The Ministerial Council On HIV/AIDS

Annual Report 2001 - 2002

Table of Contents

1.0 Message From the Co-Chairs

2.0 The Canadian Strategy on HIV/AIDS - A Brief History

3.0 Ministerial Council's Mandate, Roles and Objectives

4.0 Membership and Structure

5.0 Designation of Issues

6.0 Ministerial Council Areas of Work in 2001-2002

6.1 Promoting Intra- and Interdepartmental Collaboration

Overview
6.1.1 Citizenship and Immigration Canada
6.1.2 Solicitor General - Correctional Service of Canada
6.1.3 Justice Canada
6.1.4 Health Canada: Office of Canada's Drug Strategy

6.2 Ensuring Citizen Engagement

Overview
6.2.1 HIV-Endemic Populations (African and Caribbean)
6.2.2 Women and HIV/AIDS
6.2.3 Gay Men and HIV/AIDS
6.2.4 Injection Drug Users and HIV/AIDS
6.2.5 Aboriginal Peoples and HIV/AIDS

6.3 Securing Resources and Sustaining a Structure to Fight the Epidemic

Overview
6.3.1 Canadian Strategy on HIV/AIDS (CSHA) Direction Setting
6.3.2 Social Justice Framework and Population Health
6.3.3 CSHA Funding Adequacy
6.3.4 CSHA Evaluation
6.3.5 CSHA Resource Allocation
6.3.6 Research
6.3.7 Health Care Reform
6.3.8 Drug Review Process

6.4 Supporting the Development of Critical Initiatives

Overview
6.4.1 Vaccines and Microbicides
6.4.2 Medicinal Use of Marijuana

6.5 Preparing Canada's International Response

Overview
6.5.1 World AIDS Day
6.5.2 United Nations General Assembly Special Session on HIV/AIDS - UNGASS
6.5.3 Global Fund to fight AIDS, TB and Malaria

7.0 Appendices

Appendix 1: Terms of Reference for the Ministerial Council on HIV/AIDS
Appendix 2: Members of the Ministerial Council on HIV/AIDS
Appendix 3: How to contact the Ministerial Council on HIV/AIDS
Appendix 4: Date and Location of Ministerial Council meetings during 2001-2002

1.0 Message from the Co-Chairs

The Ministerial Council on HIV/AIDS is pleased to share with you its first annual report. This document focuses on work undertaken during fiscal year 2001-2002.

Council was established four years ago on the recommendation of national stakeholder groups working with Health Canada to create the Canadian Strategy on HIV/AIDS. A great deal has been accomplished in that time.
Council's role is to advise the Minister of Health on pan-Canadian aspects of HIV/AIDS. Our advice to the Minister has been respectful but frank. Members' collective expertise makes our work possible. Our experience and knowledge span the disciplines that form the Canadian response to the epidemic, from the research community to front-line workers involved with emerging at-risk groups. The Council also has members living with HIV/AIDS. You will find detailed information on Council's structure and membership in the following pages.

The Ministerial Council makes a difference. Council brings its pan-Canadian expertise to bear in a way that has helped the Government of Canada identify and respond to issues more quickly than was previously possible. This is aided by our ongoing dialogue with the Minister of Health and with Health Canada officials. Our recommendations have influenced Health Canada's policies and programs and those of several other federal government departments.

The Ministerial Council ensures that its work is effective. Last year, the Council underwent an independent evaluation. This year, we studied the evaluation and began to implement its recommendations. We also struck an ad hoc visioning and strategic planning committee, which has developed a planning process for the Council.

The Ministerial Council will meet for a special strategic planning day in June 2002. At that time, we will ensure that the directions developed for Council will support and be consistent with the ten directions for the Canadian Strategy on HIV/AIDS. The Strategy's directions were chosen by national stakeholders in 2000 and further developed by stakeholders in April 2002.

The Ministerial Council knows that the fight against this epidemic is not over. There is so much more to be done. Our vision of the future holds a country and a world that are no longer affected by HIV/AIDS. We will continue to provide solid advice to the Minister of Health as part of the path to that future.

2.0 The Canadian Strategy on HIV/AIDS - a brief history

The first Canadian case of AIDS was identified in 1982. Since then, over 50,000 Canadians have been infected with HIV. No vaccine exists to prevent HIV infection. There is still no cure.

In 1990, Phase I of the National AIDS Strategy was launched. This Strategy committed $112 million over three years to support a variety of research, surveillance and community development activities. Significant progress was made in education, prevention, care and treatment. It supported grassroots groups and other non?governmental organizations in their fight against HIV/AIDS, and it laid the groundwork for future partnerships with provincial and federal departments and agencies.

Phase II, which committed $211 million over five years, was launched in March 1993. It responded to the growing complexity of HIV/AIDS in Canada and the need for an extended commitment of time, funds and energy.

Phase II emphasized the building of partnerships with other federal departments, provincial and territorial governments, non?governmental organizations, the private sector, professional groups and major stakeholders. Our knowledge base broadened significantly. Progress was made in educating Canadians in schools, in the workplace, and in the community. National surveillance systems were put in place. Guidelines for training health care professionals were developed. Innovative models of individual and family care and support were introduced. More effective drugs and therapies were found and made available.

By the end of Phase II in March 1998, Canadians could look back on the substantial progress that
had been achieved. Thanks to better treatment, there were 33% fewer AIDS cases in 1996 than in
1995, and 36% fewer deaths related to HIV. From their first appearance to the end of the 1980s, HIV infections were primarily concentrated in two population groups: gay men and people infected through the blood supply. Education and prevention efforts have greatly reduced the number of new infections among gay men, while improvements to the blood system have meant that Canadians have access to safe blood and blood products. Progress has been made, but it is not enough because the epidemic has spread to other populations and remains a serious threat to some of the initially infected populations, particularly gay men.

In 1998 the Canadian Strategy on HIV/AIDS was developed. Ongoing annual funding for the Strategy was secured at $42.2 million.

The following policy directions have been guiding the implementation of the new Strategy:

• enhanced sustainability and integration
• increased focus on those most at risk
• increased public accountability

These policy directions are based on the goals of the Strategy, which were developed in collaboration with stakeholders.

The goals of the Strategy are to:

• prevent the spread of HIV infection in Canada
• find a cure
• find and provide effective vaccines, drugs and therapies
• ensure care, treatment and support for Canadians living with HIV/AIDS, their families, friends and caregivers
• minimize the adverse impact of HIV/AIDS on individuals and communities
• minimize the impact of social and economic factors that increase individual and collective risk for HIV infection.

The 10 program components of the Strategy are:

• prevention
• community development and support to national non-governmental organizations
• care, treatment and support
• research
• surveillance
• international collaboration
• legal, ethical and human rights
• Aboriginal communities
• consultation, evaluation, monitoring and reporting
• Correctional Service of Canada

One of the important innovations of the Strategy is the creation of a Ministerial Council on HIV/AIDS which brings together expertise that encompasses all aspects of HIV/AIDS in Canada, including a strong voice of people living with HIV/AIDS. The Council provides ongoing advice to the Minister of Health in four crucial areas: keeping the Strategy flexible and responsive to the changing nature of the epidemic; promoting alliances and joint efforts; reaching groups at risk and responding to their needs; and assisting in the development of long?term plans for future action on HIV/AIDS.

3.0 Ministerial Council's mandate, roles and objectives

Mandate: To provide advice to the Minister of Health on pan-Canadian aspects of HIV/AIDS.

Role: To ensure that current and emerging issues regarding HIV/AIDS are being adequately addressed.
Objectives:

• to identify and prioritize current and emerging issues of the HIV/AIDS epidemic
• to communicate the priority issues of the HIV/AIDS epidemic to the Minister
• to shift priorities when appropriate as new issues emerge

Role: To be visionary in providing long-term directions.
Objectives:

• to identify the possible long-term consequences of existing trends and policy on the Canadian HIV/AIDS epidemic
• to provide long-term direction regarding the Canadian HIV/AIDS epidemic
• to advise on the federal government's process of partner and stakeholder consultation in the development of long-term HIV/AIDS strategies and directions

Role: To monitor and evaluate the implementation of the Canadian Strategy on HIV/AIDS and to support its effectiveness and its flexibility to meet changing circumstances.
Objectives:

• to periodically review and provide advice regarding the existing resource allocation within the CSHA
• to regularly review and monitor the financial expenditures of the CSHA
• to recommend allocation of unspent CSHA funds as appropriate
• to monitor and provide advice regarding the CHSA evaluation processes
• to review and provide advice regarding the annual progress reports

See Appendix 1 for the Ministerial Council's Terms of Reference.

4.0 Membership and Structure

Council members are appointed by the Minister of Health and are chosen for their experience and collective expertise. Because the Council must be the voice of those infected with and affected by HIV/AIDS, five of its 15 members are people living with HIV/AIDS. The Minister of Health reviews the membership of the Council on a regular basis to ensure that it consists of members who can provide the best timely advice.

To encourage collaborative efforts with the provinces and territories, the Provincial Co-Chair of the Federal/Provincial/Territorial Advisory Committee on HIV/AIDS holds an ex-officio position on the Ministerial Council. The lead Assistant Deputy Minister for the Canadian Strategy on HIV/AIDS also holds an ex-officio position as Health Canada's standing representative on the Council.

See Appendix 2 for a list of Ministerial Council members and their biographies.

