Epi Update series published in April 2002. A new resource, “A Guide to HIV/AIDS Epidemiological and Surveillance Terms” may also be of assistance.

Each of the above mentioned documents may be accessed online at . Hard copies are available through the Division of HIV/AIDS Epidemiology and Surveillance, CIDPC or through the HIV/AIDS Clearinghouse. For more information, please contact Dana Reid by e-mail at Dana_Reid@hc-sc.gc.ca.

Developing a National Risk Behaviour Surveillance System
a system for injection drug users and men who have sex with men

Injection Drug Users (IDU) are at risk of acquiring HIV and other blood-borne viruses through contaminated injecting equipment and unsafe sexual practices. Although several ongoing regional studies in Canada collect risk behaviour data on IDU and a number of cross-sectional surveys on risk-taking among IDU have been conducted, it is challenging, if not impossible, to compare levels of risk behaviours between data sets.

An HIV- and hepatitis C (HCV)- associated risk behaviour surveillance system is being established by Health Canada at sentinel centres across Canada through collaboration with regional health authorities, community stakeholders, and researchers. The pilot phase of this surveillance system was undertaken in October/November 2002 in Regina, Victoria, and Sudbury and Toronto; linkages are also being made with IDU studies in Quebec. It is expected that the surveillance survey will be conducted on an annual basis.

This sentinel surveillance system will track HIV- and hepatitis C (HCV) - associated risk behaviour in IDU populations in urban and semi-urban centres across Canada and will provide critical information for those involved in planning and evaluating the response to HIV/HCV among IDU. Through this system, national, and to a certain extent, provincial and local trends in injecting and sexual risk behaviours can be assessed. Further, behavioural trend data will enhance existing national surveillance data and national incidence and prevalence estimates in monitoring the course of the HIV and HCV epidemics among IDU. The data can also be used in combination with other data sources to assess the effects of prevention efforts and policies at the national and provincial levels.

Since the mid-1990s, the use of highly active antiretroviral therapies (HAART) have significantly reduced death from HIV infection. There has been growing optimism among MSM about HIV treatment, which may be associated with a coinciding rise in risk behaviour. Recent data suggest that MSM continue to be at risk for HIV infection and other sexually transmitted infections (STI) by engaging in unsafe sexual practices. They highlight the need to monitor the HIV and STI associated risk behaviour more closely in order to enhance reportable disease surveillance systems and to better guide prevention and care programs.

A working group is currently developing the survey instrument and the methodological template for the surveillance system. The purpose of this group is to advise to the Centre for Infectious Diseases Prevention and Control (CIDPC) of Health Canada on the development of a surveillance system for HIV and STI associated risk behaviour among MSM in order to provide data for use in planning and evaluating HIV and STI prevention programs and policies at the national, provincial, and local level. Once a generic template is agreed upon, discussions will proceed separately with provincial authorities and interested stakeholders to establish pilot sites and further refine methodological details. During early 2003, CIDPC will initiate discussions with provincial health authorities. Provincial health partners and researchers will help CIDPC identify interested stakeholders who should be involved in implementing this surveillance system. For more information, please contact Yogesh Choudhri at Yogesh_Choudhri@hc-sc.gc.ca.

3. ISSUES

First Canadian Harm Reduction Conference

The first Canadian Harm Reduction Conference, held November 22 to 24, 2002 in Toronto, Ontario, drew more than 350 delegates from across Canada. Participants included current and former injection drug users, front-line service providers and professionals.

Education and skills-building sessions addressed such topics as health issues related to HIV/AIDS, hepatitis C and drug use; accessibility of health care and harm reduction programming; best practices for harm reduction policy and programming; and the negative impact of drug and enforcement policies on the harm reduction agenda.

Integral to the success of the conference was the involvement of current and former users in all aspects of conference planning, curriculum development and facilitation. Prior to the conference, peer networkers in twelve communities across Canada worked with a research team to connect with marginalized injection drug users to gather input for the curriculum and help potential participants overcome barriers to attending the conference. Conference scholarships enabled 100 current and former drug users to attend.

Overall outcomes from the conference indicated a readiness to move forward with a national harm reduction agenda. Key issues included the need for enhanced advocacy, education and resources to support harm reduction approaches, increased availability and accessibility of lower-threshold harm reduction services, the need for safe injection facilities and the coordination of a national response to support harm reduction initiatives.

The Street Health Nursing Foundation of Toronto hosted the conference and it was funded jointly by the HIV/AIDS Policy, Coordination and Programs Division, the Hepatitis C Division, the Office of Canada's Drug Strategy, and the First Nations and Inuit Health Branch. For more information, please contact Jacqueline Arthur by e-mail at Jacqueline_Arthur@hc-sc.gc.ca.

