The Ministerial Council On HIV/AIDS

Annual Report 2002 - 2003

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 2002-2003

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 Populations from Endemic Countries (Africa and the 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 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) - Follow-up
6.5.3 Global Fund to fight AIDS, Tuberculosis and Malaria
6.5.4 Other International Issues

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 2002-2003

1.0 Message from the Co-Chairs

The Ministerial Council on HIV/AIDS is pleased to share with you the results of its work during 2002-2003 in this second Annual Report. This was a year of intense activity as you will see in the following pages.

The Canadian Strategy on HIV/AIDS has been in effect for five years. It is a good time to stop and take stock of our progress and to identify gaps and emerging needs. The Ministerial Council on HIV/AIDS has been active in the Five-Year Review of the Strategy and in the development of a pan-Canadian Strategic Plan for the next five years. This process involves a large community of stakeholders. We are optimistic that this work will help the Minister to build a strong case for increased funding for the Strategy.

The Ministerial Council on HIV/AIDS played a pivotal role in collaboration with other stakeholders in helping to raise the profile of HIV/AIDS research within the Canadian Institutes of Health Research (CIHR). A member of the Council will sit on the new HIV/AIDS Advisory Committee that will work to ensure that HIV/AIDS research benefits from an integrated approach involving all Institutes at CIHR. This year a new home for HIV/AIDS community-based research was created at CIHR. We hope that this program will flourish and we will monitor developments to ensure that the principles of community-based research are upheld.

In order to foster an effective pan-Canadian response to the epidemic, we placed a strong emphasis this year on inter-ministerial collaboration within the Government of Canada and on linkages with the Federal/Provincial/Territorial Advisory Committee on HIV/AIDS. The papers that we commissioned on inter-ministerial collaboration and on the determinants of health are important contributions to the process of developing more integrated working relationships. We also participated in the development of a social justice framework for the Canadian Strategy on HIV/AIDS which will require the partnership of all levels of government.

Canada works in partnership with many other countries to confront the global HIV/AIDS epidemic. The Ministerial Council therefore devoted particular attention this year to the ways in which Canada is honouring its commitments under the Declaration of Commitment developed at the United Nations General Assembly Special Session on HIV/AIDS in 2001. We have advised the Minister to encourage the federal government to increase its contribution to the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria. Our study of the impact of global trade agreements on health care has heightened our awareness of the interconnectedness of a variety of global initiatives. We believe that the work done by the Ministerial Council on HIV/AIDS on inter-ministerial collaboration, health determinants and social justice will contribute to Canada's ability to develop integrated policy approaches with other countries.

This year we have had the pleasure of advising and working with the Honourable Anne McLellan, Minister of Health. We are optimistic that her commitment to the issues raised by HIV/AIDS will encourage an increasingly effective response to HIV/AIDS in Canada and globally.

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

The first Canadian case of AIDS was identified in 1982. Since then, more than 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 guide the implementation of the 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 (CSHA) 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 (Dr. Bryce Larke) holds an ex-officio position on the Ministerial Council. The lead Assistant Deputy Minister for the Canadian Strategy on HIV/AIDS (J. Scott Broughton or his representative, Dr. Howard Njoo) 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 meets face-to-face three times a year. Between Council meetings the committees meet by teleconference. The Ministerial Council on HIV/AIDS has established the following standing committees:

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. It ensures that evaluation and resource allocation procedures within the Canadian Strategy on HIV/AIDS are adequate. The Executive Committee carries the responsibilities of evaluating the effectiveness of the Council and suggesting ways to improve the efficiency of the Council's work.

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 and Liaison Committee

The role of the Communications and Liaison Committee is to participate in the development and updating of communications tools such as the website and to oversee processes put in place to communicate with the Minister and a diverse group of stakeholders. Committee members provide advice to the Minister on specific occasions such as World AIDS Day. This committee assumes responsibility for guiding the strategic planning of the Council's own work.

Research Committee

The role of the Research Committee is to monitor research issues arising under the Canadian Strategy on HIV/AIDS and to develop recommendations for the Council's consideration.

During 2002-2003, the Council dissolved the following committees:
Monitoring and Evaluation Committee
The Monitoring and Evaluation Committee was dissolved because the Council considered that sound monitoring and evaluation procedures had been developed under the Canadian Strategy on HIV/AIDS. The ongoing role of monitoring and evaluation was assumed by the Executive Committee.
Special Working Group on Aboriginal Issues
This working group was dissolved because a new relationship between the Council and the National Aboriginal Council on HIV/AIDS is being developed to address Aboriginal issues.

Ad-hoc Visioning Committee
This committee successfully completed its task of guiding the development of a strategic plan for the Council.

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 requests during a yearly face-to-face meeting with Council members. 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.

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 committees of the Ministerial Council direct their energies. To guide them, the committees ask if the issue under consideration 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.

In its 2002-2003 workplan, the Council designated the following priority issues:

• • Canadian Strategy on HIV/AIDS: Directions; Review; Strategic Plan
• Social Justice Framework
• Resource allocation
• Determinants of health
• Inter-ministerial issues
• Immigration
• Correctional Service of Canada
• Bill C-217: compulsory testing
• Injection drug use (including addictions): research and policy
• Populations from HIV-endemic countries
• Women's issues
• Mother-to-child registry
• HIV testing in pregnancy
• Gay men's issues
• Aboriginal issues
• Canadian Institutes of Health Research
• Community-based research • Microbicides
• Vaccines
• Medical marijuana: research and policy
• Epidemiology and surveillance
• Health care reform
• Drug review process
• Co-infections: policy and research
• Public health measures and criminal law
• Sex workers: law; policy; and confidentiality
• Point-of-care testing
• HIV testing policy, including testing for immigration, rapid tests and testing in Aboriginal communities
• United Nations General Assembly Special Session on HIV/AIDS: follow-up
• International trade
• Global Fund to fight AIDS, Tuberculosis and Malaria
• Canadian International Development Agency: HIV/AIDS programs

6.0 Ministerial Council Areas of Work in 2002-2003

The following report provides details on major areas of work for the Ministerial Council in 2002-2003. In addition to the areas of work described, the Council also studied many ongoing and developing issues in order to remain informed and prepared to provide advice to the Minister of Health when necessary.

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 other federal ministries. In addition to Health Canada, the departments of Justice, Foreign Affairs and International Trade, International Cooperation, 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. In its meeting with Minister McLellan, the Council stressed the need for departments and agencies other than Health Canada to respond to the epidemic. Minister McLellan has reiterated her commitment to fostering interdepartmental collaboration and expressed the hope that some additional funds could be found to raise the profile of this collaborative work. The Minister has also made a commitment to go to Cabinet in the next year to seek its support for increased funding for the Canadian Strategy on HIV/AIDS.

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) Advisory Committee on HIV/AIDS (FPT-AIDS). The provincial co-chair of FPT-AIDS is an ex-officio member of the Ministerial Council. During 2002-2003, a representative of the Ministerial Council attended an FPT-AIDS consultation meeting on the issue of people who are unwilling or unable to disclose their HIV status and the impact of this on transmission.