The Ministerial Council on HIV/AIDS has established the following standing committees and working groups. The Ministerial Council meets face-to-face four times a year. Between Council meetings the sub-committees meet by teleconference.

Executive Committee
The role of the Executive Committee is to ensure that all of the work needed to ensure productive Council meetings is done in a timely manner. The Executive Committee is responsible for monitoring the workload of the Secretariat.

Championing Committee
The role of the Championing Committee is to identify current and emerging HIV/AIDS related issues. The issues identified are the object of an analysis by committee members in order to determine if recommendations will be developed for the Minister.

Communications Committee
The Communications Committee participates in the development and updating of communications tools such as the website and oversees processes put in place to communicate with the Minister and a diverse group of stakeholders. Committee members also provide advice to the Minister on specific occasions such as World AIDS Day.

Monitoring and Evaluation Committee
The Monitoring and Evaluation Committee ensures that evaluation and resource allocation procedures within the Canadian Strategy on HIV/AIDS are adequate. The committee provides input into the Strategy Direction Setting processes. The Committee carries the responsibilities of evaluating the effectiveness of the Council and suggesting ways to improve the efficiency of the Council's work.

Research Committee
This new committee will examine all research issues arising under the Strategy.

Special Working Group on Aboriginal Issues
The role of this committee is to ensure that Aboriginal realities are reflected in the complexity of HIV/AIDS issues and that they are a constant priority for the Council.

Ad Hoc Committee on Visioning and Strategic Planning
The Council established this committee in 2001-2002 to guide the development of strategic planning of the Council's own work.

 

5.0 Designation of Issues

Issues are brought forward to the Ministerial Council table in a number of ways. First, and most commonly, the Minister of Health may request that the Council provide advice on a particular issue. The Minister has a unique opportunity to present his/her request when he/she meets with Council members once a year. Individuals or groups bring issues to the attention of the Ministerial Council by addressing a letter to the Council Secretariat. Please see Appendix 3 for the Council's contact information. Finally, Council members bring forward issues that have come to their attention through their ongoing involvement in the community and through their work and participation in conferences and committees. The Ministerial Council may invite guest presenters to provide the Council with information on an issue.

As a rule, there are a significant number of issues that the Ministerial Council is working on or following at any given time. Some issues require ongoing follow-up and have been on the agenda since the Council's inception, while new issues are raised at most meetings. There are a number of factors that must be considered in determining where the subcommittees of the Ministerial Council direct their energies. To guide them, the subcommittees ask if the issue is:

• within the mandate of the Minister of Health
• within the mandate of the Ministerial Council on HIV/AIDS
• national in scope
• likely to affect a significant proportion of the population or a sub-population
• able to be addressed with the resources and time that the Ministerial Council has at its disposal.

6.0 Ministerial Council Areas of Work in 2001-2002

6.1 Promoting Intra- and Interdepartmental Collaboration
Overview

Promoting both intra- and interdepartmental collaboration is an important function of the Canadian Strategy on HIV/AIDS because the issues raised by HIV/AIDS fall within the mandates of several areas of Health Canada and of several federal ministries. In addition to Health Canada, the departments of Justice, Foreign Affairs and International Trade, Citizenship and Immigration, and the Solicitor General have been involved in HIV/AIDS issues during the past year. It is vital that federal ministries work in a collaborative way in order to make the Canadian Strategy on HIV/AIDS most effective. Minister Rock had discussed interdepartmental collaboration with his Cabinet colleagues and was prepared to argue for increased funding for the CSHA. Since September 11, 2001, government spending priorities have shifted toward public and health security. In January 2002 the Honourable Anne McLellan became Minister of Health. The Ministerial Council expects to meet with her during the coming year to brief her and raise outstanding issues.

In addition to interdepartmental collaboration within the Government of Canada, the Council is concerned with intergovernmental collaboration and has strong links to the Federal/Provincial/Territorial (FPT) Committee on AIDS (FPT-AIDS). The provincial co-chair of FPT-AIDS is an ex-officio member of the Ministerial Council.

During the past year, the Ministerial Council collaborated with the Federal/Provincial/Territorial Committee on HIV/AIDS to commission a study of HIV and health determinants. This paper will be available in April 2002 and will be used to guide interdepartmental collaboration. The objectives of the study are:

• to identify existing data on HIV/AIDS-related determinants of health
• to increase the knowledge and awareness of government departments other than Health Canada about these issues
• to develop tools and mechanisms that other departments can use to assess the impact of their work on HIV/AIDS.

6.1.1 Citizenship and Immigration Canada

The Issue
Under a new Citizenship and Immigration policy, HIV testing became mandatory for prospective immigrants. The Ministerial Council does not support the mandatory testing policy, arguing that prevention education is an approach more consistent with respect for human rights. The Minister of Health supported the policy of mandatory testing, but advised Citizenship and Immigration Canada that positive serostatus not be used as grounds for automatically excluding immigrants for reasons of public health.

Role of the Ministerial Council

In its role as champion of important issues, the Ministerial Council engaged in ongoing dialogue with the Minister of Health, giving him advice and requesting that he raise this issue with the Minister of Citizenship and Immigration.

Work Done During 2001-2002

• The Ministerial Council advised the Minister of Health on two occasions during the year and requested:
  
  • o that the program of mandatory HIV testing for prospective immigrants to Canada conform to the Canadian Medical Association's Counselling Guidelines for HIV Testing when testing is done abroad
  • o that, in assessing on the requisite case-by-case basis whether a prospective immigrant will be considered "medically inadmissible" to Canada on the basis of anticipated "excessive demand" on health and social services, Citizenship and Immigration Canada (CIC) use a cost-benefit approach that considers both the economic and non-economic contributions that HIV-positive immigrants will make to Canadian society and the projected costs to the health and social services systems
• In addition, the Ministerial Council asked that the Minister of Health arrange a meeting for representatives of the Council with the Minister of Citizenship and Immigration. This has been postponed because of the Cabinet shuffle in January 2002.
• The Council had a briefing from an official of the department of Citizenship and Immigration. Following this briefing, the Council offered its help to CIC in developing counselling guidelines for HIV testing and requested a follow-up meeting in order to pursue this issue further.

Future Activities
The Ministerial Council will raise this as an issue of concern with the new Minister of Health. The Council will pursue its request to meet the new Minister of Citizenship and Immigration and follow up on its offer to assist CIC in developing testing and counselling guidelines. The Council will also follow the implementation of the new policy of routine and mandatory testing and the manner in which "excessive demand" is to be assessed in making determinations about medical admissibility or inadmissibility.

 

6.1.2 Solicitor General - Correctional Service of Canada

The Issue
The rate of HIV infection in Canada's prisons is ten times higher than in the general population. The rate of seroconversion due to exposure in prison is thought to be high. Although injection drug use and sexual activity
occur in prison, access to needle exchange, condoms and methadone maintenance is limited.

Role of the Ministerial Council
The Ministerial Council advised the Minister of Health on this issue and encouraged him to support his ministerial colleague the Solicitor General in bringing about reforms.

Work Done During 2001-2002
Following a meeting last year with the Commissioner of the Correctional Service of Canada, the Ministerial Council advised the Minister of Health of their concerns and advised him to meet with the Solicitor General, who is responsible for the Correctional Service of Canada, to express encouragement and support for a harm reduction approach and HIV prevention programs in prisons. The Solicitor General expressed his willingness to meet with the Minister of Health on these issues. Council expressed its willingness to support the Minister of Health at this meeting.

Future Activities
The Ministerial Council will continue to monitor and give advice on this issue. The Council also plans to meet with the Minister of Justice.

6.1.3 Justice Canada

The Issue
The proposed Blood Samples Act, Bill C-217, was a private member's Bill that would allow justices of the peace to order a blood sample taken when there exist "reasonable grounds" to believe that a Good Samaritan assisting another person, or peace officer, firefighter, health care worker or other frontline emergency worker (or someone helping those people to do their job) has been exposed to the risk of HIV infection. Health Canada and Justice Canada both raised serious concerns about this Bill before the House of Commons Standing Committee on Justice and Human Rights at its hearings into the proposed legislation. At the beginning of March 2002, the Standing Committee recommended to the House of Commons that the bill not proceed, but that the issues raised in the Bill be discussed by federal, provincial and territorial ministers of justice and the Uniform Law Conference, and that Health Canada increase its efforts to gather statistics on the extent of occupational exposures.

Role of the Ministerial Council
The Council monitored this issue and gave advice to the Minister of Health.

Work Done During 2001-2002

• The Ministerial Council reviewed the issues raised by Bill C-217 and advised the Minister of Health, stressing its concern for the serious legal and human rights questions of privacy and bodily integrity. The Council was concerned that the passage of this Bill would add to the already difficult environment within which HIV test results are provided and would further stigmatize those living with HIV/AIDS, as well as being of limited benefit to those exposed persons it ostensibly aimed to assist.
• In discussions with Health Canada officials, the Council stressed that the question of workplace safety raised by Bill C-217 fell within provincial rather than federal (criminal law) jurisdiction.

Future Activities
The Council will continue to monitor developments on the issue of legislation authorizing compulsory HIV testing and provide further analysis, advice and assistance to the Minister as necessary.

