The Ministerial Council On HIV/AIDS

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Annual Report April 1, 2003 - March 31, 2004

6.2 Comprehensive prevention, care, treatment and support for all communities

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 in Canada. 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 of this report) highlighted as a key commitment the engagement of vulnerable populations at the national level. At the suggestion of the national stakeholders and the Ministerial Council, Health Canada undertook an initiative in 2002-2003 to engage vulnerable populations and people living with HIV/AIDS in the renewal process of the Canadian Strategy on HIV/AIDS and in determining policies and practices that affect their lives. This work has been incorporated into the Canadian Strategy on HIV/AIDS draft Action Plan, Leading Together: An HIV/AIDS Action Plan for All Canada 2004-2008, which will be finalized during the summer of 2004 after extensive national consultation with stakeholders.

There is a continuing need for strong prevention, care, treatment and support programs. Health Canada estimates that between 2800 and 5200 new HIV infections occur each year. In 2002, an estimated 40% of new infections were in men who have sex with men, 30% occurred in injection drug users and 24% occurred through heterosexual contact. Nearly 25% of new infections in Canada in 2002 were in women. Aboriginal peoples and people from HIV-endemic countries (Africa and Caribbean) each accounted for between 6% and 12% of new HIV infections in 2002. An estimated 56,000 Canadians live with HIV.

A Health Canada-sponsored national telephone survey completed in 2003 revealed that most Canadians do not consider themselves at significant risk for HIV infection and that one person in five believes that HIV/AIDS can be cured if treated early. The same survey highlighted the magnitude of stigma and discrimination surrounding HIV/AIDS: almost half of Canadians believe that people living with HIV/AIDS should not be allowed to work in public positions. In 2003 the Canadian HIV/AIDS Legal Network launched a project on stigma and discrimination in partnership with other organizations in order to address this issue. This is a global, as well as a Canadian, concern: the theme for World AIDS Day 2003 was stigma and discrimination for the second consecutive year (see section 6.5.1 of this report).

The need for new prevention approaches for youth was an active issue during 2003-2004 with the publication of the Council of Ministers of Education study on Canadian Youth, Sexual Health and HIV/AIDS. The study, involving 11,000 students in Grades 7, 9 and 11 across Canada, revealed that:

• students in 2002 have lower levels of sexual knowledge than those surveyed in 1989
• two-thirds of Grade 7 students and half of Grade 9 students believe there is a cure for HIV/AIDS
• fear of harmful outcomes has only a slight impact on decisions to become sexually active
• students are familiar with condom use but use condoms less than half the times they have intercourse.

The Ministerial Council studied this report and kept a watching brief on the issue of youth and prevention during 2003-2004. Health Canada informed the Council that it intended to use the results of the youth survey to provide direction for awareness-raising among Canadians. The Council‘s Research and Championing committees examined the telephone and youth surveys and will facilitate a discussion of the full Council concerning their implications and what to advise the Minister.

6.2.1 Populations from HIV-endemic countries (African and Caribbean communities)

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. It is estimated that 70% of all maternal HIV transmissions to children in Canada have occurred among women of African and Caribbean origin. An estimated 3700 to 5700 people who were born in HIV-endemic countries were living with HIV at the end of 2002, accounting for 7%-10% of the national total. Most of them were infected since living in Canada. Close to 16% of AIDS cases in Canada in the first six months of 2002 occurred in communities from HIV-endemic countries (up from 8.3% in 1999); these communities represent 2% of the Canadian population.

Diagnosis of HIV infection is also occurring among older children from HIV-endemic countries 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 in order to minimize the potential for stigmatization of communities. HIV is now reportable in all jurisdictions in Canada but most jurisdictions do not collect data on ethnicity. There is a growing recognition by communities of the need to do so in order to understand the leading edge of the HIV epidemic. This remains a contentious issue that must be resolved with the communities affected. A Health Canada Epi Update on populations from HIV-endemic countries is expected to be released in April 2004.

