The Ministerial Council On HIV/AIDS

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Annual Report April 1, 2003 - March 31, 2004

6.5 Canada's international response to HIV/AIDS

Overview
HIV/AIDS is a global issue, with more than 40 million people infected worldwide and an infection rate of five million people a year. More than 95% of new infections are in developing countries. The Joint United Nations Programme on HIV/AIDS (UNAIDS) predicts that by 2005 more than 50 million people will be living with HIV/AIDS. An estimated 20 million people worldwide have died of AIDS. The Canadian Strategy on HIV/AIDS has a component of international collaboration housed within Health Canada with a budget of $300,000, focused on information sharing and coordination of Canada's international activities. In addition, the Canadian International Development Agency (CIDA) spends more than $50 million a year on international HIV/AIDS programs. The Consultative Group on HIV/AIDS and International Issues, a multi-sectoral group including government and community representation, serves as a forum for consultation and discussion of Canada's international HIV/AIDS activities.

Canada has close ties with the Joint United Nations Programme on HIV/AIDS (UNAIDS) and will become Chair of the UNAIDS Programme Coordinating Board in June 2004. Health Canada and UNAIDS signed a renewed agreement of cooperation for 2003-2006 which encourages collaboration on joint activities such as policy dialogues, conferences, dissemination of best practices and research, epidemiology and surveillance, and staff secondments.

Canada's international response to HIV/AIDS has been a major focus for the Ministerial Council in 2003-2004. During 2003-2004, the Ministerial Council established as one of its five strategic directions Canada's international response to HIV/AIDS and struck an ad-hoc Committee on International Affairs to take the lead on this work. The Ministerial Council has worked to influence policy toward a more integrated approach to domestic and international aspects of the HIV/AIDS epidemic. As part of its attention to international issues, the Ministerial Council prepared a report on Canada's international response at the request of the Minister of Foreign Affairs and International Trade (see section 6.5.6 of this report).

The Ministerial Council expressed to the Minister of Health its willingness to broaden its mandate to include working with other departments to foster inter-departmental collaboration on Canada's international response, as was suggested by the Minister of Foreign Affairs and International Trade. The Ministerial Council also studied the human rights-based approach to health in an international context and its relation to the Canadian social justice framework approach to HIV/AIDS. The Ministerial Council raised international issues in its meetings with both the former and the new Minister of Health.

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 and 2003 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, Canada's Minister of Health has released an annual report on the Canadian Strategy on HIV/AIDS. The 2003 World AIDS Day report, Looking Forward: Focussing the Response - Canada's Report on HIV/AIDS 2003. The report is an overview of Canada's domestic and international response to HIV/AIDS. In Canada, the week preceding December 1 is HIV/AIDS Awareness Week and December 1 is also Aboriginal AIDS Awareness Day.

Work done during 2003-2004

• The Ministerial Council contributed a message to the World AIDS Day annual report. The Council's message called for an urgent increase in the federal investment in the Canadian Strategy on HIV/AIDS and supported the development of a strategic plan for the Strategy which would more fully align Canada's domestic and international responses to HIV/AIDS.
• The Ministerial Council was represented on the Editorial Board of the World AIDS Day annual report. The Council reviewed the report and provided input to Health Canada.
• The Council advised the Minister on her messages for World AIDS Day and on possible ministerial activities. In its meeting with the Minister, the Council encouraged her to highlight the impact of stigma and discrimination that still occurs in Canada, as evidenced by recent opinion surveys showing lack of awareness and discriminatory attitudes. 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 Minister said that she would be visible on World AIDS Day to underscore its importance. The Council was subsequently disappointed by the Minister's lack of participation in World AIDS Day events and planned to raise the importance of ministerial visibility with the new Minister.

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. The Council will also continue to participate on the Annual Report Editorial Board. The Council will encourage the new Minister to participate in World AIDS Day activities in a visible way.

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 of this report). Canada has signed the Declaration of Commitment which requires governments to report annually on their implementation of the Declaration. In signing the Declaration, Canada committed itself to: secure more resources to fight HIV/AIDS; ensure that a wide range of prevention programs are available; ensure that young people have access to information, education and services to reduce their vulnerability to HIV/AIDS; reduce the rate of infection in young people; reduce the proportion of infants born with HIV; strengthen anti-discrimination and human rights protection for people living with HIV/AIDS and vulnerable groups; strengthen participatory programs to protect the health of those most affected by HIV/AIDS; empower women to reduce their vulnerability; and develop national strategies to strengthen health care systems and address access to HIV/AIDS drugs.