6.1.4 Health Canada: Office of Canada's Drug Strategy

The Issue
Canada's Drug Strategy, in place since 1998, has the goal of reducing the harm done by alcohol and drugs to individuals, families and communities. At issue is the question of whether the harm reduction aspects of the Drug Strategy are being given sufficient weight relative to the enforcement and control aspects. This is of special concern because drug policy has a significant impact on the spread of HIV and on the access that people who use illicit drugs (including people with HIV/AIDS) have to care, treatment and support. A high proportion of new HIV infections are among injection drug users.

Role of the Ministerial Council
In its championing role, the Ministerial Council has strongly urged the Minister of Health to strengthen the harm reduction aspects of the Strategy, and consult widely with stakeholders, including drug users. The Council has been influential in having drug use seen as a health, rather than a criminal, issue.

Work Done During 2001-2002

• The Ministerial Council was briefed by Health Canada officials on Canada's Drug Strategy. Following that briefing, the Council gave its advice to the Minister of Health, urging that:
  • Canada's Drug Strategy be adequately funded
  • current drug laws and their impact on the health of Canadians be examined
  • Canada's international law enforcement and drug control commitments and their impact on the health and human rights of Canadians be reviewed
  • pilot projects be established and evaluated for safe injection and heroin maintenance as first steps toward further implementation of these harm reduction measures
  • a broadly-based public consultation on the Drug Strategy be held that reflects meaningful participation of drug users and the organizations that provide services to them
  • a ministerial council be established to advise the Minister of Health on the Drug Strategy
  • all components of the Drug Strategy be evaluated, including enforcement and control.
• The Ministerial Council supported the recommendation of the Federal/Provincial/Territorial Committee on Injection Drug Use that supervised injection drug sites and clinical trials of heroin prescription be considered.

Future Activities
The Ministerial Council will continue to follow and champion this issue.

 

6.2 Ensuring Citizen Engagement

Overview
One of the cornerstones of the Canadian Strategy on HIV/AIDS is the commitment that people living with HIV/AIDS will have a central role in providing expertise and leadership. This has been central to the approach to all HIV/AIDS work since the beginning of the epidemic. The Ministerial Council remains vigilant to ensure that persons living with HIV/AIDS are actively engaged as citizens in the Strategy. The Strategy also encourages the engagement of communities and populations that are vulnerable to, or disproportionately affected by, the epidemic.

6.2.1 HIV-Endemic Populations (African and Caribbean)

The Issue
Surveillance data show that an increasing proportion of AIDS cases in Canada are among persons from countries where HIV is endemic, mainly in African and Caribbean communities. It is estimated that 70% of all maternal HIV transmissions to children in Canada have occurred among women of African and Caribbean origin. Diagnosis of HIV infection is also occurring among older children in populations from countries where HIV is endemic, who were born before HIV testing during pregnancy became a policy issue. Possible reasons for this include late diagnosis of HIV because of limited access to information and services, reduced access to treatment, and increasing infection rates. Lack of uniformity in collection of ethnicity data by provinces and territories across Canada impedes monitoring of these trends. There is a need for direct community involvement in collecting and analyzing data.

Role of the Ministerial Council
In its role as champion of emerging issues, the Ministerial Council has identified the needs of populations from countries where HIV is endemic as a concern.

Work Done During 2001-2002

• Through the Council's link with the Federal/Provincial/Territorial Committee on HIV/AIDS, and through Council members' involvement on provincial task forces on populations from countries where HIV is endemic, the Council closely followed this issue.
• The Council received presentations from several experts.
• The Council recommended to the Minister of Health that he and his department take a leadership role and convene a meeting of relevant stakeholders to identify issues and develop strategies for dealing with them
• The Council communicated its concerns to Health Canada's HIV surveillance group.

Future Activities
The Council will continue to champion this issue.

6.2.2 Women and HIV/AIDS
The Issue
HIV infection rates among women in Canada have been rising steadily in recent years. A National Reference Group on Women and HIV/AIDS, convened by Health Canada, met during 2000-2001 and gave advice on program and policy priorities that will inform Health Canada's work planning for several years. The group was disbanded in early 2001.

Mother to child transmission of HIV and treatment regimes used to lessen transmission continue to be concerns. As a result of the use of antiretroviral therapies during pregnancy, the rate of transmission of HIV infection from mother to child has been significantly reduced. There are no data regarding the potential long-term effects on the pregnant woman or her children. A national group of stakeholders has been working to develop the Canadian Perinatal Exposure to Antiretrovirals Registry (PEAR).

Role of the Ministerial Council
The Council studied these issues and expressed strong concern to the Minister of Health.

Work Done During 2001-2002

• The Council recommended to the Minister of Health that the National Reference Group on Women and AIDS be reinstated so that it can coordinate, monitor and evaluate the implementation of its recommendations. The Council asked the Minister to inform it of Health Canada's plans for ensuring that the Group's recommendations are implemented.
• The Council studied the feasibility of a Mother to Child Surveillance Registry and studied issues of drug toxicity to mothers and children.
• The Council recommended to the Minister the establishment of a Canadian registry of HIV-infected women and their antiretroviral-exposed children so that the short- and long-term effects on woman and their children of antiretroviral therapies during pregnancy can be determined. Council recommended that Health Canada encourage the development of the national registry and that it find a program home for the registry within Health Canada.
• The Council investigated possibilities for working collaboratively on mother to child issues with the Federal/Provincial/Territorial Committee on AIDS and its Pediatric Antiretroviral Therapy Surveillance Working Group, and through the Council's links to mechanisms for international collaboration and information exchange.
  

Future Activities
Council will provide advice to the Minister of Health on the issue of mother to child transmission, outlining a facilitative process, and stressing the need for political commitment and funding on this issue from sources outside the Canadian Strategy on HIV/AIDS.

 

6.2.3 Gay Men and HIV/AIDS

The Issue
Two-thirds of the people living with HIV/AIDS in Canada are gay men or other men who have sex with men. A resurgence of HIV infections, particularly among younger gay men, is a cause for concern. Members of the gay community are calling for an approach to HIV prevention and treatment in the context of gay men's health, including psychosocial health. Aboriginal two-spirited people are seeking greater representation in processes concerned with gay men's health.

A National Reference Group on Gay Men's Health met during the past year and produced two reports: Framing Gay Men's Health in a Population Health Discourse and Valuing Gay Men's Lives: Reinvigorating HIV prevention in the context of our health and wellness. Health Canada has developed a policy framework for gay men's HIV prevention and has worked with a national committee on HIV prevention for gay men to include prevention for gay men as a component of a comprehensive HIV prevention strategy.

Role of the Ministerial Council
The Council championed the issues of gay men and supported a renewed emphasis on HIV prevention and care for gay men.

Work Done During 2001-2002
The Council studied the issue of gay men and HIV and was briefed on the work of the National Reference group on Gay Men's Health and on Health Canada's response. A member of the Council sits on the new national committee on HIV prevention for gay men. Council members called for the inclusion of more Aboriginal, two-spirited and ethno-cultural representation on these issues.

Future Activities
Council will continue to champion these issues.

6.2.4 Injection Drug Users and HIV/AIDS

The Issue
Injection drug users are among the fastest growing populations of newly infected Canadians. Injection drug use is affected by Canada's Drug Strategy (see section 5.1.4). In 1999, the Canadian HIV/AIDS Legal Network published a report on injection drug use, Injection Drug Use and HIV/AIDS: Legal and Ethical Issues. In its August 2001 reply, Health Canada focused on: harm reduction; care, treatment and support; and involving drug users in policy making. Health Canada will be commissioning studies on drug use and HIV, including a study on the provision of controlled substances to HIV-positive injection drug users in care settings. Injection drug use has legal as well as health aspects, which necessitates interdepartmental collaboration between the departments of Health, Justice and the Solicitor General.

Role of the Ministerial Council
The Council champions this issue and provides advice focused on interdepartmental collaboration, federal/provincial/territorial collaboration and congruence with Canada's Drug Strategy. The Council was linked to the Safe Injection Site Task Group through a member of Council who sat on the Task Group.

Work Done During 2001-2002

• The Council did an extensive study of Health Canada's response to the Canadian HIV/AIDS Legal Network report and provided advice to the Minister and Health Canada officials on this issue throughout the year, stressing the need for interdepartmental collaboration, greater attention to the needs of Aboriginal peoples (e.g. the difficulty of obtaining methadone or needle exchange on reserve), and the need to integrate approaches into Canada's Drug Strategy.
• The Council gave its advice to the Minister of Health regarding Health Canada's response to the Canadian HIV/AIDS Legal Network's report. They commended Health Canada for many of its initiatives and also expressed concern about:
  • drug laws and policies, recommending that Health Canada proceed with an examination of drug laws and how they may infringe on the human rights of drug users and how the harms resulting from current drug laws can be reduced
  • health and social services for drug users, recommending that Health Canada show leadership in developing a harm reduction approach to public policy
  • prescription of opiates and controlled substances, recommending that Health Canada study the feasibility of programs such as heroin prescription
  • needle exchange and methadone maintenance treatment, recommending that pilot projects be undertaken in correctional facilities and that the Minister discuss this with the Solicitor General.
• The Council met with the Minister of Health and advised him that Health Canada's response to the 1999 report of the Canadian HIV/AIDS Legal Network needed to be strengthened and that federal/provincial/territorial mechanisms need to be invoked to this end.
• The Ministerial Council supported the recommendation of the report of the Federal/Provincial/Territorial Committee on Injection Drug Use, Reducing the Harm Associated with Injection Drug Use, that supervised injection drug facilities and clinical trials of heroin prescription be considered. This report was discussed by the health ministers at their meeting in September 2001.
• The Council requested an update from the Minister of Health on his meeting with provincial and territorial health ministers in September 2001 and their discussion of harm reduction and injection drug use. The Council thanked him for championing injection drug use issues and in particular for endorsing the piloting of safe injection facilities.
  