This year the Ministerial Council decided to revisit the study Towards a Broader Vision of Health: Strengthening Inter-Ministerial Collaboration on HIV/AIDS in Canada that the Council commissioned in 2001, in order to ensure greater follow-up on the recommendations of the study. The Ministerial Council also finalized and published its paper HIV/AIDS and Health Determinants: Lessons for Coordinating Policy and Action, which is intended to guide interdepartmental collaboration. The paper was distributed to ministers of federal departments with an involvement in HIV/AIDS. The paper is available on the Ministerial Council's website at http://www.phac-aspc.gc.ca/aids-sida/fi-if/minister-eng.php . The objectives of the paper 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 the present Citizenship and Immigration policy, HIV testing is mandatory for prospective immigrants 15 years of age and over. The Ministerial Council does not support the mandatory testing policy, arguing that prevention education is an approach more consistent with respect for human rights. According to officials of Citizenship and Immigration Canada, approximately 300 people living with HIV would be admitted to Canada each year (excluding visitors), which represents about 80% of those testing HIV-positive.

Role of the Ministerial Council
The Ministerial Council engages in ongoing dialogue with the Minister of Health, giving her advice and requesting that she raise pertinent issues with the Minister of Citizenship and Immigration.

Work Done During 2002-2003
The Ministerial Council followed up on the work it did in 2001-2002 and on its briefing with the Director General, Medical Services Branch, Citizenship and Immigration, which took place in March 2002. The Council had a second meeting with this official at its November 2002 meeting. The Council's concerns focused on:

• the need to train and monitor Designated Medical Practitioners, who do HIV screening abroad, in pre and post-test counselling. The Council expressed its willingness to assist Citizenship and Immigration Canada (CIC) in finding stakeholders who could help CIC to develop counselling guidelines.
• the use of the criterion of "excessive demand" on health and social services for determining admissibility to Canada. This criterion is no longer used for those claiming refugee status or for some sponsored persons in the family category. The Council indicated its interest to CIC in participating in discussions of what constitutes "excessive demand".
• the number of people who are excluded on the basis of being HIV-positive. The Council requested statistics on the number of those admitted and excluded.
• the possibility of exclusion of those on anti-retroviral therapy who have employment in Canada
• the need for HIV care, treatment and prevention programs for new immigrants
• the need for CIC to connect with community-based expertise in Canada (e.g. HIV Endemic Task Force) and with FPT-AIDS. The Council offered to work with CIC to facilitate these linkages.
• admission of persons living with HIV/AIDS who plan to work on, or attend, the 2006 International AIDS Conference in Toronto
• the need for collaboration between CIC and the epidemiology and surveillance sections of the Centre for Infectious Disease Prevention and Control, Health Canada.

The Council welcomed the willingness of CIC officials to work with the Council on developing a communications strategy on the issues of numbers of HIV-positive persons entering Canada as refugees.

Future Activities
The Ministerial Council will continue to advise the Minister of Health on these issues and will dialogue and work with officials of Citizenship and Immigration Canada.

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. During 2002-2003 a group of 12 community-based HIV/AIDS organizations and service providers withdrew from participation in HIV and Hepatitis C consultation committees of the Correctional Service of Canada (CSC) after a decade of involvement. The basis of the withdrawal was the stakeholders' lack of confidence that their participation would affect the policies and practices of CSC.
Role of the Ministerial Council
The Ministerial Council advises the Minister of Health and encourages her to meet with and support the Solicitor General in bringing about reforms.
Work Done During 2002-2003

• The Council expressed its concern to the Minister about harm reduction interventions in prisons, including access to methadone. The Minister replied that she would bring this to the attention of the Solicitor General and provincial/territorial ministers responsible for correctional facilities.
• In its face-to-face meeting with the Minister, the Council requested that she bring to the attention of the Solicitor General the need for needle exchange in prisons and the need to implement the Aboriginal strategy on HIV/AIDS in prisons.
• The Council also encouraged the Minister to discuss with the Solicitor General the decision by 12 community-based organizations and service providers to withdraw from formal discussions with CSC.
• The Minister requested that officials of Health Canada facilitate a meeting between the Minister of Health, the Solicitor General and interested members of the Ministerial Council.
• The Council studied the report card of the Canadian HIV/AIDS Legal Network on the response to HIV/AIDS by Canada's prison system.

Future Activities
The Ministerial Council will continue to monitor and give advice to the Minister on this issue.

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 a 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 to HIV. Ontario has passed a Bill similar to Bill C-217.

Role of the Ministerial Council
The Ministerial Council continues to monitor this issue following extensive work on Bill C-217 during 2001-2002.

Work Done During 2002-2003

• The Ministerial Council monitored developments with this type of legislation in order to advise the Minister as appropriate and necessary.

Future Activities

The Ministerial 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 living with HIV/AIDS) have to care, treatment and support. A high proportion of new HIV infections are among injection drug users. Issues faced by Aboriginal peoples are of particular concern.

Role of the Ministerial Council
The Ministerial Council strongly urges the Minister of Health to strengthen the harm reduction aspects of the Strategy, and to 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 2002-2003

Work during 2002-2003 built on the extensive work done by the Ministerial Council during 2001-2002.

• The Ministerial Council discussed supervised injection facilities with the Minister of Health. The Council welcomed the fact that Health Canada was issuing guidelines for granting exemptions from the Controlled Drugs and Substances Act so that these sites could operate. The Council stressed that more leadership is required with respect to funding pilot projects and promoting the need for supervised injection sites with those in the community who are opposed to them. The Minister outlined the practical challenges of the initiative, including the need to agree with the provinces and municipalities that wish the sites. She underlined Health Canada's commitment to quick processing of any applications.
• The Council engaged in discussions with FPT-AIDS on the issue of supervised injection sites.
• The Council had in previous years expressed to the Minister its concern that existing criminal law not impede harm reduction interventions such as needle exchanges, and that the possession of small amounts of drugs be decriminalized. The Minister responded this year that these issues were not the exclusive responsibility of Health Canada and that she would be happy to continue the necessary dialogue on these subjects with her Cabinet colleagues.
• The Council had raised with the Minister the issue of the prescription of opiates and controlled substances as part of harm reduction programs. The Minister responded that a feasibility study was initiated in the past fiscal year that could pave the way for more targeted interventions and increase the evidence regarding a range of models for treatment, prevention and harm reduction programs relying on opiates other than methadone. The Minister said that Health Canada would collaborate with the Canadian Institutes of Health Research to ensure a strategic approach prior to broad public solicitations.
• The Council raised the question of whether Health Canada could provide information to Canadians on the interactions between controlled substances and medication. The Minister replied that the department was committed to providing accessible and meaningful information to Canadians where such advice is available.

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 a fundamental 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. The Declaration of Commitment made at the 2001 United Nations General Assembly Special Session on HIV/AIDS (see section 6.5.2) highlighted as a key commitment the engagement of vulnerable populations at the national level. At the suggestion of the Ministerial Council, Health Canada is undertaking an initiative to engage vulnerable populations and people living with HIV/AIDS in the development of the Canadian Strategy on HIV/AIDS and in determining policies and practices that affect their lives. Representatives of affected communities will be involved in the development of this initiative.

6.2.1 Populations from Endemic Countries (Africa and the Caribbean)

The Issue
Surveillance data show that an increasing proportion of AIDS cases in Canada occur among persons from countries where HIV is endemic, mainly in African and Caribbean communities, with a growing number from Asian 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. HIV is now reportable in all jurisdictions in Canada. Most jurisdictions do not collect data on ethnicity, but there is a growing recognition of the need to do so in order to track the HIV epidemic. This remains a contentious issue that must be resolved with the communities affected.

Role of the Ministerial Council
The Ministerial Council advises the Minister on issues involving the needs of populations from countries where HIV is endemic.

