The Ministerial Council On HIV/AIDS

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Annual Report April 1, 2003 - March 31, 2004

6.0 Ministerial Council areas of work in 2003-2004

The following report provides details on major areas of work for the Ministerial Council in 2003-2004. Some readers of this report may choose to read selectively depending on their interests; there is therefore some repetition in the sections that outline issues so that all readers may have a full understanding of the work done by the Ministerial Council.

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 Intra- and inter-departmental collaboration in response to HIV/AIDS

Overview

Promoting both intra- and inter-departmental 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 Foreign Affairs and International Trade,¹ International Cooperation, Citizenship and Immigration, and the Solicitor General have been involved in HIV/AIDS issues during the past year. Several other federal departments could potentially be involved in the Canadian Strategy on HIV/AIDS in order to address the links between HIV/AIDS and issues such as homelessness or income security, for example. It is vital that federal ministries work in a collaborative way in order to make the Canadian Strategy on HIV/AIDS most effective. The 2003 report of the Commons Standing Committee on Health, Strengthening the Canadian Strategy on HIV/AIDS, stressed the importance of involving all relevant federal departments in a coordinated way. Both the Five-Year Review of the Strategy and the draft 2004-2008 Strategy Action Plan stress the need for greater involvement and coordination of federal departments and inter-governmental cooperation. In 2003-2004, Health Canada commissioned a discussion paper, Directions for Inter-departmental Collaboration on HIV/AIDS within the Federal Government, which it is using as a focus to guide its discussions with other departments. The Ministerial Council was invited by Health Canada to review this document.

In addition to inter-departmental collaboration within the Government of Canada, the Ministerial Council is concerned with inter-governmental 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.

The Ministerial Council has consistently encouraged the Minister to foster intra- and inter-departmental collaboration. This year the Ministerial Council actively disseminated two of its discussion papers in order to stimulate discussion and action on inter-departmental and inter-governmental collaboration:

• Towards a Broader Vision of Health: Strengthening Inter-Ministerial Collaboration on HIV/AIDS in Canada (Ministerial Council on HIV/AIDS, 2001). This paper was sent to the Minister and is available on the Ministerial Council's website.
• HIV/AIDS and Health Determinants: Lessons for Coordinating Policy and Action (Ministerial Council on HIV/AIDS, 2002, with the support of the Federal/Provincial/Territorial Committee on HIV/AIDS), which is intended to guide inter-departmental collaboration according to a population health framework . The Council sent this discussion paper to the Minister of Health in May 2003, suggesting that she use the paper as a tool in developing strong inter-departmental relationships on HIV/AIDS. In its letter, the Council identified the following departments as important targets:
  
  • Canadian International Development Agency
  • Citizenship and Immigration Canada
  • Correctional Service of Canada
  • Department of Foreign Affairs and International Trade
  • Human Resources Development Canada
  • Industry Canada
  • Department of Justice Canada.

The Ministerial Council offered its active support to the Minister in her efforts to foster stronger inter-departmental partnerships. During her meeting with the Ministerial Council in September 2003, the Minister stated that she hoped to play an important role in encouraging better inter-departmental collaboration.

During 2003-2004, the Minister of Health received a request from the Minister of Foreign Affairs and International Trade asking that the Ministerial Council assist the Department of Foreign Affairs and International Trade in identifying opportunities for Canadian political leadership and advocacy on international HIV/AIDS issues. The Minister of Health requested the Council to address these issues. This initiative was seen as an indication of the Government of Canada's interest in strengthening inter-departmental partnership on HIV/AIDS. Further details are given in section 6.5.6 of this report.

6.1.1 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 and the rate of seroconversion due to exposure in prison is thought to be high. A total of 223 inmates in federal penitentiaries (1.8% of the inmate population) were reported to be HIV-positive at the end of 2001. The HIV infection rate among female offenders is significantly higher than among male offenders. Adequate prevention, care, treatment and support for inmates are ongoing concerns.

The Correctional Service of Canada (CSC) is a partner in the Canadian Strategy on HIV/AIDS and is allocated $600,000 annually under the Strategy to undertake a range of prevention and education activities in federal prisons. CSC invests an additional $3 million annually in HIV/AIDS programming in federal penitentiaries. CSC is also a partner with Health Canada in Canada's Drug Strategy. In addition to providing health care, CSC has developed training programs in palliative care and staff training for self-protection against infectious diseases. CSC has also developed prevention messages for target populations, including Aboriginal inmates, injection drug users and women, as part of peer education and counselling programs which have been partially implemented. The Special Inmates Initiatives Program, available in a limited number of federal institutions, enables inmates to become directly involved in developing programs to improve HIV/AIDS awareness.

Although injection drug use and sexual activity occur in prison, access to needle exchange, condoms and methadone maintenance is limited. Approximately 500 inmates across Canada are participating in a methadone maintenance treatment program. 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.