Work done during 2003-2004

• The Ministerial Council followed this issue closely through its link with the Federal/Provincial/Territorial Advisory Committee on HIV/AIDS and through Council members' involvement on the Ontario African and Caribbean Council on HIV/AIDS.
• A member of the Ministerial Council attended the 2003 National HIV/AIDS/STI (sexually transmitted infections) Surveillance Meeting where she made a presentation on HIV/AIDS surveillance data elements and populations from HIV-endemic countries in Canada.
• The Council studied the report of the National Surveillance Meeting to determine if further work was required on this issue.
• The Council had a presentation on HIV/AIDS surveillance in Canada, including issues of identifying ethnicity, from the HIV/AIDS Epidemiology and Surveillance Division, Health Canada.

Future activities
The Ministerial Council will continue to monitor these issues and provide advice to the Minister.

6.2.2 Women and HIV/AIDS

The issue
HIV infection rates among women in Canada have been rising steadily in recent years. The number of diagnosed and reported HIV infections in women has increased, particularly in women aged 20-39 (many of whom are Aboriginal), African and Caribbean women from HIV-endemic countries (most of whom were infected in Canada) and injection drug users. Women now account for 23% of all new infections and 45% of HIV infections in people aged 15-29. At the end of 2002, an estimated 7700 women were living with HIV in Canada. The women who are most at risk may not have the knowledge, resources or power within their relationships to protect themselves from infection.

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, transmission of HIV from mother to child has been almost eliminated: the proportion of infants in Canada confirmed infected has dropped from 50% in 1991 to 2% in 2002; only three infants were confirmed HIV-positive in 2002. These numbers do not reflect all infants exposed to HIV because some women are unaware of their HIV status. Prenatal HIV testing programs are now in place in all provinces and territories in Canada. In some provinces, women have to give their consent to be tested while in others they are automatically tested unless they specifically ask not to be tested for HIV. The Federal/Provincial/ Territorial Advisory Committee on HIV/AIDS has issued Guiding Principles for HIV Testing of Women during Pregnancy that support the principles of voluntary testing, confidentiality and informed consent.

During 2002, 90% of known HIV-positive pregnant women seen at specialty clinics received at least some antiretroviral treatment. There are no data regarding the potential long-term effects of these treatments on women and their children. Recent research has shown possible developmental differences between HIV-negative children exposed to antiretrovirals before birth and those who were not exposed to either HIV or antiretrovirals. A national group of stakeholders has been working to develop the Canadian Perinatal Exposure to Antiretrovirals Registry in order to monitor such long-term effects.

Work done during 2003-2004

• The Ministerial Council continued to advise the Minister that a Canadian registry of HIV-infected women and their antiretroviral-exposed children must be established so that the short- and long-term effects on woman and their children of antiretroviral therapies during pregnancy can be determined. The Council had recommended to the Minister during 2001-2002 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. In her reply to the Council in 2003, the Minister stated 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 Ministerial Council wrote again to the Minister about this issue in 2003. In its letter, the Council cited recent research showing the possibility of developmental effects on children from antiretroviral therapy taken during pregnancy. The Council strongly advised that since the federal government has responsibility for post-approval surveillance of drugs, it therefore has an obligation to ensure that women and children exposed to antiretroviral therapies are monitored over the long term. The Council recognized the obstacles outlined by the Minister in her 2003 letter but thought that the barriers could be overcome. The Council suggested that a portion of the increased funds provided in the 2003 federal budget for improving the drug review process in Canada, including post-approval surveillance, could be used to develop the perinatal exposure surveillance system. The Council offered its assistance to the Minister in working with appropriate stakeholders to overcome the potential obstacles she had outlined in her letter.
• The Ministerial 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 Ministerial Council advised the Minister that, to provide an alternative to breast feeding, baby formula should be covered as a benefit for HIV-positive mothers from Aboriginal populations whose health benefits are provided by Health Canada (First Nations and Inuit Health Branch) under the Non-Insured Benefits program that covers the cost of First Nations health care not paid for by the provinces and territories. Research has shown that breast feeding presents a 14% risk of HIV transmission from mother to child.
• The Ministerial Council studied the issue of HIV screening for pregnant women and whether to advise the Minister to dialogue with the provinces and territories about making such testing completely voluntary in all jurisdictions by informing women that they could choose to be tested (opting in) rather than making testing the default position unless women request to opt out of the test.
• The Ministerial Council continued to monitor women's issues, in particular those raised by the National Reference Group on Women and HIV/AIDS (disbanded in 2001) which gave advice on policy and program priorities that informs Health Canada's work planning.