Work Done During 2002-2003

• Through the Council's link with the Federal/Provincial/Territorial Advisory 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.
• In its discussions with Health Canada officials, the Council pointed out that work must be pan-Canadian and extend beyond communities in Quebec and Ontario.
• The Council advised the Minister that communities from countries where HIV is endemic must be included in the development and implementation of epidemiological surveillance programs in order for the communities to participate in a meaningful manner. The Minister responded that officials in the Division of HIV/AIDS Epidemiology and Surveillance had met with representatives of these communities in April 2002 and would be meeting with the HIV Endemic Task Force. She stated that Health Canada had no plans to develop an Epi Update (a synthesis of federal, provincial and territorial data) focusing on HIV-endemic populations and that it was agreed that such an initiative would require the involvement of the communities.
• The Council will be advising the Minister early in 2003-2004 that African and Caribbean communities must be involved in determining if and how epidemiological data would be collected and communicated.
• The Council will recommend to the Minister early in 2003-2004 that a national meeting be organized with representatives of Health Canada, the provinces and territories, and affected communities. The purpose of the meeting would be to discuss the inclusion of data on ethnic origin in surveillance reporting in order to stay ahead of the epidemic.
• In its meeting with the Minister, the Council advised her that the needs of communities from HIV-endemic countries must be taken into account in considering additional funding for the Canadian Strategy on HIV/AIDS.

Future Activities
The Ministerial 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 are continuing 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.

Role of the Ministerial Council

The Ministerial Council continues to build on its earlier work and raises concerns with the Minister of Health.

Work Done During 2002-2003

• The Council recommended to the Minister of Health in 2001-2002 that the National Reference Group on Women and AIDS be reinstated so that it could coordinate, monitor and evaluate the implementation of its recommendations. The Council had asked the previous Minister to inform it of Health Canada's plans for ensuring that the Group's recommendations are implemented. Minister McLellan replied this year that the National Reference Group (NGR) had fulfilled its mandate of presenting recommendations to Health Canada, and that the group would not be re-established. The Minister stated that the NGR's recommendations were being used by Health Canada to assist with work planning and priority setting for 2002-2003 within the HIV/AIDS Policy, Coordination and Programs Division. The Council requested information on how the NRG recommendations were being incorporated into Health Canada workplans.
• The Council reiterated its recommendation of 2001-2002 to the Minister that a Canadian registry of HIV-infected women and their antiretroviral-exposed children be established 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 a Canadian Perinatal Exposure to Antiretroviral Registry, which would require the involvement of all levels of government, and that it find a program home for the registry within Health Canada.
  The Minister replied that the establishment and maintenance of such a registry was beyond the scope of the Therapeutic Products Division of Health Canada. She suggested that the Canadian Perinatal Exposure to Antiretroviral Surveillance Committee request funding from the department for a feasibility study that could identify the most appropriate organizations for the registry, including human resource and financial responsibility.
  The Council will advise the Minister, early in 2003-2004, that some of the funds in the federal budget of February 2003 designated for post-approval surveillance of drugs be spent on the Canadian Perinatal Exposure to Antiretroviral Registry. The Canadian Perinatal Exposure to Antiretroviral Surveillance Committee has requested funding from the Canadian Institutes of Health Research.
• The Council continued to investigate possibilities for working collaboratively on mother-to-child issues both with the Pediatric Antiretroviral Therapy Surveillance Working Group of the Federal/Provincial/Territorial Advisory Committee on AIDS and through the Council's links to mechanisms for international collaboration and information exchange.
• The Council will advise the Minister early in 2003-2004 that access to baby formula for HIV-positive Aboriginal mothers needs to be covered under the Non-Insured Benefits program that covers the cost of First Nations health care not paid for by the provinces and territories. This would lessen the risk of HIV transmission from mother to child by providing an alternative to breast feeding.

Future Activities
The Ministerial Council will continue to champion issues relating to women and HIV.

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 to provide their perspectives on behalf of the two-spirited community.

A National Reference Group on Gay Men's Health produced two reports in 2000: 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. These reports continue to inform work on gay men and HIV/AIDS. Health Canada has a policy framework for gay men's HIV prevention which will be a component of a comprehensive HIV prevention strategy that is being developed.

Role of the Ministerial Council

The Ministerial Council continues to champion the issues of gay men and supports a renewed emphasis on HIV prevention and care for gay men.

Work Done During 2002-2003
The Council continued to track the issue of gay men and HIV/AIDS.

Future Activities

The Ministerial 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 6.1.4). 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 commissioned 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 Ministerial Council champions this issue and provides advice focused on interdepartmental collaboration, federal/provincial/territorial collaboration and congruence with Canada's Drug Strategy. The Council is linked to the Safe Injection Site Task Group through a member of Council who sits on the Task Group.

Work Done During 2002-2003

• The Council built on its work in 2001-2002, during which it 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 exchanges on reserve), and the need to integrate these approaches into Canada's Drug Strategy.
• In 2001-2002, 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
  • the need to implement the Aboriginal strategy on HIV/AIDS in prisons
  • 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.
• This year, the Minister replied to the Council's concerns about Health Canada's response to the Canadian HIV/AIDS Legal Network's report. She agreed that injection drug use is primarily a health issue with a complex context of legal, social and human rights. For this reason, Health Canada favours a harm-reduction model. The Minister also stated that:
  • Health Canada would undertake interventions consistent with the work of partners in the Canadian Strategy on HIV/AIDS and would build on the findings of a feasibility study on the use of controlled drugs and substances in the health care environment
  • the development of a social justice framework to guide the Strategy would set the stage for systematic analysis of issues that have an impact on vulnerable people
  • the existence of multiple jurisdictions increases the challenge of putting into place effective public policy.
• The Council provided advice to the Minister about supervised injection sites and other aspects of Canada's Drug Strategy (see section 6.1.4).

Future Activities

The Ministerial 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 is growing among Aboriginal peoples, a conclusion based largely on data collected in urban areas. The Canadian Strategy on HIV/AIDS has an 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.

In 2001-2002, a National Aboriginal Council on HIV/AIDS (NACHA) was formed as a collaborative mechanism to provide advice to Health Canada on all aspects of the Canadian Strategy on HIV/AIDS and to become the single advisory group on Aboriginal issues. NACHA is composed of four caucuses: First Nations; Inuit; Métis; and Community.

Role of the Ministerial Council

The Ministerial Council maintains its advocacy for Aboriginal issues and its links to the National Aboriginal Council on HIV/AIDS and to other Aboriginal groups and processes. The Council's Situational Analysis report on Aboriginal issues continues to be a widely-used foundation document.

Work Done During 2002-2003

• The Ministerial Council monitored the work of Health Canada's First Nations and Inuit Health Branch with respect to HIV. The Council's Special Working Group on Aboriginal Issues played an ongoing active role in this respect until its dissolution (see below).
• With the creation of the National Aboriginal Council on HIV/AIDS, which will be the primary mechanism for advising Health Canada on Aboriginal issues related to HIV/AIDS, the Ministerial Council's Special Working Group on Aboriginal Issues (SWGAI) recommended to the Ministerial Council that SWGAI be dissolved and that a liaison be created between NACHA and the Ministerial Council. The Ministerial Council agreed with this recommendation and dissolved SWGAI. Work is ongoing to determine the most effective liaison mechanism between NACHA and the Ministerial Council.
• The Council expressed concern to Health Canada officials about the decision not to fund a third Aboriginal HIV/AIDS summit meeting. Health Canada replied that discussions were ongoing.
• During its November meeting, the Ministerial Council met with representatives of the National Aboriginal Council on HIV/AIDS and had a full briefing and dialogue about NACHA's work.
• As part of its work on the question of where to locate community-based research (see section 6.3.6), the Ministerial Council monitored progress on determining a location for the Aboriginal Community-Based Research Program. The program receives $800,000 each year under the Canadian Strategy on HIV/AIDS. This process is being developed by NACHA and Health Canada.
• In its meeting with the Minister, the Ministerial Council advised her that the needs of Aboriginal communities should be taken into account in any discussions of increased funding for the Canadian Strategy on HIV/AIDS.
• The Council stressed that Aboriginal needs and concerns needed to be included in Canada's reports to the United Nations (see section 6.5.2).
• The Council will advise the Minister early in 2003-2004 that access to baby formula for HIV-positive Aboriginal mothers needs to be covered under the Non-Insured Benefits program that covers the cost of First Nations health care not paid for by the provinces and territories. This would lessen the risk of HIV transmission from mother to child by providing an alternative to breast feeding.