Future Activities
The Council will continue to take an active interest in this issue and will provide advice to the Minister of Health.

 

6.2.5 Aboriginal Peoples and HIV/AIDS

The Issue
The HIV epidemic appears to be growing among Aboriginal peoples, a conclusion based largely on data collected in urban areas. The Canadian Strategy on HIV/AIDS has a strong Aboriginal component, with $2.6 million dedicated to Aboriginal communities. In addition, there are dedicated funds for an Aboriginal research program. The First Nations and Inuit Health Branch of Health Canada spends an additional $2.5 million annually on HIV programs.

The Aboriginal community is developing mechanisms to coordinate Aboriginal aspects of the Strategy. In 2001-2002, a National Aboriginal Council on HIV/AIDS was formed as a collaborative mechanism to provide advice on all aspects of the Canadian Strategy on HIV/AIDS.

Role of the Ministerial Council
The Council has been a strong advocate of Aboriginal issues. The Council has had a Special Working Group on Aboriginal Issues since the establishment of the Council. The Council's Situational Analysis report on Aboriginal issues is a widely-used foundation document. Through its members, the Council is linked to the new National Aboriginal Council on HIV/AIDS and to other Aboriginal groups and processes.

Work Done During 2001-2002

• The Ministerial Council monitored the work of Health Canada's First Nations and Inuit Health Branch (FNIHB) with respect to HIV. The Council's Special Working Group on Aboriginal Issues played an ongoing active role in this respect. Council raised issues with Health Canada about the need for greater integration of the work of FNIHB and the Canadian Strategy on HIV/AIDS.
• The Council focused on questions of on- and off-reserve funding, accountability mechanisms, links to the Correctional Service of Canada, and the involvement of Aboriginal persons living with HIV/AIDS.
• The Council studied the issue of an Aboriginal AIDS Strategy on HIV/AIDS in Canada within the Canadian Strategy on HIV/AIDS.
• Through its Aboriginal members, the Council had links to the Aboriginal Summits on HIV/AIDS held during 2001/02 and to the new National Aboriginal Council on HIV/AIDS. The 1999 Ministerial Council study, Situational Analysis - A Background Paper on HIV/AIDS and Aboriginal People, was distributed at the Aboriginal summits.
• The Council studied the issue of Aboriginal research and was briefed on research programs developed by the Aboriginal community that build capacity in the community. The Council discussed the issue of how to provide ethics reviews for research when most review boards are not familiar with Aboriginal issues.
• The Council linked to the activities of the Aboriginal working group of the Federal/Provincial/Territorial-AIDS Committee.

Future Activities
The Council and its Special Working Group on Aboriginal Issues will continue to be actively involved in championing, monitoring and advising on Aboriginal issues.

6.3 Securing Resources and Sustaining a Structure to Fight the Epidemic

Overview
Funding levels for the Canadian Strategy on HIV/AIDS have not been increased significantly for almost a decade, despite an increase in the number of Canadians infected and the growing international epidemic. New populations have emerged which are marginalized, vulnerable and hard to reach. Compared to other countries such as Australia and the United Kingdom, which have also invested strategically in HIV/AIDS, Canada is falling behind.

6.3.1 Canadian Strategy on HIV/AIDS (CSHA) Direction Setting

The Issue
In October 2000, a representative group of stakeholders met with Health Canada at Gray Rocks in Quebec to identify broad strategic directions for the Canadian Strategy for HIV/AIDS (CSHA) for the following year. At this meeting, the group proposed 10 directions:

• Mobilize integrated action on HIV/AIDS
• Build unique approaches for Aboriginal Peoples within the CSHA
• Build a broad information strategy
• Get public commitment, political leadership and funding
• Build a strategic approach to prevention
• Build a strategic approach to care, treatment and support
• Renew and develop human resources
• Engage vulnerable Canadians
• Move to a social justice framework
• Develop a five-year operational/strategic plan

Three members of the Ministerial Council and the ex-officio Ministerial Council member from the Federal/Provincial/Territorial Committee on AIDS attended the Gray Rocks meeting.

The challenge since the Gray Rocks meeting has been to follow up and assist those working in the field of HIV/AIDS to implement the 10 directions and coordinate their work plans. A report prepared for Health Canada about the collaborative work planning process concluded that it is not possible to move forward with large-scale collaborative work planning at this time. A particular challenge in this respect is to ensure representation for vulnerable populations in these processes.

A second national direction-setting meeting will be held in April 2002 with the goals of updating partners on recent developments, furthering collaborative action on the implementation of the 10 directions and strengthening national collaborative planning capacity under the CSHA. The Ministerial Council has two representatives on the planning group for the April 2002 meeting.

 

Role of the Ministerial Council
In its roles of monitoring and evaluating, championing issues and providing long-term guidance, the Ministerial Council took an active interest in follow-up activity by Health Canada after the October 2000 meeting. The Council encouraged Health Canada to build on the enthusiasm generated at the meeting by implementing the follow-up recommendations from the meeting and convening a work planning meeting for stakeholders.

The Ministerial Council delegated two members to sit on the task group that is planning the second direction-setting meeting in April 2002. A third member of the Council sits on the task group representing Aboriginal organizations.

Work Done During 2001-2002

• The Council monitored progress on the follow-up to the 2000 direction-setting meeting and actively encouraged Health Canada to implement its commitments for action made at that meeting, particularly with respect to national collaborative work planning.
• The Council expressed its concern to the Minister of Health about delays in following up on the commitments made by Health Canada at 2000 direction-setting meeting. The Council advised the Minister to encourage his officials to convene a follow-up stakeholder work planning meeting.
• The Council was fully briefed on planning for the April 2002 direction-setting meeting and provided advice to the planners. As the process of planning this meeting evolved, the Council named two members (a Co-Chair and the Chair of the Monitoring & Evaluation Committee) to sit on the planning committee.
  

Future Activities
The Ministerial Council will be actively involved in the April 2002 direction-setting meeting and will monitor the implementation of decisions made at that meeting.

6.3.2 Social Justice Framework and Population Health

The Issue
A social justice framework for dealing with HIV/AIDS addresses the social, economic and political factors that worsen the epidemic, such as gender-based inequalities, poverty, discrimination, social conditions and legal and government policy. It looks at the range of social determinants and their impact on health and recognizes that protecting, promoting and fulfilling human rights is fundamental to realizing social justice. Moving to a social justice framework was one of the 10 Directions set for the Canadian Strategy on HIV/AIDS at the Gray Rocks stakeholders' meeting in 2000. This direction will be developed further at the April 2002 stakeholders' meeting.

The development of a social justice framework based on human rights concepts and principles, and linked to the determinants of health, builds on the work of HIV/AIDS pioneer Dr. Jonathan Mann. Human rights and social justice have increasingly been identified as key determinants of health by stakeholders during recent years. Support for this approach derives also from international human rights law, such as the positions declared at the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) in June 2001 (see section 6.5.2).

Social injustices that affect Aboriginal peoples and communities need to be included in a social justice framework for dealing with HIV/AIDS.

Role of the Ministerial Council
The Council supports the development of a social justice framework and studied the issue during the year.

Work Done During 2001-2002

• The Council commissioned a study on the determinants of health in collaboration with the Federal/Provincial/Territorial Committee on AIDS. The Council intends to link this paper to the work on the development of a social justice framework and work on intergovernmental collaboration. The report will be available in April 2002. The Council considered a proposal from FPT-AIDS that the two groups jointly sponsor a think tank on the findings of the paper to help in finding methods of overcoming barriers to inter-governmental collaboration.
• The Council received a briefing and had input on issues to be considered in developing the social justice framework, including the development of a discussion paper for the April 2002 direction-setting meeting. Among the many issues they discussed was the need to incorporate Aboriginal thinking, acknowledging that much wisdom is contained in the oral tradition. The Council also stressed to Health Canada that the framework must incorporate legal and social considerations, as well as an international perspective.
• The Council participated in planning for the national stakeholders' meeting in April 2002 where work will be done on the development of a social justice framework.
• The Council encouraged Health Canada to create a think tank to advise on the development of the social justice framework.

Future Activities
The Council will participate actively in the development of the social justice framework at the April 2002 stakeholders' meeting and will continue to monitor its development during the coming year.

 

6.3.3 CSHA Funding Adequacy

The Issue
Funding levels for the Canadian Strategy on HIV/AIDS (CSHA) have not increased since 1994, when they were set at $42.2 million. In the early 1990s, 30,000 Canadians were living with HIV; today that number is more than 50,000. Inflation has eroded the $42.2 million to $34 million in 1991 dollars. Funding levels were originally set in times of annual federal deficits, whereas we are now in a time of budget surpluses. The challenge is to determine adequate levels of funding and secure that funding. During the year, the previous Minister of Health informed the Council that he intended to seek support from Cabinet for increased funding for the Strategy. Action on this has been postponed because of the appointment of a new Minister of Health in January 2002.