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
Men who have sex with men (including gay and bisexual men) continue to be the group most affected by HIV/AIDS in Canada. Close to 60% 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 since 1990, particularly among younger gay men, is a cause for concern. In 2002, close to 40% of new infections were in men who have sex with men. This highlights the lack of investment in prevention programs targeted to gay men in recent years. It may also indicate a need for a greater understanding of the broader social and cultural factors that affect men who have sex with men, in order to support them in sustaining long-term healthy behaviours.

Members of the gay community have called for an approach to HIV prevention and treatment in the context of gay men's health, including psychosocial health. 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. The Canadian Strategy on HIV/AIDS draft Action Plan for 2004-2008 incorporates some of the principles of these reports. Aboriginal two-spirited people are seeking to provide their perspectives on behalf of the two-spirited community.

During 2003-2004, work progressed on the establishment of a pilot surveillance system at sentinel centres across Canada to track risk behaviour among men who have sex with men in urban and semi-urban centres (see section 6.4.7 of this report).

Work done during 2003-2004
The Ministerial Council continued to monitor the issues of gay men and supported a renewed emphasis on HIV prevention and care for gay men.

Future activities
The Ministerial Council will continue to champion these issues.

6.2.4 Sex workers

The issue
Sex workers are a population that is vulnerable to HIV transmission. Prevention, care, treatment and support programs for sex workers have been supported by the Canadian Strategy on HIV/AIDS, largely through funding to community-based organizations. Current HIV/AIDS surveillance does not capture data about the sex trade, but some research has been funded by the Strategy.

Work done during 2003-2004
The Ministerial Council kept a watching brief on issues involving sex workers.

Future activities
The Ministerial Council will continue to monitor these issues.

6.2.5 Injection drug use (policy)

The issue
Injection drug users are among the fastest growing populations of newly infected Canadians. Issues faced by Aboriginal peoples are of particular concern. 20% of people living with HIV/AIDS in Canada are injection drug users. There has been some progress in prevention—in 2002, 30% of new infections occurred among injection drug users, down from 34% in 1999—but this population remains vulnerable. Strategy-funded initiatives involving injection drug use have included: the 2002 First National Harm Reduction Conference sponsored in part by Health Canada; the 1999 report of the Canadian HIV/AIDS Legal Network, Injection Drug Use and HIV/AIDS: Legal and Ethical Issues; and the Legal Network's initiative to champion the inclusion of drug users and other marginalized populations in all of the Network's activities and to encourage other organizations to do the same.

Health Canada has commissioned studies on drug use and HIV, including a study on the provision of controlled substances to HIV-positive injection drug users in health care settings. Injection drug use has legal as well as health aspects, which necessitates inter-departmental collaboration between the departments of Health, Justice and the Solicitor General.

Canada's Drug Strategy, which is linked to HIV issues, but not funded by the Canadian Strategy on HIV/AIDS, is coordinated by Health Canada. The Drug Strategy has the goal of reducing the harm done by alcohol and drugs to individuals, families and communities. Stakeholders are still debating 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 access to care, treatment and support by people who use illicit drugs (including people living with HIV/AIDS).

During 2002 Health Canada issued guidelines for granting exemptions from the Controlled Drugs and Substances Act so that pilot supervised injection sites could begin operating in jurisdictions that requested them. Canada's Drug Strategy provided operational guidelines for communities interested in establishing a pilot site. Vancouver opened a supervised injection site in 2003. In addition, controlled trials of medically-prescribed heroin-assisted therapy have been designed and are moving through the review and approval process.

