The Ministerial Council On HIV/AIDS

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Annual Report April 1, 2004 - March 31, 2005

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. An estimated 20 million people worldwide have died of AIDS. The area of greatest HIV prevalence remains sub-Saharan Africa , where more than 25 million people are living with HIV/AIDS; the Caribbean has the world's second-highest HIV prevalence. The areas of steepest increase in HIV transmission are East Asia, Eastern Europe and Central Asia.

The draft pan-Canadian Action Plan, Leading Together: Canada 's HIV/AIDS Action Plan 2005-2010, has a strong component of Canadian leadership in global efforts to fight the HIV/AIDS epidemic and find a cure. The Federal Initiative to Address HIV/AIDS in Canada aims to improve the alignment of Canada's approaches with international goals and commitments. The global engagement action area of the Federal Initiative includes: provision of technical support and policy guidance on global issues; coordination of federal engagement in the 2006 International AIDS Conference in Toronto; in collaboration with global partners, provision of technical and policy advice and training in lab science, epidemiology and modelling; development of Government of Canada-wide strategic approach on global HIV/AIDS activities; and sharing of best practices among non-governmental organizations. The global engagement action area of the Federal Initiative will have an annual budget of $2.2 million by fiscal year 2008-2009.

The Canadian International Development Agency (CIDA), which does not receive funds under the Federal Initiative, spends more than $50 million a year on international HIV/AIDS programs. Health Canada coordinates the Consultative Group on Global HIV/AIDS Issues, a multi-sectoral group including government and community representation, which serves as a forum for consultation and discussion of Canada's international HIV/AIDS activities. The Ministerial Council is exploring the possibility of a formal link to the Consultative Group.

Canada has close ties with the Joint United Nations Programme on HIV/AIDS (UNAIDS) and became Chair of the UNAIDS governing body in June 2004. Health Canada and UNAIDS have an 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.

In 2003-2004, the Ministerial Council developed a report at the request of the Minister of Foreign Affairs and International Trade. The report, Meeting the Challenge: Canada's Foreign Policy on HIV/AIDS With a Particular Focus on Africa, has been the subject of discussions between the Ministerial Council and Foreign Affairs Canada, International Trade Canada, Health Canada and the Canadian International Development Agency.

The Ministerial Council has discussed with 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. The Ministerial Council raised international issues in its meetings with the Minister of Health and the Minister of State (Public Health). The Ministerial Council has also told the Minister of Health that it would like to be included in HIV/AIDS-related visits of people from other countries. At its November 2004 meeting, the Ministerial Council devoted a full day to international issues and had several special presentations.

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 2004 was "Have you heard me today?" which sought to raise awareness of and help address the many issues that make women and girls particularly susceptible to HIV. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that young women and girls are 2.5 times more likely to be HIV-infected than their male counterparts.

The communications activities associated with World AIDS Day provide 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 Canada's response to HIV/AIDS. The 2004 World AIDS Day report, Strategic Approaches: Renewing the Response - Canada's Report on HIV/AIDS 2004.. 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 Aboriginal HIV/AIDS Awareness Week. December 1 is also Aboriginal AIDS Awareness Day.

Work done during 2004-2005

• The Ministerial Council contributed a message to the World AIDS Day annual report. The Council's message stressed the need to address issues facing women and girls, including the need for microbicides and equitable access to treatment. The Council praised the Canadian government's leadership in adopting legislation to enable the exporting of generic versions of patented medicines to countries in need.
• 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 the Public Health Agency of Canada.
• The Ministerial Council advised the Minister of Health and the Minister of State (Public Health) on their messages for Canadian HIV/AIDS Awareness Week and World AIDS Day and on possible ministerial activities on World AIDS Day. The Council was pleased that both ministers participated in World AIDS Day events, as did the Minister of International Cooperation, and expressed their thanks to the ministers. The Ministerial Council expressed special thanks to the ministers for their articulation of HIV/AIDS issues and particularly the need to eliminate stigma and discrimination.