Canada's second national progress report on meeting the UNGASS commitments was submitted to the United Nations in 2003, when the first set of targets of the Declaration of Commitment became due. The report was developed in consultation with stakeholders and included submissions by Health Canada and the Canadian International Development Agency which were combined into a single report by the Department of Foreign Affairs and International Trade. The report outlined Canada's progress using indicators developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS) to measure outcomes. Health Canada is developing data collection mechanisms which reflect these indicators, in collaboration with a variety of stakeholders.

In 2003, the Prime Minister and the Minister of Foreign Affairs and International Trade participated in the United Nations General Assembly High Level Meeting on HIV and AIDS, the first follow-up meeting to UNGASS. The Prime Minister stressed the need to combat stigma and discrimination with respect to HIV/AIDS.

As part of Canada's response to UNGASS, the International Affairs Directorate of Health Canada prepared a report in 2002 for distribution to the Canadian business community, Enhancing Canadian Business Involvement in the Global Response to HIV/AIDS .The report makes the case for business involvement on the basis of corporate social responsibility and the economic devastation caused by HIV/AIDS.

Work done during 2003-2004

• The Ministerial Council wrote to the Minister to provide advice on Canada's 2003 UNGASS follow-up report. The Council:
  • urged the Minister to ensure better coordination of the reporting process and closer collaboration among federal departments, provinces and territories, and stakeholders
  • offered to contribute to the process of developing the UNGASS follow-up report.

Further communication from the Minister and Health Canada indicated that most of the Ministerial Council's concerns had been acted on. The Minister encouraged the Council to work with Health Canada on improving the reporting process.

• The Ministerial Council wrote to Health Canada's International Affairs Directorate recommending that it follow up on the recommendations of its 2002 report, Enhancing Canadian Business Involvement in the Global Response to HIV/AIDS, and that it establish a multi-stakeholder group to develop a long-term action plan that would outline what the private sector can do in Canada and identify the potential role the private sector can play in responding to HIV/AIDS internationally. The Ministerial Council offered to provide further recommendations as the process unfolded.
  The report was distributed more widely in 2003 by Health Canada to Canadian business groups on the advice of the Ministerial Council.

Future activities
The Ministerial Council will continue to monitor Canada's follow-up to UNGASS, advise the Minister of Health on these issues and contribute to the process of developing Canada's UNGASS follow-up report.

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, calling 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. Canada's contribution to the Global Fund is the responsibility of the Canadian International Development Agency (CIDA) (see section 6.5.4 of this report). Canada began a term on the board of the Global Fund in January 2004. In 2003 the House of Commons Subcommittee on Human Rights and International Development urged the government to triple its contribution to the Global Fund.

The Ministerial Council has consistently advised the Minister that Canada's contribution to the Global Fund must be increased.

Work done during 2003-2004

• The Ministerial Council reiterated its earlier advice to the Minister and to Health Canada that Canada should increase its contribution to the Global Fund.
• In its meeting with the Minister, the Ministerial Council stressed the importance of strengthening Canada's contribution to the Global Fund as well as to other international assistance in HIV/AIDS.

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

6.5.4 CIDA HIV/AIDS programs

The issue
The Canadian International Development Agency (CIDA) is the primary federal department contributing to international HIV/AIDS programs, although CIDA is not a formal partner in the Canadian Strategy on HIV/AIDS. CIDA reports to Parliament through the Minister for International Cooperation. CIDA's HIV/AIDS Action Plan was launched in 2000 and includes a commitment to a five-year investment totalling $270 million to a variety of international programs. In addition, CIDA is contributing:

• US$100 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria (see section 6.5.3 of this report)
• $50 million to support HIV vaccine research
• $12 million to a Canadian HIV/AIDS Coalition of non-governmental organizations in support of African youth, with a focus on social issues surrounding HIV/AIDS
• core funding to the Joint United Nations Programme on HIV/AIDS (UNAIDS) and other United Nations organizations engaged in HIV/AIDS initiatives
• bilateral funding for programs in numerous countries and regions of the world
• funding to Canadian organizations involved in international HIV/AIDS work.