Role of the Ministerial Council
The Ministerial Council's role is to monitor and evaluate the implementation of the CSHA, including reviewing and recommending financial allocations under the CSHA, and monitoring and advising the Minister on CSHA evaluations to ensure that the needs of stakeholders are being met. The Council's Monitoring & Evaluation Committee assumes primary responsibility for this and reports to the Council.

In 2001, the Ministerial Council commissioned a study on the adequacy of federal funding for the CSHA, which found that the present funding level is inadequate. The study recommended that clear objectives be set for the CSHA and that new, adequate funding levels be determined based on these objectives. The study, Taking Stock: Assessing the Adequacy of the Government of Canada Investment in the Canadian Strategy on HIVAIDS, is available on the Ministerial Council's web site.

The Ministerial Council advises the Minister and Health Canada officials on reallocation of surplus funds or deficits in each year, and on overall funding levels for the CSHA. For example, in 1998/99, the Council's advice led to Health Canada safeguarding $1.8 million in research funds. The Council's position has consistently been that more funds are needed for the Strategy.

Work Done During 2001-2002
The Ministerial Council gave advice to the Minister of Health advocating increased funding for the CSHA to a level of $85 million a year. The Council's arguments focused on:

• increased number of Canadian infected and affected by HIV
• erosion due to inflation
• the more diverse populations affected that require new approaches and investments, particularly if the determinants of health that lead to HIV infection are addressed
• the needs of Aboriginal communities
• Canada's poor performance relative to Australia and the United Kingdom
• improved surveillance
• the need for stability of community-based organizations
• economic arguments for the cost benefits of investment in HIV prevention: reducing HIV infections from the present level of 4,200 a year to 1,700 a year could save Canada $4 billion over the next five years.

Future Activities
The Council will continue to monitor funding levels for the CSHA and advocate increased funding. This issue will be raised with the new Minister of Health.

6.3.4 CSHA Evaluation

The Issue
An annual accountability report on the Canadian Strategy on HIV/AIDS is produced by Health Canada and released by the Minister of Health on World AIDS Day (December 1). In 2001-02, a Year Three evaluation of the CSHA commissioned by Health Canada was amalgamated with the annual report and planning was begun for a Year Five evaluation. The Year Three evaluation looks at the overall effectiveness of the Strategy and does not review individual components of the Strategy. The Correctional Service of Canada also participated in the Year Three Evaluation.

Role of the Ministerial Council
In its monitoring and evaluation role, the Council participates in all CSHA evaluations. Its particular role is to monitor and advise on CSHA evaluations to ensure that the needs of stakeholders are being met.

Work Done During 2001-2002

• The Council's Monitoring & Evaluation Committee and its Communications Committee participated actively in the annual report/Year Three evaluation process.
• The Council continued its study and implementation of recommendations from the evaluation report on the Ministerial Council done in the previous year.
  

Future Activities
Members of the Council will play an active advisory role with respect to evaluation of the Strategy, working with Health Canada.

 

6.3.5 CSHA Resource Allocation

The Issue
Resources are allocated at fixed levels to specific components of the Canadian Strategy on HIV/AIDS, based on the recommendations of a National Stakeholder Group in 1997. Health Canada reports annually to the Treasury Board and has created a process for reviewing Strategy allocations as part of its accountability framework. Ongoing work is needed to assess whether the allocations established in 1998 are still relevant and whether reallocation is needed to existing or newly-created components of the Strategy.

The Council's role is to monitor and evaluate the implementation of the Canadian Strategy on HIV/AIDS and to support its effectiveness and its flexibility to meet changing circumstances. As part of this role, the Council reviews existing allocations and recommends financial allocations under the Strategy. The Council has collaborated with Health Canada on the development of a Quick Response Reallocation Mechanism (QRRM) for dealing with potential surpluses within a fiscal year. The QRRM reallocates funds in four stages:

• redirect funds in line with their intended use
• redirect funds in line with their intended client group
• redirect funds to address pressures
• redirect funds to enhance other HIV/AIDS-specific activities in Health Canada

The Council's Monitoring & Evaluation Committee is particularly active in this respect, bringing its perspective and recommendations to the entire Council for decisions.

The Council advises the Minister and works closely with Health Canada to ensure that allocations meet the needs of the Strategy and the stakeholders

Work Done During 2001-2002

• The Council played a major role in the development of a report on the Resource Allocation Framework that will be ready in early in the fiscal year 2002-2003. The Council had membership on a task group advising on the development of the refined allocation framework.
• The Council expressed particular concern about the possibility of some funds remaining unspent in the prevention, care and treatment program, given the great needs in that area.
  

Future Activities
The Council will be active in developing the Resource Allocation Framework, the Year Five evaluation of the Canadian Strategy on HIV/AIDS, and the CSHA Annual Report.

6.3.6 Research

The Issue
Research is a major component of the Canadian Strategy on HIV/AIDS, with more than 30% of the Strategy funds being dedicated to research. Research is conducted in bio-psycho-social fields in the effort to find effective prevention and treatment for the diverse populations infected and affected by HIV.

The Strategy supports community-based research and an Aboriginal Community-Based Research Program. Both the community-based program and the Aboriginal Community-Based Research Program have a capacity-building component to enhance the ability of communities to engage in research. At issue during the past year was the need to find a home for both the community-based research program and the Aboriginal research program, which were formerly included in the National Health Research Development Program (NHRDP) which ended in March 2001. Community stakeholders have voiced concerns over the amount of paperwork required when applying for community-based research grants, as well as issues such as the lack of access to ethics review boards and liability insurance for community-based research projects.

A further issue is the integration of HIV research into the structure of the Canadian Institutes of Health Research (CIHR).

An ongoing issue for all types of research is the translation of research findings to those working on the front line.

The continuing emergence of antiretroviral-resistant strains of HIV and the need to find new therapies to counteract resistance are ongoing issues.

Role of the Ministerial Council
The Council plays both a monitoring and championing role with respect to research issues. During the year, the Council struck a new committee on research.

Work Done During 2001-2002

• The Council stuck a permanent Research Committee. In the past, research issues were followed by the Championing Committee.
• Some Council members participated in steering groups involved in initiating a study of options for relocation of the community-based research program and studied this report when it was completed in the spring of 2002.
• The Council studied the issue of community-based research and support for Aboriginal research and made recommendations to Health Canada for making these programs more effective within a reasonable time.
• The Council urged Health Canada to put processes in place that would make completed research results available to the community.
• The Council invited Dr. Alan Bernstein, President of the Canadian Institutes of Health Research (CIHR), to make a presentation about CIHR and the place of HIV research within CIHR. Following this presentation, the Council advised the Minister of Health that an Office of HIV/AIDS Research is needed as a coordinating body within CIHR to work across all Institutes. The Council advised the Minister that the present arrangement of housing HIV solely within the CIHR Institute of Infection and Immunity would hamper the effective coordination of HIV research. The Council offered to meet with officials from CIHR to discuss the establishment of an Office of HIV/AIDS Research or the creation of a National HIV/AIDS Research Advisory Partnership and asked the Minister to facilitate such a meeting. The Council also wrote to Dr. Bernstein about the establishment of an HIV Office within CIHR.
• The Council brought to the Minister's attention its concerns about CIHR's roles in vaccine research, research coordination and consultation with stakeholders.
• The Council studied the question of whether the HIV Clinical Trials Network, now housed within CIHR, would be run in accordance with the funding guidelines of the Canadian Strategy on HIV/AIDS.
• The Council advised the Minister that CIHR would not be an appropriate home for community-based HIV research because CIHR does not have an affinity for the community-based approach.
• The Council requested a second meeting with Dr. Bernstein, which is scheduled for April 2002.
• The Council was briefed on the emergence of HIV strains that are multi-drug-resistant. The Council linked with the work of the Federal/Provincial/Territorial Committee on AIDS in this regard and with the work of the new Health Canada HIV Strain and Drug Resistance Surveillance Program. The Council expressed concern to Health Canada about releasing a public paper on this issue for World AIDS Day 2001 because it thought that further work was required before a public position could be taken.
  

Future Activities
The Council will continue to be active in the issues of community-based research and Aboriginal research, the creation of suitable research infrastructures at CIHR, and emerging areas of research.

 

6.3.7 Health Care Reform

The Issue
During the past two years, there have been a number of health care reform reports commissioned by the provinces. In addition, the Senate of Canada has an active commission on health reform (the Kirby Commission) and the federal government in April 2001 created a Commission on the Future of Canada's Health Care System (the Romanow Commission) to report in late 2002. The Romanow Commission is holding extensive public hearings across Canada. At issue is the future of public health care in Canada, and specifically the Canada Health Act. The public health system is a vital support for all Canadians, and particularly for vulnerable populations and people living with HIV/AIDS.

Role of the Ministerial Council
The Council plays the role of champion in ensuring that current and emerging issues are being adequately addressed. It also has a role of being visionary in providing long-term directions and anticipating the consequences of existing trends and policies. The Council accordingly takes an active interest in the debate about health care reform in Canada.

Work Done During 2001-2002

• The Council took an active interest in the implications of the provincial health reform reports, the Kirby Commission reports, and in the briefs submitted by stakeholder groups to the Romanow Commission. The Council considered whether to submit a brief to the Romanow Commission.
• The Council had a preliminary discussion about the new Minister of Health's position on a possible policing mechanism to ensure that the provinces respect the Canada Health Act.
  