Future activities

The Ministerial Council will continue to advise the Minister and federal officials staff about the messages and activities planned for World AIDS Day and about the Annual Report released on that day. The Council will continue to participate on the Annual Report Editorial Board.

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.

The draft pan-Canadian Action Plan, Leading Together: Canada 's HIV/AIDS Action Plan 2005-2010, and The Federal Initiative to Address HIV/AIDS in Canada both incorporate the principles and goals of the UNGASS Declaration.

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. Canada was not required to submit a progress report on the UNGASS commitments in 2004-2005.

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 2004-2005

The Ministerial Council continued to use UNGASS Declaration commitments in its analysis of issues.

Future activities

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

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 (see section 6.5.4). In 2003 the House of Commons Subcommittee on Human Rights and International Development urged the government to triple its contribution to the Global Fund. Canada began a term on the board of the Global Fund in 2004 and announced that it would contribute an additional $70 million to the Global Fund in 2005.

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

Work done during 2004-2005

• The Ministerial Council wrote to the Minister of International Cooperation to congratulate her on Canada's increased contribution to the Global Fund.
• The Ministerial Council remained informed of issues related to the Global Fund.

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 Federal Initiative to Address HIV/AIDS in Canada. CIDA reports to Parliament through the Minister for International Cooperation. CIDA's HIV/AIDS Action Plan was launched in 2000 and included a commitment to a five-year investment totalling $270 million for a variety of international programs. In addition, CIDA is contributing:

• $220 million over five years to the Global Fund to Fight AIDS, Tuberculosis and Malaria (see section 6.5.3)
• $100 million to the World Health Organization in support of the 3 by 5 Initiative (this initiative seeks to provide antiretroviral drug treatments to three million people living with HIV/AIDS by the end of 2005)
• up to $100 million to support African-led initiatives to broaden treatment access
• $50 million to support HIV vaccine research
• $12 million to build capacity to respond to HIV in sub-Saharan Africa
• 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 is developing a renewed HIV/AIDS Action Plan. There is concern among Canadian stakeholders that CIDA programs need to be more closely integrated with the pan-Canadian Action Plan and the Federal Initiative and that greater collaboration between CIDA and other federal departments is needed to enhance Canada's international response to HIV/AIDS.

Work done during 2004-2005

• The Co-Chairs of the Ministerial Council met with the Deputy Executive Director of UNAIDS and discussed the need for Canada to play a leadership role in the World Health Organization's 3 by 5 Initiative.
• The Ministerial Council had a special presentation from an official of the Canadian International Development Agency at its November 2004 meeting. In addition to describing the CIDA programs outlined above, the official stated that CIDA is examining gender issues in relation to the HIV/AIDS pandemic.
• The Ministerial Council wrote to the Minister of Health expressing its concerns about the lack of adequate communication with Canadian organizations during a CIDA-sponsored study tour of Canada by a South African group. The Council expressed its hope that there would be future opportunities for such study tours and that these tours would be more effectively organized.
• The Ministerial Council wrote to the Minister for International Cooperation congratulating her on the $15 million contribution by CIDA to the International Partnership for Microbicides.

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. Following its public commitment to make affordable HIV/AIDS medication available to developing countries, the federal government passed legislation in 2004 (Bill C-9, the Jean Chrétien Pledge to Africa Act) that implemented a World Trade Organization decision that waived some provisions of the Agreement on Trade-Related Aspects of Intellection Property Rights to 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. Canada became the first country in the world to do this.

Work done during 2004-2005

• The Ministerial Council had a special presentation on international affairs at its November 2004 meeting, including presentations from officials of International Trade Canada. The presentations focused on Canada's trade policy and its positions on the General Agreement on Trade in Services (GATS) and its relations with the World Trade Organization. The Ministerial Council expressed its concern that Canada's public health system might be subject to GATS regulations. The presenter clarified that public health is not subject to GATS, but that health insurance is. With respect to intellectual property agreements, the ability of countries to export generic drugs is limited because of drug patents.