Correctional Service of Canada Expands Methadone Maintenance Treatment Program

In May 2002, the Correctional Service of Canada (CSC) expanded its Methadone Maintenance Treatment (MMT) program. MMT has been available for opioid-addicted inmates in CSC institutions since 1998, offered primarily to those who were already on an MMT program in the community prior to being sentenced. In 1999, the program was expanded to include exceptional cases, meaning that in some instances, MMT could be initiated within the institutions.

With the expansion of the program in 2002, all opioid-addicted inmates are now eligible to be considered for the program. The National Methadone Guidelines developed by CSC are consistent with the standards established by Health Canada and the provincial Colleges of Physicians and Surgeons.

The expansion of the MMT program augments the measures that CSC's National Infectious Diseases Program (funded, in part, by the CSHA) has taken to reduce the spread of infectious diseases among inmates in federal penitentiaries, such as:

• the availability of condoms, dental dams and lubricants;
• the availability of bleach;
• voluntary HIV testing and counselling offered to inmates at reception and throughout their incarceration;
• HIV/AIDS awareness and education programs for both inmates and staff; HIV/AIDS peer education and counselling program for inmates; and,
• staff training, including the importance of exercising universal precautions at all times.

4. EVALUATION

Five-Year Review of the Federal Role in the CSHA

The CSHA, launched by the Federal Minister of Health in May 1998, is now almost five years old. At the time of the launch of the CSHA, a commitment was made by Health Canada to report to Cabinet on the CSHA's progress to date, gaps and the way ahead by July 2003. As well, the current Minister of Health has identified the need to build a solid case for increased federal government funding for the CSHA.

The Five-Year Review is intended to address both the Cabinet commitment as well as the case for increased federal investment. To this end, the review will:

• examine the federal response over the past five years and will identify the successes, challenges and lessons learned;
• propose options for the federal role in the CSHA over the next five years;
• provide evidence-based recommendations regarding the reallocation of existing federal funding in the CSHA ($42.2M) as well as an analysis of the adequacy of this funding level. The review incorporates the resource allocation process which began in June 2001.

The review will build on previous CSHA activities including the Direction-Setting Meetings held in Gray Rocks and Montreal and will be linked to the strategic planning process underway for the CSHA (Direction #10). For more information please contact Marsha Hay-Snyder by e-mail at Marsha_Hay-Snyder@hc-sc.gc.ca.

Stakeholder Support for International HIV/AIDS Program

In the fall of 2002, Health Canada's International Affairs Directorate (IAD) undertook an external review of the International Collaboration component of the Canadian Strategy on HIV/AIDS (CSHA).

The review found solid support for the program. Stakeholders indicated that the program's activities are an important part of the CSHA; particularly in supporting Canada's participation in international HIV/AIDS work. Stakeholders also noted that these international efforts are being delivered cost-effectively.

IAD commissioned the review to solicit feedback from external and internal partners as well as stakeholders. The objective was to assess progress in implementing the CSHA's international elements; to determine whether the program is properly designed and supported; to identify lessons learned; and to suggest cost-effective investments.

Stakeholders said program activities - including co-ordination, sharing information with other countries and international organizations, and building capacity in NGOs and ASOs - have enhanced Canada's influence in the international arena. Many highlighted the importance of the Division's Working Group on International HIV/AIDS Issues, which is the only forum for dialogue among NGOs/ASOs and the federal departments involved in international HIV/AIDS work.

Direction 10 - Strategic Plan
the strategic plan to frame a national approach to the epidemic in Canada

The work on the five year strategic plan to guide a focussed national response is underway. Thirty people with a wide range of expertise in and perspectives on HIV/AIDS issues gathered in Ste-Adèle, Québec from December 3 to 6, 2002 to identify key issues, SMARTER objectives and broad actions to address the epidemic in Canada, and Canada's global responsibilities. The participants have turned the results of their deliberations over to the Strategic Plan Steering Committee for further development.

Next Steps

• draft strategic plan and consultation plan by February 28, 2003
• widespread consultations March to June 2003
• launch of final plan on World AIDS Day 2003

For more information, please contact Marsha Hay-Snyder by e-mail at Marsha_Hay-Snyder@hc-sc.gc.ca.

5. RESOURCES

Report on Infectious Diseases in Canadian Federal Penitentiaries

The report Infectious Diseases Prevention and Control in Canadian Penitentiaries 2000-2001 is the first of its kind in Canada, using routinely collected surveillance data to report on infectious diseases in correctional settings. The report was prepared jointly by infectious diseases specialists, epidemiologists and public health specialists from Health Canada's Centre for Infectious Disease Prevention and Control in partnership with the Correctional Service of Canada (CSC).