Work done during 2003-2004

• The Ministerial Council wrote to the Minister reiterating its strong encouragement given in 2002-2003 that she meet with the Solicitor General, representatives of the Correctional Service of Canada and representatives of community-based organizations responding to HIV/AIDS in prisons, to discuss improved and expanded harm reduction measures in prisons, including needle exchange programs. The Council's letter cited many Canadian and international studies demonstrating the potential benefit of needle exchange and distribution programs in reducing the transmission of HIV and Hepatitis C. The letter also expressed the Council's concern over the federal government's apparent lack of action on implementing harm reduction measures. In her reply to the Council, the Minister stated that there is strong evidence of a need for harm reduction programs in prisons to decrease rates of HIV/AIDS and Hepatitis C infection. The Minister said that discussions had taken place between her office and the office of the Solicitor General. The Minister forwarded the Council's letter to the Solicitor General for his consideration.
• The Council explored the possibility of meeting with the Federal/Provincial/Territorial Heads of Corrections Working Group to begin a dialogue about HIV/AIDS prevention and treatment issues with a particular focus on barriers to delivering prevention programs, accessing treatment, and Aboriginal issues.

Future activities
The Council will explore the possibility of dialogue with the new Minister of Public Safety and Emergency Preparedness, who is the former Minister of Health. Her new portfolio includes the Correctional Service of Canada. The Council wishes to discuss with her the possibility of enhanced inter-departmental collaboration on HIV/AIDS issues in prisons. The Ministerial Council will continue to monitor these issues and provide advice to the Minister of Health.

6.1.2 Citizenship and Immigration Canada

The issue
In January 2002, HIV testing became mandatory for prospective immigrants 15 years of age and over. The present policy of Citizenship and Immigration Canada (CIC) is based in part on advice given in 2001 by the Minister of Health to the effect that mandatory testing was recommended by Health Canada and that HIV-positive persons should not be automatically excluded because of public health concerns. According to officials of Citizenship and Immigration Canada, close to 90% of those testing HIV-positive are admissible to enter Canada. The Ministerial Council does not support the mandatory testing policy, and has argued since 2000 that prevention education is an approach more consistent with respect for human rights.

In 2001, the Ministerial Council recommended that mandatory testing should follow the Canadian Medical Association Counselling Guidelines for HIV testing. The Council further advised CIC that, when determining if an HIV-positive person would be excluded on the grounds that they could cause excessive demand on the health care and social service system, CIC should use a cost-benefit approach that takes into account both the economic and non-economic contributions that the potential immigrant could make to the Canadian economy.

Work done during 2003-2004
The Ministerial Council followed up on its work during 2002-2003 and on its two briefings in 2002 with an official of Citizenship and Immigration which focused on testing, medical inadmissibility and the definition of excessive demand on the health care and social service system.
In 2003-2004, the Ministerial Council wrote to Citizenship and Immigration Canada (CIC). In its letter, the Ministerial Council:

• restated the Council's opposition to mandatory testing on the grounds that it would contribute to further stigmatization of both people living with HIV/AIDS and immigrants and refugees
• expressed concern about media coverage quoting a CIC official who indicated that mandatory testing protected the health and safety of Canadians and prevented excessive demand on health and social services; the Council offered to work with CIC to develop a communications strategy regarding public statements
• suggested that the federal government engage the provinces and territories in discussion about their release of data on the number of HIV-positive migrants residing in their jurisdiction
• asked for an update on, and expressed a desire to participate in, discussions of what constitutes excessive demand in the Immigration and Refugee Protection Regulations
• expressed a willingness to provide input to the development by CIC of exemptions for people living with HIV/AIDS seeking to enter Canada to work for organizations hiring HIV-positive foreign workers (for example, the International Council of AIDS Service Organizations [ICASO] which is based in Toronto; ICASO had experienced difficulty with the admission of a foreign worker and had communicated this experience to the Ministerial Council)
• inquired about measures to ensure the admission of persons living with HIV/AIDS who are planning to work for or attend the International AIDS Conference in Toronto in 2006 and encouraged CIC and Health Canada to ensure adequate training of CIC personnel in advance of the Conference
• offered to work with CIC to identify means of connecting HIV-positive migrants to follow-up health care and community services and support.

 

The reply from Citizenship and Immigration Canada (CIC) stated that:

• CIC would strive to ensure that positive messages regarding testing are delivered in future media coverage.
• the release of HIV testing information by provinces and territories is beyond the control of CIC and that Health Canada would be informed of this concern. (Health Canada is responsible for coordinating federal/provincial/territorial surveillance reporting at the national level.)
• the determination of "excessive demand" is under review.
• nearly 90% of all HIV-positive persons identified during immigration medical screening are admissible to enter Canada.
• the development of exemptions for international organizations hiring foreign workers living with HIV/AIDS has been discussed at the inter-departmental level by CIC, the Canadian International Development Agency, Foreign Affairs and International Trade, and Health Canada. An action plan has not yet been developed.
• CIC anticipates training for its officials in preparation for the 2006 International AIDS Conference in Toronto.
• all migrants who are tested for HIV are given a handout with information on health care and community support services.