 

Future Activities

The Ministerial Council will continue to support Aboriginal issues through its working relationship with the National Aboriginal Council on HIV/AIDS.

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 Direction Setting

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

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

A second national direction-setting meeting was 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. At this meeting, preliminary action plans were developed for each of the 10 directions. Health Canada then worked with the Canadian Strategy on HIV/AIDS Direction-Setting Process Task Group to develop and implement a comprehensive follow-up and communications strategy that included:

• a record of proceedings of the April 2002 meeting
• teleconference meetings to further develop the actions proposed under Directions 1 to 9
• a working group to design a process for implementing Direction 10
• regular updates on follow-up activities.

Development of the five-year strategic plan envisioned by Direction 10 is proceeding in parallel with the five-year review of the Canadian Strategy on HIV/AIDS (see section 6.3.4) so that lessons learned from the review can inform planning for the next five years. The findings from the five-year review will influence the Minister's decision to recommend to Cabinet that funding for the Strategy be increased.

Participants at a strategic planning meeting in December 2002 discussed key issues and worked toward developing goals, objectives and actions, and identifying gaps. The key issues that will be addressed in the draft Strategic Plan are:

• communications and awareness
• dynamic prevention, care and treatment
• drug policy and harm reduction
• research
• community-based agencies
• positive action
• strategies for unique populations
• social justice
• the global response to HIV/AIDS
• strategic approach to funding
• governance.
  

A draft plan was circulated for consultation in March 2003. The Strategic Plan, involving pan-Canadian stakeholders, is expected to be launched in December 2003. The Federal Action Plan, which may possibly include additional funding, is expected to be launched in March 2004.

Role of the Ministerial Council

In its roles of monitoring and evaluating, championing issues and providing long-term guidance, the Ministerial Council monitors follow-up activity by Health Canada and provides advice with respect to direction-setting for the Strategy.

Three members of the Ministerial Council and the ex-officio Ministerial Council member from the Federal/Provincial/Territorial Advisory Committee on AIDS attended the October 2000 stakeholders' meeting. The Ministerial Council delegated two members to sit on the task group that planned the second direction-setting meeting in April 2002. A third member of the Council sat on the task group that represented Aboriginal organizations.

Work Done During 2002-2003

• The Council had a full briefing on the directions-setting process, the Five-Year Review and the development of the five-year Strategic Plan at its June 2002 meeting. The Council provided its perspective to Health Canada officials.
• The Council had a further briefing on the Strategic Plan at its November 2002 meeting. Health Canada officials stressed the inter-relationship between strategic planning and the Five-Year review of the federal role in the Canadian Strategy on HIV/AIDS. Council members expressed their concerns about the length of time being taken by the process and the delay this would impose on securing additional funds for the Strategy. Members also expressed concern that gaps in the current Strategy such as the needs of Aboriginal peoples and communities from HIV-endemic countries need to be addressed in planning for the future.
• The Council had a third briefing on the strategic planning process at its March 2003 meeting.
• A member of the Council sat on the Directions Setting Process Task Group.
• The Council was represented at the December 2002 strategic planning consultation.
• The Council participated in the Five-Year Review process.

Future Activities
The Ministerial Council will continue to be involved in the process of acting on the 10 directions, developing the five-year strategic plan, and completing the five-year review.

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 stakeholders' meeting in 2000. A preliminary action plan was developed 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 and the positions declared at the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) in June 2001 (see section 6.5.2).

The socio-economic conditions 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 Ministerial Council supports the social justice framework and contributes to its development.

Work Done During 2002-2003

• The Council disseminated its study on the determinants of health. The study, HIV/AIDS and Health Determinants: Lessons for Coordinating Policy and Action, is available on the Ministerial Council's website at http://www.phac-aspc.gc.ca/aids-sida/fi-if/minister-eng.php .
  
  The Council intends to link this paper to the work on the development of a social justice framework and work on intergovernmental collaboration.
  
  The executive summary portion of the paper was distributed to stakeholders attending the April 2002 direction-setting follow-up meeting. The paper will also be distributed to provincial, territorial and Aboriginal stakeholder organizations and will be available at the Canadian HIV/AIDS Information Centre. The Council will recommend that the Minister allow the Council to approach other government departments to request meetings to discuss the issues raised in the paper.
• Three members of the Council worked actively with Health Canada on the development of a social justice framework in preparation for the April 2002 stakeholders' direction-setting follow-up meeting.
• The Council worked with Health Canada on the clarification of values and principles.
• The Council had a special presentation on the concept of social justice from one of its members at its November meeting.

Future Activities

The Ministerial Council will continue to participate in the development of the social justice framework.

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. New needs have arisen that require adequate support. The Minister has reiterated the commitment made by her predecessor to seek additional funding for the Strategy provided that the results of the five-year review and the new five-year strategic plan make a sound case for more funding. It is expected that the Minister may approach Cabinet with a request for additional funding in the fall of 2003 and that additional funding may be available by 2004.

Role of the Ministerial Council

The Ministerial Council monitors and evaluates the implementation of the CSHA, including reviewing and recommending financial allocations under the CSHA, and advises the Minister on CSHA evaluations to ensure that the needs of stakeholders are being met.

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.

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 .

Work Done During 2002-2003

In its meeting with the Minister, the Council expressed its disappointment that the process to possibly secure additional funding for the Strategy will take until 2004. The Council expressed its willingness to work with Health Canada to create a case for additional funding by mid-December 2002 in order to be included in the February 2003 federal budget. The Minister discussed with the Council the many steps involved in securing funding increases and the need to build a solid case for Treasury Board and Cabinet to justify additional funding.

Future Activities

The Ministerial Council will continue to be involved in the effort to secure additional funding for the Strategy.

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 was amalgamated with the annual report. In 2002-2003, the Five-Year Review and the CSHA strategic planning for the next five years were begun. The two processes are operating in parallel in an interactive way. The impetus for a five-year strategic plan developed at the two direction-setting meetings in 2000 and April 2002 at which stakeholders called for a more proactive and strategic approach to HIV/AIDS in Canada. The Strategic Plan will be pan-Canadian in nature while the Five-Year Review will focus only on the federal role in the CSHA. The Five-Year Review results from a commitment made to Cabinet in 1998. The Minister will be guided by the results of the Five-Year Review and the Strategic Plan in making a case to Cabinet for increased funding for the Strategy. The Five-Year Review is expected to be completed by June 2003. The Strategic Plan will be developed in consultation with stakeholders and is expected to be completed by late 2003.

Role of the Ministerial Council
In its monitoring and evaluation role, the Council participates in all evaluations of the Canadian Strategy on HIV/AIDS. Its particular role is to monitor and advise on CSHA evaluations to ensure that the needs of stakeholders are being met. The Ministerial Council is represented in the strategic planning process and on the Advisory Committee for the Five-Year Review. The Council will provide its advice to the Minister on the final reports.