The Ministerial Council champions issues related to injection drug use and provides advice focused on inter-departmental 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. The Ministerial Council has strongly urged 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.

The research aspects of injection drug use are discussed in section 6.4.5 of this report.

Work done during 2003-2004

• The Ministerial Council built on its extensive work in previous years on injection drug issues focusing on: harm reduction; social justice; inter-departmental and inter-governmental collaboration; and prevention, care, treatment and support.
• At its September 2003 meeting with the Minister of Health, the Ministerial Council expressed its satisfaction with the progress made on supervised injection sites.

Future activities
The Ministerial Council will continue to monitor these issues and provide advice to the Minister of Health.

6.2.6 HIV testing

The issue
HIV testing has several dimensions: health, legal, ethical, technical and economic. The advent of rapid, low-cost testing can make HIV testing more accessible both in Canada and in developing countries, which can support more effective prevention, care, treatment and support programs. At the same time, rapid low-cost tests, particularly those that are self-administered, reduce the possibility that persons being tested will receive adequate support, counselling and referral. Ethical issues involving testing include: whether to request information on ethnocultural origin when testing and whether and how to report this information as part of HIV/AIDS surveillance in ways that do not lead to increased stigma and discrimination; and whether those being tested are genuinely giving informed consent. The development of policies and programs involving HIV testing requires intra- and inter-governmental collaboration at the federal level, collaboration at the federal/provincial/territorial level and partnership with a variety of stakeholders. HIV testing is also discussed in this report in sections 6.2.1 (Populations from HIV-Endemic Countries), 6.2.2 (Women and HIV/AIDS) and 6.4.7 (Epidemiological surveillance).

Work done during 2003-2004
The Ministerial Council maintained a watching brief on HIV testing issues.

Future activities
The Ministerial Council will continue to monitor these issues and provide advice to the Minister.

6.2.7 Medical use of marihuana (policy)

The issue
Marihuana has been recognized as a useful therapy for some persons living with HIV/AIDS. Following a series of court decisions that declared unconstitutional the denial of access to marihuana for medical purposes and required the government to provide a lawful source of seed and dried marihuana, Health Canada began granting exemptions in 1999 for medical marihuana use. In doing so, Canada became the first government in the world to provide medical marihuana. In 2000, Health Canada began to develop new regulations and interim policies and entered into a contract with a Saskatoon company to produce marihuana for research purposes (and by 2003 for distribution purposes to patients). In July 2003, Health Canada announced an interim policy and in December 2003 announced the amendment of the Marihuana Medical Access Regulations to provide for reasonable access to a legal source of marihuana for medical purposes. The amended regulations reduce barriers to access. As of September 2003, 642 persons in Canada were authorized to possess marihuana for medical purposes and 500 persons were authorized to cultivate or produce marihuana. During 2002-2003, Health Canada established a Stakeholder Advisory Committee on Marihuana for Medical Purposes in order to dialogue with stakeholders with a view to further amending the regulations in 2004.

Under present regulations, the need for medical marihuana must be attested by a physician and only specialists may prescribe marihuana, whereas the majority of HIV-positive patients are cared for by primary care physicians rather than specialists. Professional medical bodies have advised physicians not to put themselves at risk of prosecution by prescribing marihuana. This further reduces access to medical marihuana by persons living with HIV/AIDS. Health Canada provides a research literature summary for health care professionals on the medical use of marihuana so that they may become better informed. The research aspects of the medical use of marihuana are discussed in section 6.4.6 of this report. Further details of Health Canada's medical marihuana programs.

Work done during 2003-2004

• The Ministerial Council had special presentations on the medical use of marihuana at its September 2003 meeting from a representative of the Canadian AIDS Society and from two Health Canada officials. The presentation of the Canadian AIDS Society focused on: obstacles to access; lack of research; and Health Canada's lack of progress on stakeholder concerns.
  