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. The Co-Chairs of the Ministerial Council will meet with the Deputy Minister and other officials of Citizenship and Immigration Canada in April 2004.

6.1.3 Justice Canada

The issue
Criminal and other legislation pertaining to public health can have an impact on HIV/AIDS. The Supreme Court in 2003 heard a case involving compulsory notification of potential sexual partners by persons living with HIV/AIDS if they are aware of their status. Another example was the proposed Blood Samples Act, Bill C-217, a private member's Bill that would allow a blood sample to be taken when there existed "reasonable grounds" to believe that persons in the course of doing their job or assisting another person had been exposed to HIV. The federal bill was not passed but Ontario has passed a Bill similar to Bill C-217.

Work done during 2003-2004

• The Ministerial Council continued to monitor these issues following its extensive work on Bill C-217 during 2001-2002.
• The Ministerial Council monitored developments in criminal law and public health in order to advise the Minister as appropriate and necessary.

Future activities
The Ministerial Council will continue to monitor developments in criminal law and public health measures and will provide advice to the Minister.

6.1.4 Other federal departments

The issue
Effective response to HIV/AIDS requires the involvement of many federal departments, particularly when HIV/AIDS is viewed through the lens of the determinants of health that render individuals and communities at increased risk of HIV infection. The Ministerial Council's 2001 paper, Towards a Broader Vision of Health: Strengthening Inter-Ministerial Collaboration on HIV/AIDS in Canada and its 2002 paper, HIV/AIDS and Health Determinants: Lessons for Coordinating Policy and Action, both call for the involvement of federal departments concerned with issues of homelessness, income security, Aboriginal issues (Indian and Northern Affairs), health technology, international affairs and so on, in addition to those departments that are current partners in the Canadian Strategy on HIV/AIDS. Health Canada produced a report in 2003, Directions for Inter-departmental Collaboration on HIV/AIDS within the Federal Government, which it is using as a focus for action. The need for federal inter-departmental coordination and partnership has been increasingly recognized and promoted in recent years both within the federal government and among external stakeholders. Programs of the Canadian International Development Agency (CIDA) are discussed in more detail in section 6.5.4 of this report. The Ministerial Council's work with the Department of Foreign Affairs and International Trade is discussed in section 6.5.5 of this report.

Work done during 2003-2004

• The Ministerial Council actively encouraged the Minister and other federal officials to work collaboratively at the inter-departmental level on all issues addressed by the Council.
• The Council widely disseminated its two discussion papers on inter-departmental collaboration and reviewed Health Canada's discussion paper.

Future activities
The Ministerial Council will continue to encourage the Minister and other federal officials to collaborate at the inter-departmental level and will engage in collaborative and coordination efforts where possible.

6.1.5 Health Canada

The issue
Health Canada is the lead federal department for issues related to HIV/AIDS and houses the HIV/AIDS Policy, Coordination and Programs Division which has responsibility for coordination of the Canadian Strategy on HIV/AIDS. Several responsibility centres within Health Canada contribute to work under the Strategy, including:

• Centre for Infectious Disease Prevention and Control (HIV/AIDS Policy, Coordination and Programs Division; HIV/AIDS Epidemiology and Surveillance Division)
• Centre for Surveillance Coordination
• Departmental Program Evaluation Division
• First Nations and Inuit Health Branch
• Regional Health Canada offices
• International Affairs Directorate.

Other Health Canada initiatives are closely linked to HIVAIDS issues, such as Canada's Drug Strategy.

The Canadian Institutes of Health Research (CIHR) is an independent agency linked to the Canadian Strategy on HIV/AIDS which reports to Parliament through the Minister of Health. CIHR receives funding through the Strategy (see section 6.4.1 of this report).

Effective response to HIV/AIDS requires intra-departmental collaboration within Health Canada and between Health Canada and CIHR. The 2003 Health Canada report, Directions for Inter-departmental Collaboration on HIV/AIDS within the Federal Government, also suggested the increased intra-departmental involvement in HIV/AIDS of additional Health Canada branches and programs.

Work done during 2003-2004

• The Ministerial Council advised the Minister on ways to enhance intra-departmental collaboration and actively participated with Health Canada in discussions and initiatives to foster this collaboration, including committee work on the Health Canada World AIDS Day Annual Report, the Five-Year Review of the Canadian Strategy on HIV/AIDS and the draft Strategy Action Plan 2004-2008.
• The Ministerial Council reviewed Health Canada's discussion paper, Directions for Inter-departmental Collaboration on HIV/AIDS within the Federal Government, and provided feedback.

Future activities
The Ministerial Council will continue to advise the Minister on ways of achieving greater intra-departmental collaboration and will provide assistance to Health Canada as appropriate.

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¹On December 12, 2003, the Department of Foriegn Affairs and International Trade was split into two departments : Foriegn Affairs; and International Trade.

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