Work Done During 2002-2003

• The Council suggested that Health Canada begin the Five-Year Review early in order to avoid problems encountered with the Year Three evaluation. It also suggested that a Council member sit on the evaluation advisory committee, which should be composed of persons from across Canada with a mix of HIV/AIDS and large-scale evaluation expertise.
• The Council advised Health Canada that evaluations of the Strategy need only be done every five years.
• The Council had an in-depth discussion of the Five-Year Review and the CSHA Strategic Planning process with Health Canada officials at its November 2002 meeting.
• The Council raised its concerns with the Minister about the effect of the Five-Year Review and strategic planning processes in delaying the flow of additional funds to the Strategy. The Minister stressed that she needed the results of this work in order to make a case with her Cabinet colleagues for increased funding.

Future Activities
The Ministerial Council will continue to play an advisory role with respect to evaluation of the Strategy.

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.
Health Canada uses a Quick Response Reallocation Mechanism (QRRM) to reallocate surpluses within the 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 Auditor General recommended in 2001 that all funding for projects be decided through a competitive process. As a result, Health Canada has discontinued directed funding for projects which lengthens the time cycle for awarding contributions.

Role of the Ministerial Council

The Ministerial Council monitors and evaluates the implementation of the Canadian Strategy on HIV/AIDS in order to support its effectiveness and flexibility to meet changing circumstances. As part of this role, the Council reviews allocations under the Strategy and provides advice.
In previous years, the Council collaborated with Health Canada on the development of the Quick Response Reallocation Mechanism for dealing with potential surpluses within a fiscal year.

Work Done During 2002-2003

• The Council engaged in dialogue with Health Canada and raised concerns about the management of Strategy dollars and the deployment of surplus funds in the final quarter of 2001-2002.
• The Council discussed with Health Canada: the question of departmental levies to cover overhead; the funding process for the AIDS Community Action Program; and underspending in some programs in 2002-2003.
• The Council requested information about the new National HIV/AIDS Demonstration Fund and, in particular, how priority populations were selected and how the peer review process functioned.
  Future Activities
  The Ministerial Council will continue to monitor allocations under the Strategy and provide its advice.

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 ($1 million annually) and an Aboriginal Community-Based Research Program ($800,000 annually). 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. Health Canada commissioned a study, Building on the Strengths of Communities: Options for Redesigning and Relocating the Community-Based Research Program, to inform the process of decision making. A Community-Based Research Steering Committee has been working with Health Canada and the Canadian Institutes of Health Research (CIHR) on resolving this issue. During 2002-2003, a decision was made to locate the general community-based research program at CIHR. An agreement between Health Canada and CIHR is expected to be completed early in 2003-2004.

The question of relocating the Aboriginal Community-Based Research Program is being considered through a separate process in consultation with the National Aboriginal Council on HIV/AIDS and the Canadian Aboriginal AIDS Network.
Community stakeholders have voiced concerns over the amount of paperwork required when applying for community-based research grants, as well 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). HIV/AIDS is currently housed within the Institute of Infection and Immunity. The Ministerial Council and stakeholders, including researchers, have called for a stronger presence for HIV/AIDS research within CIHR.

An issue for all types of research is the transfer 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. Health Canada monitors drug-resistant HIV through the Canadian HIV Strain and Resistance Surveillance Program. The report of a working group on the issue was completed in 2002-2003 and presented to the Federal/Provincial/Territorial Advisory Committee on HIV/AIDS and given to the Ministerial Council. In March 2003, a second national workshop on drug resistance was held.

Role of the Ministerial Council

The Ministerial Council plays both monitoring and championing roles with respect to research issues, which include epidemiology, basic science, clinical science, psycho-social and community-based research. The Council has representation on the Canadian Institutes of Health Research HIV/AIDS Advisory Committee and on the Community-Based Research Steering Committee.

Work Done During 2002-2003

• The Council reviewed the study outlining options for relocation of the community-based research program. Their comments were given to the Community-Based Research Steering Committee. The Council discussed possible options with Health Canada and informed Health Canada and CIHR that it supported the housing of the general Community-Based Research Program at CIHR (in the Institute of Infection and Immunity) provided that:
  • the community has an opportunity to participate in the development of the Memorandum of Understanding with CIHR
  • if there are major problems with housing the Program at CIHR, the agreement with CIHR can be rescinded.
• The Council expressed its concerns to Health Canada about the potential challenges involved in locating community-based research within CIHR and recommended that the Letter of Agreement between Health Canada and CIHR take into account the questions of: applications for funding; ethics review; administrative costs not to be taken from research funds; and the need for evaluation and the possible withdrawal of the program from CIHR.
• The Council remained informed about the relocation of the Aboriginal Community-Based Research Program and some of the challenges faced by stakeholders in having their research funded under the program.
• Representatives of the Council met with officials of the Canadian Institutes of Health Research (CIHR) and of the Canadian Association for HIV/AIDS Research to discuss the question of a possible Office of HIV/AIDS research at CIHR.
• CIHR proposed that it establish an HIV/AIDS Advisory Committee rather than an Office. After study of this proposal and dialogue with other stakeholders, the Council informed CIHR that it agreed with the establishment of an Advisory Committee and that the Committee should:
  • have sufficient power to put forth recommendations
  • have the capacity to cross all institutes
  • be a championing group that could set research priorities
  • ensure that the allocated funds are used appropriately
  • be built on existing HIV/AIDS stakeholders' experience in working together
  • have a policy coordination and direction role
  • have a monitoring role
  • be a voice for HIV researchers
  • seek appropriate representation of community, researchers, CIHR and Health Canada
  • have observer status for the Ministerial Council on HIV/AIDS
  • have co-chairs, one from CIHR and another chosen from researchers and community representatives.
    
    The Council selected one of its members to sit on the CIHR HIV/AIDS Research Advisory Committee.
    
    The Council also advised CIHR on a process for selecting community representatives for the Advisory Committee.
    
• The Council began an examination of the jurisdictional issues involved in HIV/AIDS surveillance and barriers to the establishment of a nationally coordinated surveillance system.
• The Council reviewed the report of the working group on multi-drug resistant HIV. This issue is being studied by the Federal/Provincial/Territorial Advisory Committee on HIV/AIDS, which has links to the Council. The Council monitored this issue throughout the year.

Future Activities
The Ministerial Council will continue to provide advice on the issues of community-based research, the creation of suitable research infrastructures at CIHR, surveillance and emerging areas of research.

6.3.7 Health Care Reform

The Issue
The Commission on the Future of Health Care in Canada (the Romanow commission) released its report in late 2002. In recent 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) which has issued several reports. Following the release of the Romanow report, the First Ministers' Accord on Health Care Renewal was reached in February 2003. The Accord focuses on primary health care, home care, catastrophic drug coverage, access to diagnostic/medical equipment and information technology, and electronic health records. At issue in the debate about health care reform 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 Ministerial 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 health care reform in Canada.

Work Done During 2002-2003

The Council reviewed the interim and final reports of the Romanow commission, the Kirby commission reports and the First Ministers' Accord. The Council's concerns focused on:

• the need to protect the public health care system
• the basic elements of the health care system which should include home care, adequate palliative care and drug access for all Canadians
• insufficient funding for the Accord provisions
• the lack of a conscience in the health care system
• the shortage of physicians and nurses
• the potential for privatization under the Accord
• the reporting relationship of the Health Council announced in the Accord, which reports to the federal/provincial/territorial ministers of health rather than to Parliament, as the Romanow report had recommended.
  The Council will communicate its advice to the Minister early in 2003-2004.