  The Health Canada presentation focused on: the history of Health Canada's medical marihuana program; supply options, costs and distribution; research; and the concerns of stakeholders, physicians, pharmacists, law enforcement officials and municipalities.
  
  The Council discussion following these presentations centered on: consultation with stakeholders and policy development that reflects this consultation; research; access to high-quality marihuana and a variety of types; the cost of legal appeals by the Government of Canada against the court decisions requiring access to medical marihuana; the use of compassionate access programs; and comparisons with the more liberal marihuana access policy now in effect in the Netherlands. The Health Canada officials reported that discussions were underway with pharmacists about a potential role in distribution, and with physicians to consider whether family physicians can be considered specialists for the purpose of prescribing marihuana.
  
  The Council subsequently wrote to Health Canada stating that the Council would continue to monitor the issue, paying particular attention to:
  • the strength, quality and type of marijuana supplied by Health Canada to those with legal permission to obtain it for medical use
  • the difficult situation created when people are required to give up their licence to produce in order to obtain the Health Canada product and then receive a product whose quality does not meet their therapeutic needs
  • the development of an over-arching research strategy with clear research goals
  • the cumbersome application process
  • the availability of product through compassionate access programs to those who need it
  • the legal costs incurred by the Government of Canada in resisting court applications and appealing decisions
  • the involvement of stakeholders in addressing issues.
    
• In its March 2004 reply to the Council's letter, Health Canada provided an update on recent developments:
  • The government can now distribute marihuana product to patients.
  • The quality of government-produced marihuana will be assured by adherence to standards
  • Patients who surrender their growing licence in favour of receiving government-produced marihuana can now request reactivation of their personal production licence without submitting a new application for cultivation. This measure will reduce delay.
  • The application form is being made more user-friendly.
  • The annual renewal process is being streamlined.
  • Consultations are underway with stakeholders to discuss amendments to the regulations.
  • A research strategy has been in place since 1999 and Health Canada is exploring ways to improve the strategy.
    
• In its meeting with the Minister, the Ministerial Council raised the issue of medical marihuana and urged the Minister to:
  • champion a multi-stakeholder meeting to work on guidelines that are practical and acceptable to all stakeholders
  • direct Health Canada to bring together appropriate stakeholders to develop a research strategy
  • direct Health Canada to provide a compassionate access program so that those who need marihuana can obtain it until a workable system is developed
  • encourage the federal government's withdrawal from appealing a court decision requiring the provision of medical marihuana
  • reconsider the strategy of dealing with this issue from a legal perspective and instead deal with it as a health issue.
  

 

Future activities
The Ministerial Council will continue to monitor these issues and provide advice to the Minister.

6.2.8 Co-infections (policy)

The issue
Many persons who are vulnerable to HIV infection or living with HIV/AIDS are also living with other infections or diseases such as tuberculosis, Hepatitis C and a variety of sexually transmitted infections, and the co-morbidities of addictions or mental illness. They require prevention, care, treatment and support programs that recognize the complex nature of living with more than one infection or medical condition. Effective responses to co-infection require research, intra- and inter-governmental collaboration, and involvement by a variety of stakeholders. The 2003 reorganization of Health Canada's Centre for Infectious Disease Prevention and Control was intended to provide greater opportunities for collaboration between staff working with HIV/AIDS and those working on Hepatitis C, tuberculosis and sexually transmitted infections. A multi-stakeholder consensus-building meeting on co-infections was held in conjunction with the 4th Canadian HIV/AIDS Skills Building Symposium in November 2003. The purpose of the meeting was to raise the profile of co-infection issues.

Work done during 2003-2004
The Ministerial Council monitored this issue. A member of the Council participated in meetings of the planning committee for the national multi-stakeholder consensus-building meeting held in November 2003.

Future activities
The Ministerial Council will continue to monitor these issues and provide advice to the Minister.

