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In 2004 the Government of Canada announced a step-wise doubling of funding for HIV/AIDS from the level of $42.2 million in 2003-2004 under the Canadian Strategy on HIV/AIDS to a level of $84.4 million by fiscal year 2008-2009 under the new Federal Initiative to Address HIV/AIDS in Canada. Some of this funding will support the development of pan-Canadian collaborative approaches under the Action Plan, Leading Together: Canada 's HIV/AIDS Action Plan 2005-2010, which will involve all stakeholders and levels of government. The draft Action Plan resulted from extensive consultation and partnership by all stakeholders while the Federal Initiative is the Government of Canada's framework for the federal component of the Action Plan. See sections 2.0 and 6.3.1 for further details.
During 2003-2004, all stakeholders engaged in intensive work on a renewed framework for the Canadian Strategy on HIV/AIDS, which had been in place since 1998. A Five-Year Review of the Strategy, completed in 2003, documented lessons learned, identified gaps and recommend directions for the next five years. The Review called for increased funding from the present annual level of $42.2 million to a level of $85 million or $106 million, representing enhanced levels of commitment to managing or getting ahead of the epidemic.
In a parallel initiative, a draft Action Plan, developed in 2003 by partners in the Strategy following a consultation across Canada, will finalized in 2005. The draft Action Plan, Leading Together: Canada 's HIV/AIDS Action Plan 2005-2010, is the culmination of several years of development work on renewed directions for the Strategy by all stakeholders, including provincial governments. The draft Action Plan incorporates a social justice, human rights and determinants of health framework. Its vision statement is: By 2010, the end of the HIV/AIDS epidemic is in sight. The goals of the draft Action Plan are:
The six strategic actions of the draft Action Plan are:
Click to view draft Action Plan.
During 2003, the House of Commons Standing Committee on Health delivered a report on its review of the Canadian Strategy on HIV/AIDS. The report called for increased funding for the Strategy at an annual level of $100 million with targeted funding for initiatives involving inmates, Aboriginal peoples, and vaccine development. The report also called for a stronger coordination role for Health Canada as the lead federal department, targeted prevention activities for youth, Aboriginal peoples and those affected by stigma and discrimination, and harm reduction strategies for inmates.
The Government of Canada responded to these initiatives by defining a renewed federal role in the context of the draft pan-Canadian Action Plan. The new framework to the year 2010, The Federal Initiative to Address HIV/AIDS in Canada, builds on the achievements of the Canadian Strategy on HIV/AIDS and incorporates a social justice, human rights and determinants of health approach. The Federal Initiative emphasizes an integrated response by the federal government. Federal partners in the Initiative are the Public Health Agency of Canada, Health Canada, Correctional Service Canada and the Canadian Institutes of Health Research. Other federal departments and agencies have involvement in HIV/AIDS issues either on specific issues or as part of an integrated determinants of health approach to HIV/AIDS and will be invited to join the Federal Initiative. In order to foster integration of federal approaches, the Federal Initiative includes the creation of a committee of Assistant Deputy Ministers of concerned departments and a Responsibility Centre Committee.
The goals of the Federal Initiative are:
The policy directions of the Federal Initiative are: partnership and engagement; integration; and accountability. The five priority action areas of the Federal Initiative with their funding allocations by 2008-2009 are:
The Federal Initiative targets the priority populations of gay men, Aboriginal peoples, injection drug users, prison inmates, youth, women, persons from countries where HIV is endemic and persons living with HIV/AIDS.
Lead responsibility for HIV/AIDS rests with the new Public Health Agency of Canada. Funding for the Federal Initiative will increase from $42.2 million in fiscal year 2003-2004 to $84.4 million in fiscal year 2008-2009. Funding during the present fiscal year (2004-2005) is $47.2 million. Other federal departments and agencies such as the Canadian International Development Agency contribute funding to HIV/AIDS programs in addition to the funds allocated to the Federal Initiative.
The Ministerial Council participated actively in all phases of the development of the pan-Canadian Action Plan and gave advice on the development of the Federal Initiative.
The Ministerial Council agreed to consider using the Action Plan as a key input to the Council in fulfilling its mandate.
The Ministerial Council will continue to be involved in the process of advising the Minister and public officials on the Action Plan and the Federal Initiative.
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, racism, poverty, discrimination, lack of affordable housing, 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 are fundamental to realizing social justice. 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 Jonathan Mann. Support for this approach also derives from international human rights law and the positions that form part of the Declaration of Commitment of the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) in June 2001, to which Canada is a signatory (see section 6.5.2). In his preface to the Federal Initiative to Address HIV/AIDS in Canada, the Chief Public Health Officer underlined that the Federal Initiative will continue to build on population-based and health determinants approaches to HIV/AIDS so that the root causes of the epidemic can be addressed and overcome.
Both the draft pan-Canadian Action Plan and the Federal Initiative are based on the framework of social justice, human rights and determinants of health. These frameworks evolved from decades of experience in responding to HIV/AIDS and were strongly promoted by all stakeholders involved in the process of renewing Canada's response to HIV/AIDS. The commitment to a social justice framework necessitates the strong involvement of all stakeholders and the collaboration of a wide range of government and community partners.