Future Activities

The Ministerial Council will continue to follow health reform developments in Canada and will provide advice to the Minister of Health.

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. The Common Drug Review Process was established in 2002 by federal/provincial/territorial ministers of health (except Quebec) to harmonize drug review and formularies (list of drugs reimbursable under the public health plan). This process is being coordinated by the Canadian Coordinating Office for Health Technology Assessment and is still in development.

Role of the Ministerial Council

The Ministerial Council is a strong advocate for more effective drug review.
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. These recommendations led to the establishment of an Advisory Panel on Product Licensing Process 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.

Work Done During 2002-2003

• • The Council monitored the Common Review Process through its own review and its links to FPT-AIDS.
• The Council discussed its concerns about the Process, particularly the possibility that:
  • provinces and territories would restrict access to medications in an effort to standardize to the lowest common denominator
  • the maintenance of provincial drug review processes would result in the kind of duplication that the Common Review was intended to avoid.
• A member of the Council attended a community consultation on the Common Review Process organized by the Canadian Coordinating Office for Health Technology Assessment.
• In its meeting with the Minister, the Council advised that more resources are required to accelerate the review of new drugs and implement a post-approval surveillance system.
  

Future Activities

The Ministerial Council will continue to monitor this issue and provide advice to the Minister.

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 (see section 5). Those described below were the subject of particularly intensive work in 2002-2003.

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. During 2002, the Canadian HIV/AIDS Legal Network released its report HIV Vaccines in Canada: Legal and Ethical Issues - An Overview. Among other recommendations, the report called for a Canadian HIV Vaccine Plan.
Health Canada has struck an internal Working Group on HIV Vaccine Development and Equitable Distribution. The Working Group will convene a panel of government and non-governmental stakeholders to explore research requirements and legal, ethical and human rights issues with respect to the Government of Canada's role in the equitable distribution of an HIV vaccine in Canada and globally. The Working Group will hold a consultation in the Spring of 2003 and expects to produce a national HIV Vaccine Plan by the Fall of 2003.
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 Ministerial Council champions the development of vaccines and prevention agents.

Work Done During 2002-2003

• The Council studied the report of the Canadian HIV/AIDS Legal Network, monitored the issue of vaccine development and clinical trials and commissioned a paper to assist it in developing a position on vaccine development and delivery.
• The Council expects to advise the Minister on vaccines early in 2003-2004.
• The Council was linked through briefings to the progress of the Working Group on HIV Vaccine Development and Equitable Distribution.

Future Activities

The Ministerial Council will continue to monitor progress on vaccines and microbicides and provide advice to the Minister.

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 of prosecution by prescribing marijuana. This reduces access to medical marijuana by persons living with HIV/AIDS. During 2002-2003, Health Canada established a Stakeholder Advisory Committee on Marijuana for Medical Purposes which met late in 2002. Under the Marijuana Medical Access Regulations, approximately 800 authorized persons can possess and cultivate marijuana for medical purposes. Clinical trials to assess the medical effectiveness of marijuana are also being sponsored by Health Canada.

Role of the Ministerial Council

The Ministerial Council studies and provides advice on this issue.

Work Done During 2002-2003

• The Council requested that appropriate Health Canada officials be part of the consultation process on medical marijuana regulations.
• The Council wrote to the Minister of Health in 2001-2002 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. The Minister responded this year that responsible action required that there be a regulatory requirement for a specialist to be involved in the prescription of marijuana. She added that the Stakeholder Advisory Committee on Marijuana for Medical Purposes would likely look at the requirement for specialist approvals and examine it from all perspectives.
• In its meeting with the Minister, the Council stressed that people who have received permission to use marijuana for medical reasons should be able to access the crop grown by Health Canada which is intended solely for clinical trials.

Future Activities

The Ministerial Council will continue to monitor this issue and advise the Minister.

6.5 Preparing Canada's International Response

Overview
HIV/AIDS is a global issue, with more than 42 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.

Of continuing interest this year were the World Trade Organization's discussions on intellectual property and the question of mechanisms to ensure that developing countries can access affordable HIV/AIDS treatments. This year the Council took a particular interest in the impact of international trade law and policy on health care in Canada and abroad. Also of interest was Canada's contribution to the Global Fund to fight AIDS, Tuberculosis and Malaria. The Council has monitored these issues and the work that stakeholders in Canada have done to address them.
Canada has taken a leadership role within the international community on issues involving Africa. Partnerships and action for Africa's development were championed by the Prime Minister at the 2002 G8 Summit held in Canada.
Several Council members participated in the XIV International AIDS Conference in Barcelona in 2002.

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. The theme chosen by the United Nations for World AIDS Day 2002 was "Live and Let Live" which focused on eliminating stigma and discrimination. The communications activities associated with World AIDS Day are an opportunity to draw public attention to key areas where efforts need to be strengthened. On each World AIDS Day since 1997, the Minister has released an annual report on the Canadian Strategy on HIV/AIDS. The 2002 World AIDS Day report was entitled Lessons Learned: Reframing the Response - Canada's Report on HIV/AIDS 2002. December 1 is also Aboriginal AIDS Awareness Day in Canada. During 2002-2003, work was begun on a pan-Canadian HIV/AIDS Awareness Campaign to "put HIV/AIDS back on the map". This campaign will be launched on December 1, 2003.

Role of the Ministerial Council

The Ministerial Council helps the Minister to develop the key messages for 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.

Work Done During 2002-2003

• The Council received a special presentation on World AIDS Day at its November 2002 meeting.
• The Council advised the Minister on her messages for World AIDS Day and on possible ministerial activities. The Council encouraged the Minister to highlight Canada's social justice framework and to reinforce the rights of Canadians who inject drugs, gay men, women and children from countries where HIV is endemic, prisoners and sex trade workers. The Council encouraged the Minister to include Aboriginal issues in her messages and activities since December 1 is also Aboriginal AIDS Awareness Day in Canada.
• The Council was represented on the editorial board for the 2002 World AIDS Day report.
• A message from the Council was included in the 2002 World AIDS Day report.
• The Council reviewed the evaluation of the World AIDS Day process.

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

6.5.2 United Nations General Assembly Special Session on HIV/AIDS (UNGASS) - Follow-up

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 section 6.5.3). The Declaration of Commitment requires governments to report annually on their implementation of the Declaration. Because of the urgency of the issue, the United Nations General Assembly passed a resolution in March 2002 asking the UN Secretary General to submit a progress report to the General Assembly in September 2002. Canada was one of the countries that submitted a report for incorporation into the Secretary General's report to the September 2002 General Assembly. The report was prepared by Health Canada (International Affairs Directorate on behalf of the Canadian Strategy on HIV/AIDS) with stakeholder input.

A second national progress report will be submitted in 2003, when the first set of targets of the Declaration of Commitment becomes due. This report will be composed of contributions by Health Canada and the Canadian International Development Agency which will be combined into a single report by the Department of Foreign Affairs and International Trade.

As part of Canada's response to UNGASS, the International Affairs Directorate of Health Canada prepared a report for distribution to the Canadian business community, Enhancing Canadian Business Involvement in the Global Response to HIV/AIDS. The report was launched at the 2002 Barcelona International AIDS Conference. The report is intended to stimulate discussion and involvement by Canadian businesses within the context of international corporate social responsibility.