CIDA's funding supports a number of innovative programs, including a twinning program that has paired the Vancouver Area Network for Drug Users with the Society for Service to Urban Poverty in New Delhi, India.

There is concern among Canadian stakeholders that CIDA programs need to be more closely integrated with the Canadian Strategy on HIV/AIDS and that greater collaboration between CIDA, Health Canada and other federal departments is needed to enhance Canada's international response to HIV/AIDS.
In 2003-2004, the Ministerial Council designated CIDA's HIV/AIDS programs as new strategic issue for its attention.

Work done during 2003-2004

• The Ministerial Council advised the Minister and Health Canada on the importance of including CIDA in inter-departmental collaboration on HIV/AIDS.
• The Ministerial Council requested a meeting with the Minister for International Cooperation.

Future activities
The Ministerial Council will continue to monitor CIDA's HIV/AIDS programs and advise the Minister of Health and other government officials as appropriate.

6.5.5 International trade

The issue
The World Trade Organization's agreements to which Canada is signatory affect Canada's ability to fulfil its promise to make HIV/AIDS medications available to developing countries. This issue was the subject of recommendations in the Ministerial Council's report on international issues (see section 6.5.6 of this report). Following on its public commitment to make affordable HIV/AIDS medication available to developing countries, the federal government introduced legislation that would allow compulsory licensing of pharmaceutical inventions patented in Canada for the purpose of making generic products for export to countries with no or insufficient pharmaceutical manufacturing capacity of their own. Stakeholders were in favour of making affordable drugs available to developing countries, but had reservations about provisions in the proposed law that would allow pharmaceutical companies who hold patents to take over the contracts that generic manufacturers negotiate with developing countries, thus removing the incentive for generic manufacturers to engage in supplying lower-cost drugs.

Work done during 2003-2004

• In its meeting with the Minister, the Ministerial Council stressed the recommendations contained in the Council's report on international issues aimed at ensuring that the Government of Canada supports efforts to improve access to more affordable medicines in developing countries.
• The Ministerial Council wrote twice in early 2004 to the new Minister of Health about legislation tabled in the House of Commons (Bill C-9) which was intended to facilitate access to affordable pharmaceutical products by developing countries. In its first letter, the Council recommended to the Minister that the government remove provisions of the proposed legislation that would permit pharmaceutical companies holding patents to take over contracts that generic manufacturers may have negotiated with developing countries, thereby removing the incentive for generic manufacturers to become involved, and thus nullifying the intent of the legislation. The Council also recommended that the legislation permit generic manufacturers in Canada to directly contract with non-governmental humanitarian organizations to distribute medications, rather than restricting this right to governments in developing countries.
  In its second letter, the Ministerial Council expressed its pleasure at the removal from the proposed legislation of the provisions it had discussed in its first letter. The Council expressed concern at an alternate proposal from Canadian pharmaceutical companies that would undermine competition with generic manufacturers. The Council strongly urged the Minister to recommend that the government reject any provisions that would undermine access to more affordable medicines. The Council offered to meet with the Minister to discuss this issue.

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

6.5.6 Other international issues

The issues
A variety of other international issues were addressed by the Ministerial Council during 2003-2004, including an overview Canada's international response to HIV/AIDS through the development of a major report by the Council at the request of the Minister for Foreign Affairs and International Trade².

The Ministerial Council also considered the International AIDS Conference in 2004 in Bangkok, Thailand and the 2006 International AIDS Conference in Toronto. The Theme of the 2004 Bangkok conference is Access For All, with the objectives of increasing the scientific quality of the conference and unifying science and community efforts to secure access for all. The Canadian presence in Bangkok will be strong because Toronto is hosting the next conference in 2006.

Work done during 2003-2004

• The Ministerial Council responded to a request by the Minister of Foreign Affairs and International Trade made through the Minister of Health. In June 2003 the Minister of Foreign Affairs and International Trade asked the Ministerial Council to provide guidance on the international dimensions of HIV/AIDS, both in terms of Canada's international efforts and the effects on Canadians at home and abroad. He asked that the Ministerial Council address the following four issues, with a particular focus on Africa, with a view to identifying opportunities for Canadian political leadership in multilateral forums and bilateral relationships:
  • the interplay between HIV and food security, respect for human rights, women and HIV/AIDS, governance standards, and capacity in government and civil society
  • the impact of HIV on humanitarian crises, including the provision of humanitarian assistance, refugee and internally displaced populations, and agricultural development
  • the impact of HIV on regional politics in western and southern Africa, including political stability and post-conflict reconstruction
  • the economic implications for Canada and Canadian companies of growing infection rates in all countries with high rates of HIV/AIDS infection.
  