6.2.9 Aboriginal peoples and HIV/AIDS

The issue
The HIV epidemic is growing among Aboriginal peoples (First Nations, Inuit and Métis). An estimated 3000-4000 Aboriginal people in Canada were living with HIV at the end of 2002, accounting for 5-8% of the national total. Aboriginal peoples now account for 6-12% of new infections even though they constitute only 3% of Canada's population. These figures may understate the problem because most jurisdictions do not collect information on the ethnicity of persons diagnosed with HIV; in addition, these figures are based primarily on information collected among First Nations peoples and do not include Métis, Inuit or First Nations peoples living off-reserve.

The Canadian Strategy on HIV/AIDS provides $2.6 million annually to programs for Aboriginal communities. In addition, there are dedicated funds for an Aboriginal research program. The First Nations and Inuit Health Branch (FNIHB) of Health Canada spends an additional $2.5 million annually on HIV programs for Inuit and on-reserve First Nations peoples. FNIHB participates in the Federal/Provincial/Territorial Advisory Committee on HIV/AIDS in order to facilitate inter-governmental collaboration.

In October 2003 an Aboriginal Strategy on HIV/AIDS was developed in partnership between the National Aboriginal Council on HIV/AIDS, the Canadian Aboriginal AIDS Network and Health Canada's Centre for Infectious Disease Prevention and Control and the First Nations and Inuit Health Branch. The Aboriginal Strategy, Strengthening Ties - Strengthening Communities, offers a vision for First Nations, Inuit and Métis peoples to respond to HIV/AIDS. More than 170 stakeholders were consulted on the Aboriginal Strategy. The Aboriginal Strategy identifies nine strategic areas of activity: coordination and technical support; community development, capacity building and training; prevention and education; sustainability, partnerships and collaboration; legal, ethical and human rights; engaging Aboriginal groups with specific needs; supporting broadly-based harm reduction approaches; holistic care, treatment and support; and research and evaluation.

The National Aboriginal Council on HIV/AIDS (NACHA) advises Health Canada on policy and programming responses to HIV/AIDS in Aboriginal communities. NACHA is composed of four caucuses: First Nations, Inuit, Métis and Community. NACHA has been involved in the Five-Year Review and the draft Action Plan 2004-2008 of the Canadian Strategy on HIV/AIDS, the transfer of the Aboriginal Community-Based Research Program from Health Canada to the Canadian Institutes of Health Research, and the National HIV/AIDS Awareness Campaign. The Secretariat for NACHA is housed in the HIV/AIDS Policy, Coordination and Programs Division of Health Canada. Further information on the National Aboriginal Council on HIV/AIDS .

December 1 is Aboriginal AIDS Awareness Day in Canada.

The Ministerial Council remains aware of Aboriginal issues and works through its links to the National Aboriginal Council on HIV/AIDS (NACHA), which has primary responsibility for advising Health Canada on Aboriginal issues and HIV/AIDS. During 2002-2003, the Ministerial Council disbanded its Special Working Group on Aboriginal Issues because of the creation of NACHA and the Ministerial Council's links to it. The Ministerial Council's 2001 Situational Analysis report on Aboriginal issues continues to be a widely-used foundation document.

Work done during 2003-2004

• The Ministerial Council reviewed the work and funding allocations of Health Canada's First Nations and Inuit Health Branch with respect to HIV/AIDS programs as part of the Council's ongoing role in monitoring the Canadian Strategy on HIV/AIDS.
• The Council advised the Minister that access to baby formula for infants born to HIV-positive Aboriginal women 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.
• The Ministerial Council developed mini-reports following each Council meeting to keep the National Aboriginal Council on HIV/AIDS informed of Ministerial Council activities.
• As part of its involvement in the transfer of community-based research programs from Health Canada to the Canadian Institutes of Health Research, the Ministerial Council participated in some initial discussions about the transfer of the Aboriginal Community-Based Research Program. For more details about community-based research programs, see section 6.4.2 of this report.

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

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