Role of the Ministerial Council

The Ministerial Council acts as a champion and advocate with the Minister for these issues. The Council contributes its perspectives on inter-ministerial collaboration and social justice with respect to international issues.
Work Done During 2002-2003

• The Council advised the Minister on Canada's report on its response to UNGASS. The Council:
  • congratulated Canada on being one of only two developed countries (including Australia) that responded properly and in a timely fashion to the UN request for a country report.
  • expressed concern that preparation of the report was coordinated by the International Affairs Directorate rather than being more broadly shared with other areas of Health Canada and other ministries since implementation of the Declaration of Commitment is a domestic, rather than international, issue.
  • noted that several Canadian ministries are involved in meeting Canada's international commitment. The Council offered to assist the Minister in ensuring that inter-ministerial collaboration occurs so that Canada's international policy and action are consistent with Canada's stated commitment to contribute to the global response to HIV/AIDS.
  • pointed out that the provinces and territories need to be involved in the preparation of future reports, as do community stakeholders.
  • stressed that the Declaration needs to be more widely known and understood within Health Canada, other federal departments and provincial/territorial governments so that the Declaration commitments can be properly incorporated across the entire Canadian Strategy on HIV/AIDS.
  • recommended that a broader institutional responsibility be created within Health Canada for follow-up to the UNGASS Declaration of Commitment.
  • stated the Council's willingness to be involved in the preparation of future reports.
• The Council reiterated these points in its meeting with the Minister. The Minister responded that she has asked her departmental officials to work with other federal departments to ensure a cohesive domestic and international position on HIV/AIDS. She pointed out that future responses to the United Nations would be led by the Centre for Infectious Disease Prevention and control (which houses the HIV/AIDS Policy, Coordination and Programs Division), with the participation of Health Canada's International Affairs Directorate. She added that the Declaration would be considered in the development of the five-year strategic plan for the Strategy.
• The Council monitored the process of preparing Canada's 2003 report to the United Nations and provided advice to Health Canada. Early in 2003-2004, the Council intends to advise the Minister of Health and the Minister for International Cooperation on the need to ensure that Health Canada and the Canadian International Development Agency collaborate on the preparation of the 2003 UNGASS progress report.
• The Council remained informed about the response of other countries to the UNGASS Declaration.
• The Council provided advice to Health Canada on the dissemination plan and follow-up activities for the report Enhancing Canadian Business Involvement in the Global Response to HIV/AIDS.
• One of the Council's co-chairs planned to meet with the Minister for International Cooperation early in 2003-2004 to discuss a variety of HIV/AIDS issues. Council members contributed to identifying issues that could be raised in this meeting.

Future Activities

The Ministerial Council will continue to monitor Canada's follow-up to UNGASS and advise the Minister of Health.

6.5.3 Global Fund to fight AIDS, Tuberculosis and Malaria

The Issue
The Global Fund to Fight AIDS, Tuberculosis and Malaria was announced by the United Nations Secretary General in 2001. 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 meeting in June 2001. Leaders at the 2001 G8 Summit made a commitment to support the Global Fund. Contributions to the Fund have been less than 10% of the amount required.

Canada's contribution to the Global Fund is the responsibility of the Canadian International Development Agency (CIDA) which reports to the Minister for International Cooperation.

Role of the Ministerial Council

The Ministerial Council advises the Minister about the course that Canada should take with respect to the Global Fund.

Work Done During 2002-2003

• The Council advised the Minister that Canada's contribution to the Global Fund was inadequate and urged her to play a leadership role with her Cabinet colleagues to secure an increase in Canada's contribution that could be announced during the G8 summit in Canada in the summer of 2002.
• The Council had advised the previous Minister in 2001-2002 that Canada's contribution to the Global Fund needed to be increased. Minister McLellan replied this year that the Government of Canada was committed to supporting the Global Fund and had played a leading role in building international support for the Fund. Minister McLellan had forwarded this correspondence to the Honourable Susan Whelan, Minister for International Cooperation, who is responsible for Canada's contributions to the Global Fund. Minister Whelan wrote to the Council expressing her support for the Fund and outlining CIDA's initiatives in broadening support for the Global Fund beyond G8 nations. She pointed out that Canada is among the first donors to both pledge and make a payment to the Fund. She provided details on CIDA's initiatives to combat HIV/AIDS, tuberculosis and malaria.
  

 

Future Activities
The Ministerial Council will continue to monitor Canada's contribution to the Global Fund and advise the Minister.

6.5.4 Other International Issues

The Issues
In 2002, leaders of G8 countries held their annual Summit in Canada. This presented the Council with an opportunity to advise the Minister on health and HIV/AIDS issues, particularly with respect to Africa, that Canada could champion at the Summit. The Prime Minister had declared his support for African development and was leading the initiative on a New Partnership for Africa's Development that was discussed at the Summit.

The impact of international trade agreements on health was also an issue of concern to the Council.

Role of the Ministerial Council

The Ministerial Council studies international issues that have an impact on HIV/AIDS in order to provide advice to the Minister.

Work Done During 2002-2003

• The Council advised the Minister that Canada could play a leadership role at the 2002 G8 summit by encouraging heads of government to:
  • take concrete action on global health, specifically by addressing the global HIV/AIDS crisis. The Council stressed that African nations had been particularly devastated by HIV/AIDS.
  • increase financial resources for fighting communicable diseases (see Section 6.5.3).
  • ensure access to affordable medicines in developing countries, particularly with respect to overly restrictive intellectual property rights and patents on drugs. The Council pointed out that countries producing generic drugs while patents are still in effect are required by international agreements to do so for their domestic markets only. This restricts their ability to export drugs to countries that need them but do not have domestic production capacity. The Council advised Canada to show leadership in identifying a regulatory solution that would allow for export of generic drugs to countries in need.
  • increase development assistance to countries that need to build their health care infrastructure in order to deliver basic health programs. The Council recommended that this be incorporated into the Action Plan for Africa that would be discussed at the Summit.
• The Council remained informed of the work of UNAIDS and studied its reports and publications.
• The Council had a special presentation on international trade issues and HIV/AIDS from one of its members. The presentation focused on the impact of trade agreements (The North American Free Trade Agreement, the Agreement on Trade Related Aspects of Intellectual Property, the General Agreement on Trade in Services, and the Free Trade Agreement of the Americans) and their potential affects on health care in Canada and abroad, particularly with respect to the commercialization of health care, restrictions on expansion of public health programs, and patent restrictions on drugs that affect the availability and price of drugs with devastating effects on developing countries.

Future Activities

The Ministerial Council will continue to remain informed about international issues that have an impact on HIV/AIDS.

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 2002-2003 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. 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. 2. To be a champion to ensure that current and emerging issues are being adequately addressed.
3. 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
Louise 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 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.

Lindy Samson
Dr. Lindy Samson is a pediatric infectious disease specialist and HIV physician at the Children's Hospital of Eastern Ontario (CHEO) and assistant professor at the University of Ottawa. She is Director of the CHEO HIV clinic and is a strong advocate for mothers and children 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 Chair of the Canadian Pediatric AIDS Research Group.

MEMBERS

Margaret Dykeman
Dr. Margaret Dykeman has been working in HIV/AIDS in various capacities for more than 10 years as a nurse practitioner, researcher, community representative and advocate. She is an Associate Professor in the University of New Brunswick's Faculty of Nursing. Dr. Dykeman is President of AIDS New Brunswick, the provincial HIV/AIDS organization. She has broad experience and knowledge of the injection drug user population which is one of the most vulnerable to HIV infection.

Richard Elliott
Richard Elliott, a lawyer formerly in private practice, is Director of Policy and Research for the Canadian HIV/AIDS Legal Network. The Legal Network is a non-governmental organization working on HIV/AIDS and human rights issues. The Legal Network is a partner organization of the AIDS Law Project, South Africa and has Special Consultative Status with the Economic and Social Council of the United Nations. Mr. Elliott has written 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 is currently on a one-year leave of absence from the Legal Network, completing a Master of Laws degree on international trade and the human right to health at Osgoode Hall Law School, York University.