 

The Minister of Foreign Affairs and International Trade suggested that the Minister of Health consider broadening the membership of the Ministerial Council to reflect this new international mandate. The Minister of Foreign Affairs and International Trade requested that the Ministerial Council forward its recommendations to him before the September 2003 United Nations General Assembly High Level Meeting on HIV and AIDS which he and the Prime Minister would attend.

The Ministerial Council agreed to the request and hired two consultants to lead a consultation process and develop a report. Meetings were held with Ministerial Council members, Health Canada, the Department of Foreign Affairs and International Trade, the Canadian International Development Agency and Health Canada's multi-stakeholder Working Group on International HIV/AIDS Issues.

In early September, the Ministerial Council submitted its report, Meeting the Challenge: Canada's Foreign Policy on HIV/AIDS With a Particular Focus on Africa, to the Minister of Health for transmittal to the Minister of Foreign Affairs and International Trade. The report provided an analysis of Canada's present status with respect to HIV/AIDS and the Department of Foreign Affairs and International Trade and included recommendations for enhanced Canadian political leadership. The report's 61 recommendations were clustered in the areas of: Foundations; Demonstrating Leadership; Key Foreign Policy Directions; Specific Foreign Policy Initiatives; and Canadian Businesses Operating Abroad. In its letter of transmittal to the Minister of Health, the Ministerial Council highlighted the recommendations dealing with:

• a suggested announcement at the upcoming United Nations meeting that the Department of Foreign Affairs and International Trade will develop a comprehensive HIV/AIDS strategy, implement a plan for mainstreaming HIV/AIDS in its operations, and commit to basing Canada's foreign policy response to HIV/AIDS on the principles of human rights
• a leadership role for Canada among industrialized nations for encouraging the development of an equitable contributions framework for contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria
• equitable access to medications for all persons living with HIV.

The Ministerial Council suggested to the Minister of Health that the paper be shared with the Minister for International Cooperation, who is responsible for the Canadian International Development Agency, and offered to provide advice about possibilities for the paper's wider distribution. The Ministerial Council offered to meet with officials of the Department of Foreign Affairs and International Trade and other key ministries to discuss the recommendations of its report and possible next steps, and said it would welcome the opportunity to do further work in these areas.

• The Ministerial Council had a special presentation on its foreign policy report at its September 2003 meeting from one of the consultants who developed the paper.
• In its meeting with the Minister, the Ministerial Council requested a further meeting with the Minister to discuss its foreign policy report, including:
  • the substance of its 61 recommendations
  • ensuring that Health Canada participates in the coordinated, coherent government-wide response to the global epidemic that was called for by the Minister of Foreign Affairs and International Trade
  • defining the Ministerial Council's role in providing input on the Government of Canada's response to the global epidemic.

The Minister gave her assent to the Council contacting the Minister of Foreign Affairs and International Trade directly.

• The Ministerial Council wrote to the Minister of Foreign Affairs in March 2004 to follow up on its foreign policy report. The Council expressed its pleasure at the Department of Foreign Affairs' decision to create the position of Special Advisor on HIV/AIDS to the Minister of Foreign Affairs and a staff person to work on this issue; the Council offered to meet with staff and to engage in ongoing collaboration with the Minister and his department.
• The Ministerial Council met with a representative from the office of the Minister of Foreign Affairs to discuss the Ministerial Council's foreign policy report.
• In its regular discussions with Health Canada officials, the Ministerial Council stressed the importance of Health Canada playing a coordinating role with federal departments and agencies involved in the global response to HIV/AIDS.
• The Ministerial Council met the new Minister of Health in March 2004 and discussed issues arising from the 2004 International AIDS Conference in Thailand and the 2006 International AIDS Conference in Toronto.

Future activities
The Ministerial Council will continue to remain informed about international issues that have an impact on HIV/AIDS and will provide advice to the Minister and others as appropriate.

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² In December 2003, the Department of Foriegn Affairs and International Trade was split into two departments: Foriegn Affairs; and International Trade.

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