Following this discussion, the Ministerial Council requested its International Affairs Committee to provide Council members with material on GATS so that they could study the possible impact of GATS on Canada's health care system.

• In its meeting with the Minister of Health, the Ministerial Council highlighted the fact that Canada was the first country to pass legislation (Bill C-9) to permit the manufacture of generic drugs for distribution in Africa.
• The Ministerial Council provided input into the development of the HIV/AIDS Strategy being developed by Foreign Affairs Canada. Among the Council's recommendations was the need for the Strategy to take into account the impact of international trade agreements and the policies of international financial institutions.

Future activities

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

6.5.6 International AIDS conferences

The issue

Since 1985, the International AIDS Society has sponsored international conferences that bring together thousands of people working across the full spectrum of involvement in the field of HIV/AIDS, including medical, social, scientific, community and political issues. Canada hosted the 1989 conference in Montreal and the 1996 conference in Vancouver. The 2006 conference will be held in Toronto from August 13-18 with an expected attendance of 12,000 people including researchers, clinicians, community service providers, government personnel and persons living with HIV/AIDS. The conference secretariat is in Geneva and the Local Host Committee is active in Toronto with representation from Canadian stakeholder organizations.

One of the action areas for global engagement of The Federal Initiative to Address HIV/AIDS in Canada is coordination of federal engagement and support for the Toronto 2006 conference. Health Canada's International Health Division established a Federal AIDS 2006 Secretariat to coordinate federal involvement in the conference and to act as a single point of contact for groups approaching the federal government with respect to the conference.

A group of Canadian stakeholders has formed a coalition to ensure that the Toronto 2006 conference will have a women's stream.

Canada's immigration policies have been an active issue during the past year, raising concerns that persons living with HIV/AIDS may encounter problems with entry into Canada to work on organizing or to attend the conference. The visa required for temporary residents (six months or less) requires any applicant to disclose their HIV status. This raises concerns that the information may not be treated as confidential, giving rise to stigma in the applicant's country of origin (where the visa application is filled out) or creating the possibility that the information may end up on computer systems in the United States because Canada shares immigration information with the United States. There is also concern because temporary visitors to Canada who come from designated countries may be tested for HIV at the discretion of the immigration officer. Visa applicants must pay a processing fee, which can create an economic barrier for those from developing countries. It is the policy of the International AIDS Society not to hold conferences in countries that discriminate against persons living with HIV/AIDS.

Work done during 2004-2005

• The Ministerial Council provided input into materials for the Canada booth at the 2004 International AIDS Conference in Bangkok, Thailand.
• An abstract on how the Ministerial Council functions as an advisory body to the Canadian Minister of Health was accepted and presented at the Bangkok conference.
• The Ministerial Council wrote to the Minister of Health and the Minister for International Cooperation recommending that they attend the Bangkok conference.
• The Co-Chairs of the Ministerial Council met with the Deputy Minister, Citizenship and Immigration Canada (CIC), and other CIC officials to discuss: facilitating the entry into Canada of HIV-positive persons working on the Toronto 2006 conference; and ensuring that there will be no problems regarding the entry of HIV-positive delegates attending the conference. CIC officials indicated that they would be implementing a training program to address these issues.

The Ministerial Council then wrote to the Deputy Minister of CIC stating that the Council was pleased that a training program would be implemented, underlining continuing concerns about entry requirements and suggesting that CIC meet with the Toronto 2006 Local Host Committee. In his letter of reply, the Deputy Minister of CIC told the Ministerial Council that CIC was building on lessons learned from the Vancouver 1996 conference and was working with the Canadian Border Services Agency to facilitate the entry of conference participants. He reported that a working group had been created within CIC to explore opportunities for CIC to partner with other government departments to ensure a successful conference and that CIC welcomed continued input from the Toronto 2006 Local Host Committee.