Dionne A. Falconer
Dionne Falconer has extensive knowledge of HIV/AIDS issues through her involvement with community-based AIDS service organizations since the late 1980s. She is Managing Director of her own consulting firm in Toronto and works nationally and internationally on HIV/AIDS, health and social issues. Her previous staff positions include Clinical Director of Lawrence Heights Community Health Centre, Interim Executive Director of Access Alliance Multicultural Community Health Centre and Executive Director of the Black Coalition for AIDS Prevention (Black CAP). Ms. Falconer has many years of active community service and is a past member of the Board of Directors of the Ontario AIDS Network and the Canadian AIDS Society. She is currently a member and Past President of the Board of Directors for the Interagency Coalition on AIDS and Development. She holds a Master of Health Science degree in Health Administration.

William Flanagan
William Flanagan is an Associate Professor in the Faculty of Law of Queen's University and Executive Director of the Canada AIDS Russia Project, an HIV/AIDS research and training project in Russia sponsored by the Canadian International Development Agency. He has published numerous HIV/AIDS legal articles and has been actively involved in HIV/AIDS community and legal issues for many years. He has served as Chair of the Board of the AIDS Committee of Toronto and as a board member of the HIV/AIDS Legal Clinic of Ontario.

Jacqueline Gahagan
Jacqueline C. Gahagan, PhD, is an Assistant Professor in the School of Health and Human Performance of Dalhousie University. She holds cross appointments in Community Health and Epidemiology, Women's Studies, and Nursing at Dalhousie University. Dr. Gahagan is a Research Associate at the Atlantic Centre of Excellence for Women's Health where she leads the development of the research arm of the proposed International Institute on Gender-Mainstreaming and HIV/AIDS. She serves as a Commissioner on the Nova Scotia Advisory Commission on HIV/AIDS and was a member of the National Reference Group on Women and HIV/AIDS. Dr. Gahagan has extensive research experience in the field of HIV and gender. She teaches courses in program planning, measurement and evaluation and community health promotion strategies. Her current research studies include: HIV and Hepatitis C prevention, care, treatment and support needs of women in federal prisons; HIV prevention education needs of young heterosexual males; and the impact of unpaid caregiving on women's health.

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. He holds a BA from McGill University and a PhD in Philosophy from Cornell University. For the past 25 years Dr. Glouberman 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. Dr. Glouberman recently completed a major policy research effort, A Toolbox for Improving Health in Cities, which presents and tests ways of intervening in complex systems. This and other studies are available at www.healthandeverything.org .

Michael Grant
Dr. Michael Grant has been involved in the basic science of HIV/AIDS research since 1987. He trained in Vancouver and Hamilton and is now an Associate Professor of Immunology in the Faculty of Medicine of Memorial University of Newfoundland. Dr. Grant has been a member of the Canadian Association of HIV Research since its inception.

Barney Hickey
Barney Hickey (RN, MScN, CPMHN(C)), is a registered nurse with more than 20 years of extensive experience with the populations most affected by HIV/AIDS. In 2001 he received an award of excellence in AIDS care from the Canadian Association of Nurses in AIDS Care. In 2002, he received a similar award from the Registered Nurses Association of British Columbia. Mr. Hickey has been involved with the Canadian HIV/AIDS community movement since his HIV diagnosis in 1985. He has formed international ties as a result of his work with UNAIDS and international HIV/AIDS nursing groups in the United States, the United Kingdom and Africa.

René Lavoie
René Lavoie is the coordinator of the Réseau Sida/maladies infectieuses du Fonds de recherche en santé du Québec. He is former 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 Study and participates in other research on gay men. Mr. Lavoie is a long-time gay activist and founder of a number of programs for gay men. He was a member of the National Reference Group on Gay Men.

Gerry McConnery
Gerry McConnery is an active front-line volunteer worker in Alberta. He has been Co-Chair of the Alberta Positive Network since 1999 and works closely with the Alberta Community Council on HIV. Mr. McConnery has six years experience as an HIV peer-support worker and is active in the AIDS Calgary Speakers Network. He is an advocate for improved access to blood-testing facilities in rural southern Alberta. Mr. McConnery sits on the boards of directors of AIDS Calgary and the Canadian AIDS Society.

Sheena Sargeant
Sheena Sargeant is Coordinator of Education Programs at YouthCO AIDS Society in Vancouver. She has worked directly with youth to develop prevention education programming. Ms. Sargeant was selected as the Canadian youth representative to the UN Theme Meeting on Youth in 2001. In 2002, she was selected by the Canadian Public Health Association to deliver HIV/AIDS peer education best practices training for UNICEF in Eastern Europe. After serving as a member of the British Columbia Ministry of Health Planning's HIV/AIDS Advisory Committee for a year, Ms. Sargeant was appointed Co-Chair in 2001.

Esther Tharao
Esther 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 countries where HIV is endemic. She has spoken on this subject at many conferences, including the annual conference of the Canadian Association for HIV Research. Ms. Tharao is 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.

Art Zoccole
Art 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. Mr. Zoccole has coordinated the Aboriginal Women and AIDS Forum, the 3rd Canadian Conference on HIV/AIDS, and initiatives on 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 former coordinator of British Columbia's Red Road HIV/AIDS Network Society and former Executive Director of the Canadian Aboriginal AIDS Network. He is Executive Director of 2-Spirited People of the First Nations.

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

To find out more about the Ministerial Council on HIV/AIDS, visit the Council's web site at:

http://www.phac-aspc.gc.ca/aids-sida/fi-if/minister-eng.php (english)

http://www.phac-aspc.gc.ca/aids-sida/fi-if/minister-fra.php (français)

Appendix 4: Date and Location of Ministerial Council meetings during 2002-2003

June 8-10, 2002 Ottawa

Special Presentations:

1. National Aboriginal Council on HIV/AIDS:
   1. Todd Armstrong, Pauktuutit Inuit Women's Association and the Canadian Inuit HIV/AIDS Network
   2. Denise Lambert, Kimamow Atoskanow Foundation
   3. David Lee, Needle Exchange Program, Downtown Eastside Vancouver
   4. Duane Morrisseau, Métis National Council
2. Canadian Strategy on HIV/AIDS Direction-Setting Follow-up Meeting - Summary of Outcomes: Steven Sternthal, HIV/AIDS Policy, Coordination and Programs Division, Health Canada

November 17-18, 2002 Ottawa

Special Presentations:

1. Immigration and HIV/AIDS: Dr. Brian Gushulak, Director General, Medical Services, Citizenship and Immigration Canada
2. World AIDS Day: Update
   1. Steven Sternthal, HIV/AIDS Policy, Coordination and Programs Division, Health Canada
   2. Lucie Vignola, HIV/AIDS Policy, Coordination and Programs Division, Health Canada
3. Canadian Strategy on HIV/AIDS Strategic Plan and Five-Year Review of the federal role in the Strategy:
   1. Steven Sternthal, HIV/AIDS Policy, Coordination and Programs Division, Health Canada
   2. Marsha Hay Snyder, HIV/AIDS Policy, Coordination and Programs Division, Health Canada

Meeting with the Minister

March 1-3, 2003 Toronto

Special Presentations:

1. Social Justice Concepts: Sholom Glouberman, Ministerial Council on HIV/AIDS
2. International Trade: Richard Elliott, Ministerial Council on HIV/AIDS