Future Activities
The Council will continue to follow closely the health reform debate in Canada and will provide advice to the Minister of Health, particularly in response to the recommendations of the Romanow Commission.

6.3.8 Drug Review Process

The Issue
Health Canada is responsible for the review for approval of sale of new drugs and for the post-approval surveillance of drugs. The HIV/AIDS community has consistently pressed for a more efficient review and approval process, and for more extensive post-approval surveillance of drugs. A current issue is the possibility of the disbanding of the Advisory Panel on Product Licensing Process, which is a stakeholder panel advising Health Canada's Therapeutic Products Division.

Role of the Ministerial Council
As part of its championing role, the Council has been a strong advocate for more effective drug review and approval. As a result of its recommendation to the Minister of Health in 1998, a Therapeutic Products Program Working Group on HIV/AIDS was formed. This group made 29 recommendations, many of which could be extended to diseases other than HIV/AIDS. As a result, an Advisory Panel on Product Licensing Process was established with a mandate to include HIV and other diseases.

A member of the Ministerial Council sat as an observer on the Therapeutic Products Program Working Group and on the Therapeutic Products Directorate Advisory Panel on the Product Licensing Process.

The Minister of Health solicited the Council's help in keeping the drug review process effective.

Work Done During 2001-2002

• The Council strongly advised the Minister to ensure that the Advisory Panel not be disbanded, as appeared to be a strong possibility. The Council's Championing Committee kept a close watch on this issue because of concerns that the drug review process and the Advisory Panel may not be effective.
• The Council had a briefing on the new Canadian plan to improve pharmaceuticals management, which involves a single, common review process for coverage of new drugs and reimbursement. The Council monitored the development of this process through its links to FPT-AIDS.

Future Activities
The Council will raise its ongoing concerns with the new Minister of Health.

 

6.4 Supporting the Development of Critical Initiatives

Overview
As part of its role of championing existing and emerging issues, the Ministerial Council uses its collective expertise and experience and requests regular briefings on critical issues and initiatives in order to give the Minister of Health the best possible advice. The Council works concurrently on a number of critical issues. Those described below were the subject of particularly intensive work in 2001-2002.

6.4.1 Vaccines and Microbicides

The Issue
The hope for a cure for HIV/AIDS has been present since early in the epidemic. Two of the goals of the Canadian Strategy on HIV/AIDS are: find a cure; and find and provide effective vaccines, drugs and therapies. Research is ongoing to find both a curative and a preventive vaccine. A preventive vaccine is currently in clinical trials. Canada is part of this international effort.

Microbicides are also an active focus of research. Microbicides are substances that can substantially reduce the transmission of sexually transmitted infections when applied either in the vagina or rectum.

Role of the Ministerial Council
The Council champions the development of vaccines and prevention agents as an ongoing issue.

Work Done During 2001-2002

• The Council was briefed by two participants in the vaccine clinical trials taking place in Canada. The Issues raised in this meeting included: concerns about under-recruitment of a diverse population, including women, for the trials; education about the nature of vaccines; informed consent; and delivery of vaccines.
• The Council's Championing Committee studied the issue of vaccines in Canada and internationally. The Committee heard from experts working in Canada and requested information from the Canadian International Development Agency (CIDA). The Committee also received information regarding the outcomes of a multi-stakeholder dialogue held in November 2001, and has been tasked with putting together draft recommendations for the Council's consideration.
• The Championing Committee looked at the issue of microbicides and studied Canadian research on a microbicide-bearing "invisible condom" for women.
  

Future Activities

• The Council's Championing Committee will examine the question of whether a national strategy is needed to address the issues raised by vaccine trials and delivery.
• The Council will review a new report from the Canadian HIV/AIDS Legal Network on vaccines and will study the results of an international meeting on vaccines to be held in Montreal in April 2002.
• The Championing Committee will analyze the issue of microbicides and report back to the Council.

6.4.2 Medicinal Use of Marijuana

The Issue
Marijuana has been recognized as a useful therapy for some persons living with HIV/AIDS, although formal research data are scarce. Clinical trials are currently underway in Canada. Under present regulations, only HIV specialists may prescribe marijuana, whereas the majority of HIV-positive patients are cared for by primary care physicians. Professional medical bodies have advised physicians not to put themselves at risk for prosecution by prescribing marijuana. This reduces access to medical marijuana by persons living with HIV/AIDS.

Role of the Ministerial Council
The Council studied this issue in its role as a champion of emerging issues.

Work Done During 2001-2002
The Council wrote to the new Minister of Health urging her to grant exemptions to primary care physicians so that they can prescribe marijuana in appropriate circumstances and not be liable to legal prosecution.

Future Activities
The Council will continue to monitor this issue and raise it with the new Minister.

 

6.5 Preparing Canada's International Response

Overview
HIV/AIDS is a global issue, with more than 40 million people infected worldwide and an infection rate of five million people a year. The Canadian Strategy on HIV/AIDS has a component of international collaboration, with a budget of $300,000, focused on information sharing and coordination of Canada's international activities, housed within Health Canada. In addition, the Canadian International Development Agency (CIDA) spends more than $50 million a year on international HIV/AIDS programs.

In addition to the issues detailed below, of active interest this year were the World Trade Organization's (WTO) discussions on intellectual property and the question of mechanisms to ensure that developing countries can access affordable HIV/AIDS treatments. Also of interest was the creation of a new Global Fund to fight AIDS, TB and Malaria, and Canada's contribution to that Fund. The Council has monitored these issues and the work that stakeholders in Canada have done to address them.

Canada has taken a leadership role with the international community on issues involving Africa. The Ministerial Council on HIV/AIDS invited the Prime Minister's personal representative for Africa and for the 2002 G8 Summit (where the issue of partnerships and action for Africa's development will be a key focus) to attend a Council meeting; this invitation was declined.

The XIV International AIDS Conference will be held in Barcelona in 2002. The Council will be monitoring Canada's involvement.

6.5.1 World AIDS Day

The Issue
World AIDS Day, December 1, has been the annual global observance of HIV/AIDS since it was declared by the United Nations in 1988. World AIDS Day 2001 was the 20th anniversary of the first reported case of AIDS in North America. The theme chosen by the United Nations for World AIDS Day 2001 was "I care...Do you?" which was intended to focus on young men while allowing other issues to be included. The communications activities associated with World AIDS Day are an opportunity to draw public attention to key areas where efforts need to be strengthened. December 1 is also Aboriginal AIDS Awareness Day in Canada.

Role of the Ministerial Council
The Council helps the Minister to develop the key messages for his/her World AIDS Day speech and for the Annual Report on the Canadian Strategy on HIV/AIDS, released on December 1 each year. The Council also helps the Minister to plan appropriate activities for World AIDS Day. A member of the Council sat on the editorial board for the 2001 World AIDS Day report.

Work Done During 2001-2002

• The Council advised the Minister on his messages, stressing that the message of success must be balanced by a sober acknowledgement of the need to face current realities about the active epidemic in Canada. The Minister's World AIDS Day report cited some successes and called for renewed commitment.
• The Council expressed disappointment before and after December 1 at the lack of a strong message and a high-profile activity by the Minister on that day.
  

Future Activities
The Council will continue to advise the Minister and Health Canada staff about the messages and activities planned for World AIDS Day and for the Annual Report released on that day.

6.5.2 United Nations General Assembly Special Session on HIV/AIDS - UNGASS

The Issue
In June 2001, the United Nations held a General Assembly Special Session on HIV/AIDS (UNGASS). During the Session, a Declaration of Commitment was made to help set the direction for the global response to HIV/AIDS for the next decade. A global fund was also announced (see 6.5.3). The issues raised in connection with UNGASS included:

• involvement of community representatives (civil society) in UNGASS
• representation at the highest political level, the Prime Minister, on the Canadian delegation
• the size of Canada's contribution to the global fund to combat HIV/AIDS
• Canadian follow-up on the commitments it made at UNGASS
  

Role of the Ministerial Council
The Council acted as a champion and advocate with the Minister for the issues listed above.

Work Done During 2001-2002

• Before UNGASS, the Council advised the Minister to ensure that the Canadian delegation included community representatives.
• The Council wrote to the Prime Minister urging him to lead the Canadian delegation to UNGASS and to announce a sizeable contribution the Global Fund to Fight AIDS. The Prime Minister replied that he would be unable to lead the delegation. Canada's Minister for International Cooperation attended as head of Canada's delegation.
• Some Council members attended UNGASS, one as an official member of the Canadian delegation, and others as community representatives.
• After UNGASS, the Council wrote to the Minister expressing disappointment at Canada's small financial contribution to the Global Fund.
• The Council received an initial presentation on the UNGASS Declaration and the areas in which action by Canada is, or may be, needed to fulfill its commitments in the Declaration. It had a preliminary discussion of how the Council could play a role in helping Canada to achieve the targets set out in the UNGASS Declaration.
• The Council recommended to the Minister of Health that he communicate with his colleagues involved in UNGASS to determine the Canadian mechanism for reporting back on progress made in fulfilling commitments. The Council offered the Minister its assistance in this regard.

Future Activities
The Council's Championing Committee will review the UNGASS declaration and recommend action to the Council. The Council will continue to monitor Canada's follow-up to UNGASS and will raise its concerns with the new Minister of Health.