• The Ministerial Council had a special presentation at its January 2005 meeting from representatives of the Toronto 2006 Local Host Committee. The presenters provided an overview of planning for the conference and raised urgent concerns about possible immigration entry barriers for persons living with HIV/AIDS. The presenters suggested that CIC should waive the requirement for medical disclosure for those attending the conference, and clarify and make consistent decisions about HIV testing rather than leaving them to the discretion of immigration officers. The presenters asked for the Ministerial Council's support in moving these issues forward.
• The Ministerial Council had a special presentation from an official of Citizenship and Immigration Canada (CIC) at its January 2005 meeting. The official reported that CIC and the Canadian Border Services Agency had met with the Toronto 2006 Local Host Committee to discuss their concerns and that they were working to resolve problems as quickly as possible. The Ministerial Council offered its assistance in this process.
• The Ministerial Council wrote to the Minister of Health advising of the danger that the International AIDS Society could move the 2006 conference out of Canada if Canada's immigration policies discriminate against HIV-positive visitors. The Council's letter recommended that:
  • the visa application form for temporary visitors not require disclosure of HIV status
  • clear, consistent criteria be followed by all immigration/visa officers and that training for officers be given
  • immigration officers not have discretionary power to order medical examinations at ports of entry into Canada if entrants are known to be, or suspected of being, HIV-positive
  • the Minister meet with the Minister of Citizenship and Immigration to raise these issues.
• The Ministerial Council held several special teleconference meetings with CIC and the Toronto 2006 Local Host Committee to facilitate dialogue on disclosure of HIV status for visa applicants, application and adherence of policies and guidelines (i.e. pre- and post-test counselling), and mandatory HIV testing when applicants go for an immigration medical examination. Other issues such as co-infection with tuberculosis were raised. CIC reported that it was working internally and with the Local Host Committee on options to resolve these problems.
• The Ministerial Council recommended to officials of Foreign Affairs Canada (FAC) that Canada ensure that financial support is in place to allow the extensive participation at the Toronto 2006 conference of people from developing countries. The Council further recommended that FAC secure the involvement and attendance of the Prime Minister and other senior ministers at the conference and that FAC work with other departments on Canada's immigration policies with respect to the conference.
• The Ministerial Council sent a representative to the coalition working to create a stream on women's issues at the Toronto 2006 conference.
• The Ministerial Council made the Toronto 2006 conference a standing item on its meeting agendas until the conference takes place.

 

Future activities

The Ministerial Council will continue to monitor these issues and provide advice to the Minister and others as appropriate.

6.5.7 Other international issues

The issue

Other international issues were addressed by the Ministerial Council during 2004-2005. The Ministerial Council engaged in dialogue with the departments of Foreign Affairs and International Trade about their HIV/AIDS strategies as a follow-up to the Ministerial Council's 2003 paper Meeting the Challenge: Canada 's Foreign Policy on HIV/AIDS With a Particular Focus on Africa . The paper was developed at the request of the Minister for Foreign Affairs and International Trade and has been widely circulated to government officials in several ministries and agencies and to non-governmental organizations.

Work done during 2004-2005

• The Ministerial Council devoted a full day to international affairs at its November 2004 meeting and had special presentations from officials of Foreign Affairs Canada, International Trade Canada, Health Canada's International Health Division and the Canadian International Development Agency (CIDA). The purpose of dialogue with officials was to follow up the Ministerial Council's 2003 paper, determine how its recommendations might be implemented by the various federal responsibility centres and examine ways of fostering inter-departmental partnership on HIV/AIDS issues in order to promote greater federal policy coherence in the global response to HIV/AIDS.

The Ministerial Council expressed an ongoing interest in being kept informed of further developments with respect to HIV/AIDS by the departments and CIDA and offered its support.

• The Ministerial Council monitored progress by Foreign Affairs Canada in appointing a Special Advisor on HIV/AIDS, who was appointed during 2004. The Ministerial Council provided input to Foreign Affairs Canada on its draft HIV/AIDS strategy.

Future activities

The Ministerial Council will continue to monitor these issues and provide advice to the Minister and others as appropriate.

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