The Ministerial Council will continue to monitor these issues and provide advice to the Minister.
In May 2004 the Government of Canada announced that funding for HIV/AIDS would be doubled from the level of $42.2 million under the Canadian Strategy on HIV/AIDS to $84.4 million by fiscal year 2008-2009 under the Federal Initiative to Address HIV/AIDS in Canada. The funding level will be increased by increments each year until 2008-2009. For fiscal year 2004-2005, the funding level is $47.2 million, with the additional $5 million being targeted to community-based organizations serving specific vulnerable populations. The Ministerial Council played an important role in securing increased funding for HIV/AIDS.
The planned federal funding for HIV/AIDS under the Federal Initiative is:
The Ministerial Council will continue to monitor these issues and provide advice to the Minister.
Funding for the Federal Initiative to Address HIV/AIDS in Canada is allocated to specific action areas: By 2008-2009, the allocations of the total $84.4 million will be:
The four Government of Canada partners in the Federal Initiative will receive the following share of the total $84.4 million by 2008-2009:
Several other federal departments and agencies, such as the Canadian International Development Agency, contribute additional funds from their own budgets to support their involvement in HIV/AIDS.
An annual accountability report is released by the Minister of Health and the Minister of State (Public Health) on World AIDS Day, December 1. The 2004 report, Strategic Approaches: Renewing the Response.
The Ministerial Council wrote to the Minister of Health with respect to the allocations foreseen under the new draft Action Plan and Federal Initiative. At the time, the strategic areas of the new approaches had not been fully defined and the Council recommended that the strategic areas of the Canadian Strategy on HIV/AIDS remain in effect until a broad multi-stakeholder consultation could be held to address the allocation of the new funding.
The Ministerial Council will continue to monitor allocations and provide advice to the Minister and to the Public Health Agency of Canada.
The Commission on the Future of Health Care in Canada (the Romanow Commission) released its report in late 2002. The Romanow report included recommendations for Canadian home care and pharmacare programs. Following the release of the Romanow report, the First Ministers' Accord on Health Care Renewal was reached in February 2003. The Accord focused on primary health care, home care, catastrophic drug coverage, access to diagnostic/medical equipment and information technology, and electronic health records. The First Ministers met again in 2004 and announced a 10-year plan to strengthen health care, focusing on increased funding to the provinces and territories, wait times, health human resources, community-based services including home care, a pharmaceuticals strategy and effective health promotion and disease prevention. Aboriginal health was specifically addressed in a separate communiqué. The proposed pharmaceuticals strategy is of particular interest to those living with HIV/AIDS (see section 6.3.6). The components of the 10-year plan are under discussion at the federal/provincial/territorial level.
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.
In September 2004 the Government of Canada launched the new Public Health Agency of Canada to address public health issues. The Agency is now the lead federal responsibility centre for HIV/AIDS.
The Ministerial Council remained informed about health care reform and in particular about efforts by the Canadian Treatment Action Council to hold consultations and develop recommendations on a national pharmacare program.
The Ministerial Council will continue to monitor these issues and provide advice to the Minister.
The emergence of highly active antiretroviral treatments in the late 1990s has prolonged and improved quality of life for many persons living with HIV/AIDS, but difficulties in accessing treatments, treatment failures, toxic side effects and drug resistance have become more common. Health Canada is responsible for the approval of new drugs and 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 (CCOHTA) and is still in development. During 2003-2004, national stakeholders sought consumer representation on the committees and board of the CCOHTA and were refused. Stakeholder concerns centered on: timeliness of access to new drugs; accountability; an objective and informed process; an appeal process; the use of best clinical data; and the inclusion of relevant stakeholders in the Common Drug Review process. These are still active concerns.
Stakeholders have consistently raised the need for post-approval surveillance of drugs in order to track side effects. Advocates for women have asked for more clinical trials for women and better post-approval surveillance involving women because most clinical trial participants are men and the effect of drugs can differ significantly between men and women
A new issue has emerged more recently with the advent of internet pharmacies in Canada selling cheaper Canadian drugs to customers in the United States where prices are commonly at least 30% higher for the same drugs. There are concerns that shortages of drugs may result in Canada and that the major pharmaceutical firms will withhold supplies from Canada in an effort to halt cross-border sales of drugs. The situation is complicated by the selective enforcement by the United States Food and Drug Administration of the US law prohibiting importation of most of the drugs being supplied by internet pharmacies.
The Patented Medicine Prices Review Board (PMPRB) protects patents for 20 years and sets drug prices in Canada but its reviews do not apply to generic drugs manufactured in Canada (those no longer under patent protection). Most cross-border sales to the United States involve newer drugs rather than generics. Canada has provisions to allow for distribution of patent-protected drugs at lower prices in case of emergency such as drug shortages. Some Canadian physicians are signing prescriptions for American patients they have never seen, which raises questions of medical ethics, patient safety and professional disciplinary action.
The Ministerial Council will continue to monitor these issues and provide advice to the Minister.