6.5.3 Global Fund to fight AIDS, TB and Malaria

The Issue
The Global Fund to Fight AIDS, Tuberculosis and Malaria was announced by the United Nations Secretary General in April 2001. The need was estimated, and the United Nations Secretary General called for, contributions of US$7-10 billion per year. Canada announced a contribution of CDN$150 million over a four-year period to the Global Fund during the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) meeting in June 2001.

Role of the Ministerial Council
The Council's role as champion is to advise the Minister about the course that Canada should take with respect to the Global Fund.

Work Done During 2001-2002
Following UNGASS and Canada's announcement of a CDN$150 million contribution over four years, the Council advised the Minister that Canada's contribution to the Global Fund was inadequate.

Future Activities
The Council will continue to monitor Canada's contribution to the Global Fund and will raise this issue with the new Minister.

 

7.0 Appendices

For further information, please see the following appendices:
Appendix 1 Terms of Reference for the Ministerial Council on HIV/AIDS
Appendix 2 List of Ministerial Council members with brief biographies
Appendix 3 Contact information for the Ministerial Council on HIV/AIDS
Appendix 4 Date and location of Ministerial Council meetings in 2001-2002 including the presenters at each meeting

Appendix 1: Terms of Reference for the Ministerial Council on HIV/AIDS

Mandate: To provide advice to the Minister of Health on pan-Canadian aspects of HIV/AIDS

Role:
1. To monitor and evaluate the implementation of the Canadian Strategy on HIV/AIDS and to support its effectiveness and its flexibility to meet changing circumstances.
2. To be a champion to ensure that current and emerging issues are being adequately addressed.
3. To be visionary in providing long-term directions.

Reporting and Scope:

The Ministerial Council on HIV/AIDS will provide independent advice to the Minister of Health on pan-Canadian aspects of HIV/AIDS, and will report to the Minister annually. Meeting minutes, recommendations and other materials produced by the Council will be available to the general public.

The Minister will meet at least once a year with the Council and review its recommendations, and every December 1st, the Minister will announce what progress has been made towards achieving the goals of the Canadian Strategy on HIV/AIDS. The Council has no decision-making authority over operational or regulatory functions or programs, nor will it be responsible for the implementation of its advice.

Membership

Appointments and Structure
The Minister of Health will appoint a maximum of 15 members to the Ministerial Council on HIV/AIDS. A minimum of five (5) seats will be held by people living with HIV/AIDS, and consideration will be given to ethnocultural diversity, gender and regional balance on the Council.

From among Council members, the Minister will appoint Co-Chairs, one of whom will be a person living with HIV/AIDS. To help ensure that the Council influences a truly integrated approach that cuts across lines of government, the provincial Co-Chair of the FPT Advisory Committee on AIDS will hold an ex officio position on the Council. In order to provide technical advice and to facilitate coordination, one or more officials from Health Canada may hold ex officio positions. Federal and provincial government observers may attend meetings as required.

The membership structure of the Council will provide five (5) seats for professional/technical experts to be drawn from the following areas: the private sector; biomedical research; clinical trials; psycho-social research; and medicine (education, primary care physicians/nurses, regional/public health). The balance of the voting membership (10 seats) will be drawn from national HIV/AIDS organizations, community organizations and front-line workers. These members should have expertise in treatment issues, ethics/law/human rights and/or international issues, knowledge and experience with one or more groups at risk of HIV/AIDS.

Member Selection
In selecting members, consideration will be given primarily to: individual expertise in a number of issues that reflect the diverse realities of HIV/AIDS in Canada and, in particular, knowledge and front-line experience concerning emerging at-risk groups; and the need for an overall balance of expertise on the Council.

Accountability
Although Council members will be expected to conduct themselves as individual experts, affiliation with a national stakeholder organization, community organization, business, or institution with HIV/AIDS activities will enable a strong link for policy and advice based on direct experience from those infected and affected, including those potentially at risk, as well as those working in the field. Many emerging at-risk groups, however, have neither a community identity nor a national voice. For this reason, it is essential that experts, lacking an affiliation with a recognized HIV/AIDS organization, not be excluded from the Council. Members should bear responsibility for the needs of the plurality of individuals, communities, organizations, and sectors infected and affected by HIV/AIDS, while rising above any corporate interest of an organization with which they might be affiliated.

Term of Appointment
Members will be appointed by the Minister of Health for such periods as the Minister may determine, but usually for terms of one to two years. Appointments will be scheduled to ensure continuity as well as systematic rotation of membership. At the expiration of that period, the appointment normally will end; however, the Minister may review the appointment when renewal is warranted by specific Council activities. After one year, and thereafter at the Minister's discretion, the mandate, terms of reference and membership of the Council will be reviewed and adjusted to respond to changing needs.

Committees and Working Groups
The Council may establish an executive committee, standing committees and working groups to assist it in its work. Standing committees and working groups must include at least one Council member, and they will report to the Co-Chairs of the Ministerial Council on HIV/AIDS.

Support
Health Canada will provide administrative and technical support to the Council.

Legal Consideration

Conflict of Interest
Council members, who are also a member of any HIV/AIDS organization in receipt of government contributions, would find themselves in a conflict of interest situation if they were to influence the Council in a way that would benefit that member's organization.

While it is acceptable that a Council member be affiliated in some fashion with an HIV/AIDS organization, that individual must conduct him/herself as an independent expert and comply with Health Canada guidelines on conflict of interest.

Responsibilities

Members
1. adhere to the Goals and Principles of the Canadian Strategy on HIV/AIDS
2. work positively, co-operatively and respectfully with other Council members, observers and secretariat staff
3. respect and support Council decisions once these have been reached
4. in order to provide a direct link between the Council and working groups or standing committees, be prepared to serve on at least one committee or working group
5. abide by Health Canada conflict-of-interest guidelines
6. exercise and encourage frugality in all Council activities (meeting venues, accommodation, transportation, publications, etc.).

Council
1. adhere to the Goals and Principles of the Canadian Strategy on HIV/AIDS
2. review the reporting/evaluation framework and all external evaluations of the Strategy
3. encourage open and forthright examination of all issues and, when considering conflicts between particular interests, act in the greater interest of all infected, affected and at-risk Canadians
4. mediate and strive for consensus when addressing emerging issues that call for a shift in limited resources
5. assess whether potential Council activities might duplicate or be more effectively or efficiently handled by other HIV/AIDS organizations or agencies
6. annually establish Council objectives, work plan and timetable
7. annually evaluate Council performance against work plan objectives.

Health Canada
1. adhere to the Goals and Principles of the Canadian Strategy on HIV/AIDS
2. collaborate with the Council in an open and transparent manner
3. upon request by the Council, provide timely access to all available public documentation related to Strategy activities and budgets.

 

Appendix 2: Members of the Ministerial Council on HIV/AIDS

CO-CHAIRS

Louise Binder
Ms. Binder, a retired lawyer, is Chair of the Canadian Treatment Advocates Council, Chair of Voices of Positive Women, a member of the University of Toronto's HIV/AIDS Human Subjects Review Committee, and a former board member of the HIV/AIDS Legal Clinic Ontario. She was also the recipient of the YWCA of Metropolitan Toronto's 1999 Women of Distinction award for social action. Ms. Binder received an honorary Doctorate of Laws from Queens University in October 2001.

Donald Kilby
Dr. Kilby is a practising family physician and Director of Health Services at the University of Ottawa, where he cares for approximately 400 HIV-infected patients. He helped establish the OASIS program, which supports innovative harm reduction models for street-involved and injection-drug-using communities in downtown Ottawa. Dr. Kilby is Co-chair of the Ontario Advisory Committee on HIV/AIDS and has chaired the Ottawa-Carleton Council on AIDS. In 1987, he received the American Medical Writers award for his Manual of Safe Sex, which has since been translated into French and Spanish. Dr. Kilby also chairs the HIV Information Infrastructure Project Advisory Committee of the Ontario HIV Treatment Network.

MEMBERS

Richard Elliott
Richard Elliott is a lawyer formerly in private practice and currently the Director, Policy & Research with the Canadian HIV/AIDS Legal Network, a non-governmental organization working on HIV/AIDS and human rights partnered with the AIDS Law Project, South Africa. He is the author of numerous papers and articles on legal and human rights issues relating to HIV/AIDS, and has presented to community groups, and national and international conferences. He has previously served on the boards of the Legal Network, the HIV/AIDS Legal Clinic Ontario (HALCO), the Prisoners with HIV/AIDS Action & Support Network (PASAN), and has previously coordinated legal aid services to low-income people living with HIV/AIDS with the Community & Legal Aid Services Programme (CLASP) student legal aid society.

Dionne A. Falconer
Ms. Falconer has extensive knowledge of HIV/AIDS issues as she has been involved with community-based AIDS service organizations since the late 1980s. She is currently the Managing Director of her own consulting firm in Toronto and is the former Executive Director of the Black Coalition for AIDS Prevention. Ms. Falconer is a past Board member of the Ontario AIDS Network and the Canadian AIDS Society. She is presently a member of the Board of Directors for the Interagency Coalition on AIDS and Development (ICAD). She holds a Master of Health Science (M.H.Sc) degree in Health Administration.