The purpose of the report is to provide a better understanding of communicable diseases in a correctional environment through health surveillance that will allow CSC to address evolving trends in disease management, to continue to implement harm reduction strategies and to promote healthy lifestyle practices in the federal inmate population. The surveillance data can also be used to evaluate the effectiveness of existing prevention and treatment programs within CSC.

The report summarizes the analysis of data collected during two years of surveillance, covering the period from January 2000 through December 2001. The data contain relevant information on HIV, hepatitis C, hepatitis B, and sexually transmitted diseases. Specifically, Infectious Diseases Prevention and Control in Canadian Penitentiaries 2000-2001 examines the epidemiology of infections, and testing and treatment uptake among inmates.

The surveillance system for infectious diseases in federal correctional facilities forms part of a comprehensive public health approach aimed to protect the health of inmates, staff and the community at large. The report can be found on the CSC web site.

CSC's Focus on Infectious Diseases Newsletter

Spring 2002 marked the first edition of the Correctional Service of Canada's (CSC's) Focus on Infectious Diseases newsletter. The newsletter reports on issues related to interventions, treatment, prevention and control of infectious diseases within the correctional environment.

The first edition focussed on health surveillance data collection in CSC. The second edition, released in Fall 2002, contained articles on outbreak management in CSC penitentiaries, rates of HIV and HCV in women offenders, and reported on surveillance activities. The third edition, Winter 2002-2003, to be issued in February 2003, focuses on sexually transmitted infections and provides a summary of World AIDS Day 2002 activities held in CSC institutions across the country.

To obtain copies of the newsletter, send an email to gen-nhq-health@csc-scc.gc.ca or call (613) 995-3098.

6. FUNDING

Request for Proposals - HIV/AIDS Research Program

The Canadian Institutes of Health Research (CIHR) is soliciting applications for HIV/AIDS research grants and personnel awards. On behalf of the CSHA, CIHR provides funding for meritorious research grants and salary and training support for research personnel in all areas of HIV/AIDS research, including biomedical research, clinical research, research respecting health systems, health services, the health of populations, societal and cultural dimensions of health and environmental influences on health.

All of CIHR's research funding and research personnel programs with their scheduled deadlines are open to HIV/AIDS researchers who meet the eligibility requirements .Upcoming competition deadlines are:

Grants

• Operating Grants Registration deadlines: February 1, 2003; August 15, 2003
  Application deadlines: March 1, 2003; September 15, 2003
• Randomized Controlled Trials Registration deadline: March 1, 2003
• Workshops and Symposia Application deadline: March 1, 2003

Training Awards

• Fellowships Application deadline: April 1, 2003

Click here for more information on this program.

Recent Funding News

Calls for proposal for the Best Practice Models for the Integration of HIV Prevention, Care, Treatment and Support Fund and the National HIV/AIDS Capacity Building Fund were launched last fall. Proposals were invited from community organizations, health and educational institutions, and professional organizations across Canada. In total the HIV/AIDS Division received over 80 proposals, several of which are currently being recommended for funding.

Upcoming Funding Initiatives
A call for letters of intent for applications to the National HIV/AIDS Demonstration Fund will be released in the next few months. The aim of the fund is to support initiatives that will demonstrate a significant, measurable impact on the identified high risk priority populations with respect to reducing the HIV transmission and/or supporting initiatives that significantly increase access to care, treatment and support for people living with and/or affected by HIV/AIDS.

The National HIV/AIDS Information Service Initiative (HISI) and the National Non-Governmental (NGO) Organization Operational Funding Guidlines
This winter and spring, a review of the HISI and NGO operational funding guidelines is being conducted in preparation for the next funding cycle starting April 1, 2004. The National HIV/AIDS Information Service Initiative (HISI) is focussed on the provision and dissemination of prevention, care, treatment and support information, knowledge and resources. The national Non-Governmental Organization (NGO) operational fund ensures that HIV/AIDS related issues are addressed in the strategic, multi-sectoral collaborative way through a strong community infrastructure. Government and community stakeholders will be involved in the review process. The purpose of the review is to improve the guidelines to ensure they are still consistent with the goals of the CSHA and that the programs continue to have an impact on the HIV/AIDS epidemic in Canada. The RFPs will be released in June 2003 and with a planned deadline for August 2003.

National HIV/AIDS Awareness Update
The National Steering Committee on HIV/AIDS Awareness held its first face-to-face meeting last Fall to begin to develop the strategic orientation for a national HIV/AIDS awareness campaign. At the meeting the Committee recommended that "putting HIV/AIDS back on the map" be the overall goal of a national campaign.