Sholom Glouberman
Sholom Glouberman is Philosopher in Residence at Baycrest Centre for Geriatric Care, Associate Scientist at the Kunin-Lunenfeld Applied Research Unit and Adjunct Assistant Professor at the University of Toronto. For the last three years he was Director of the Health Network of the Canadian Policy Research Networks (CPRN). He has a BA from McGill and a Ph.D. in Philosophy from Cornell University. For the past 25 years he has applied philosophical methods and conceptual analysis to organizations and systems. In recent years, he has focused increasingly on the notoriously intractable area of health and health care as the single most challenging and little-charted frontier. Sholom has recently completed two major papers: a major policy research effort Towards a New Perspective on Health Policy which traces the trajectory of health policy from its beginnings into the next twenty-five years and a framework for health organizations and systems. Both are available on his web site www.healthandeverything.org.

Jennifer Hebert
Ms. Hebert brings extensive experience at the community level to the Ministerial Council. This experience includes volunteering with a buddy match program for PHAs (Person Living with HIV/AIDS), PHA community development, and front line/direct service with the Calgary Birth Control Association. Ms Hebert's roles with AIDS Calgary Awareness Association have ranged from volunteering with the Speaker's Network, membership on the Board of Directors and recently as staff doing support/outreach with street involved populations. Ms Hebert has also been involved in provincial HIV/AIDS programming as a member of the Alberta Community HIV Fund Consortium. Currently she works at the Calgary Birth Control Association as a counsellor.

Richard Jenkins
Mr. Richard Jenkins is a two-spirited Cree-Métis from Moose Mountain, Alberta and is currently the Director of Marketing and Health Promotions at the Nechi Training, Research and Health Promotions Institute. Richard is HIV- positive and has been since 1991; however this has not slowed him down in his efforts to address social and health issues in Aboriginal communities. He is a past member of the committee responsible for developing the Ontario Aboriginal (off-reserve) HIV/AIDS Strategy, was a member of the National Aboriginal Reference Group on HIV/AIDS and a member of the Aboriginal Interim Working Group on HIV/AIDS. Recently, he participated in the planning committee for the 2nd Alberta Aboriginal Conference on HIV and now is a volunteer member of the Alberta Community HIV Funding Consortium.

René Lavoie
Mr. Lavoie is the Executive Director of Séro-Zéro, a community-based HIV/AIDS prevention organization for gay men in Montreal. He is a co-researcher for the Omega Cohort Study and a study on "Young Men Living in Poverty". René is a long time gay activist and founder of a number of programs for gay men. He was also a member of the National Reference Group on Gay Men sponsored by Health Canada.

Rick Marchand
Dr. Marchand holds a Ph.D. in Adult Education from the University of Toronto. He is actively involved in developing community-based research strategies and policy for HIV prevention and health promotion. Dr. Marchand has extensive front-line experience in community-based organizations, including nine years with AIDS Vancouver and more recently with the Community Based Research Centre. He is co-author of Taking Care of Each Other: Field Guide -- Community HIV Health Promotion -- Theory, Method, Practice.

Gerry McConnery
Gerry McConnery is an active front line volunteer worker in Alberta. He has been the co-chair of the Alberta Positive Network since 1999 and works closely with the Alberta Community Council on HIV. He has five years of experience as an HIV Peer Support Worker and is active in the AIDS Calgary Speakers Network. He also provides advocacy around blood work in rural southern Alberta. Gerry McConnery's experience covers a wide spectrum of HIV/AIDS issues because of his education and prevention experience and the fact that he is living with AIDS. He sits on the AIDS Calgary Board of Directors and on the Canadian AIDS Society Board of Directors. Gerry McConnery is easily able to translate his local and provincial experiences to the national level.

Michael V. O'Shaughnessy, PhD.
Dr. M.V. O'Shaughnessy is the Centre Director of the B.C. Centre for Excellence in HIV/AIDS. Dr. O'Shaughnessy is also a Co-Director of the Canadian HIV Trials Network, was a member of the Health Research & Evaluation Advisory Committee for the Vancouver/Richmond Health Board, was the chair of the National Advisory Committee on AIDS, chaired a joint Research Gant Review Committee of NHRDP and MRC for six years and is past-president of the Canadian Association of HIV Research.
He is the Vice-President, Research for Providence Health Care and Assistant Dean of Research, Faculty of Medicine, University of British Columbia. Dr. O'Shaughnessy was awarded the Order of British Columbia in June, 1998. Dr. O'Shaughnessy received his PhD in Microbiology and Immunology from Dalhousie University.

Lindy Samson
Dr. Samson is a pediatric infectious disease specialist and HIV physician at the Children's Hospital of Eastern Ontario (CHEO) and assistant professor at he University of Ottawa. She is the director of the CHEO HIV clinic and is a strong advocate for both mother and child dealing with HIV infection. Dr. Samson has participated in studies and programs that have led to the early recognition of HIV in pregnancy and the peri-partum management of HIV to prevent infection of children. She is the chair-elect of the Canadian Pediatric AIDS Research Group.

Esther Tharao
Ms. Tharao is a graduate student in the University of Toronto's Department of Public Health Sciences, Social Science and Health Program. She also works on HIV issues with Women's Health in Women's Hands in Toronto. Ms. Tharao is considered one of Canada's primary voices on issues facing HIV-endemic countries and has spoken on this subject at many conferences. including this year's annual conference of the Canadian Association for HIV Research. Ms. Tharao is also a member of the Ontario Advisory Committee on HIV/AIDS and the HIV Endemic Task Force. She is Co-Investigator on two HIV studies: the Polaris Seroconversion Study and the East African HIV/AIDS Study at the University of Toronto.

Peter J. Zawadzki
Mr. Zawadzki is a consultant pharmacist who specializes in health promotion and education. He is the former Manager, Professional Services for AltiMed Pharmaceutical Company and was the Coordinator of Prescription Drug Plans for the Ontario Pharmacists' Association. Mr. Zawadzki, who is co-author of the book Mothers & Fathers: Health and Financial Advice to Share With Your Parents, lectures at the University of Toronto, Faculty of Pharmacy. He practises part-time in a community patient care setting in west Toronto and brings the perspectives of a health professional and community volunteer to the work of the Ministerial Council.

Art Zoccole
Mr. Zoccole is a two-spirited Anishnawbe (Ojibway) from Lac Des Mille Lacs First Nation in Ontario. He has been a community-based HIV/AIDS activist since 1989 and in 1994 coordinated the "Aboriginal Women and AIDS Forum," the "3rd Canadian Conference on HIV/AIDS," and related issues in Aboriginal communities. Considered one of Canada's leading voices on HIV/AIDS issues facing Aboriginal peoples, he was Coordinator of the B.C. Aboriginal HIV/AIDS Task Force from 1997-1999. Mr. Zoccole is the former coordinator of British Columbia's Red Road HIV/AIDS Network Society and is currently Executive Director of the Canadian Aboriginal AIDS Network.

 

Appendix 3: How to contact the Ministerial Council on HIV/AIDS

You may write to the Ministerial Council on HIV/AIDS at:

Ministerial Council on HIV/AIDS
c/o Secretariat
AL 1918B1, Jeanne Mance Building
Tunney's Pasture
Ottawa ON K1A 1B4

More about the Ministerial Council on HIV/AIDS.

Appendix 4: Date and Location of Ministerial Council meetings during 2001-2002

April 1-2, 2001 Toronto

Special Presentations:

1. Canada's Drug Strategy - Cathy Airth, Health Canada

2. HIV/AIDS and International Issues:
a. Reeta Bhatia, Health Canada, International Affairs Directorate
b. Michael O'Connor, Interagency Coalition on AIDS and Development
c. Christopher Armstrong, Canadian International Development Agency
d. Stefanie Beck, Department of Foreign Affairs and International Trade
e. Richard Burzynski, International Council of AIDS Service Organizations

June 17-18, 2001 Montreal

Special Presentation:

HIV/AIDS Aspects of First Nations and Inuit Health: Keith Conn, Health Canada, First Nations and Inuit Health Branch

September 8-10, 2001 Montreal

Meeting with the Honourable Allan Rock, Minister of Health

Special Presentations:

1. HIV/AIDS and Gay Men: Ron Clarke and Tony Caines, Co-Chairs of the National Reference Group on Gay Men.
2. Research:
a. Dr. Alan Bernstein, President, Canadian Institutes of Health Research (CIHR)
b. Dr. Bhagi Singh, Scientific Director, Institute of Infection and Immunity, CIHR

November 25-26, 2001 Toronto

Special Presentations:

1. Direction Setting for the Canadian Strategy on HIV/AIDS:
a. Steven Sternthal, Health Canada, HIV/AIDS Division, Monitoring, Evaluation and Operations Unit
b. Ross Hammond, Policy Analyst
2. Social Justice Framework
a. Michael Smith, Senior Policy Advisor
3. United Nations General Assembly Special Session on HIV/AIDS: Richard Elliott, member of the Ministerial Council on HIV/AIDS

March 8-9, 2002 Montreal

Special Presentations:

1. Immigration Regulations relative to testing for HIV: Dr. Brian Gushulak, Director General, Medical Services Branch, Citizenship and Immigration Canada.

2. Update on Direction Setting for the Canadian Strategy on HIV/AIDS: Steven Sternthal, Health Canada, HIV/AIDS Division, Monitoring, Evaluation and Operations Unit.