Meeting the Challenge: Canada's Foreign Policy on HIV/AIDS - With a Particular Focus on Africa

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Section 6.0 - Specific Foreign Policy Initiatives

This section examines additional foreign policy approaches that DFAIT should consider with respect to how it responds to HIV/AIDS. The section describes the implications of the HIV/AIDS epidemic on conflict, post-conflict and humanitarian emergency situations, with particular reference to Africa and to Canadian engagement in peacekeeping and related missions in areas in conflict. The section also examines the impact of HIV/AIDS on food security and governance; discusses steps that DFAIT can take to promote and share best practices in the response to HIV/AIDS; and examines the need to support international research on HIV/AIDS .

6.1 Human Security

Canadian foreign policy identifies an ambitious agenda for human security, one that addresses public safety, protection of civilians in conflict, conflict prevention, governance and accountability, and support for peace. The Canadian approach to security issues includes an emphasis on human rights for women and gender training.¹²⁶

As indicated in Section 2.0 (The Impact of HIV/AIDS), HIV/AIDS has major implications for human security at the community, national and international levels. HIV/AIDS is frequently a contributing cause of insecurity and conflict and is also exacerbated by it. It follows, therefore, that HIV/AIDS should be seen as an integral factor to be addressed in the context of Canada's promotion globally of a human security agenda. This sub-section deals with some of the military aspects of human security. It should be noted, however, that achieving human security requires action on a much broader front - including, for example, ensuring that there is a functioning social and health infrastructure, providing access to medical care, eliminating gender inequality, and ending gender-based violence and other forms of violence fuelled by stigma and discrimination. The most effective way to deal with the impact HIV/AIDS has on human security is to address HIV/AIDS itself as well as the underlying factors that make people vulnerable to HIV.

Conflict, HIV/AIDS and the role of African armed forces

The Security Council recognizes that further efforts are necessary to reduce the negative impact of conflict and disasters on the spread of HIV/AIDS, and to develop the capacity of peacekeepers to become advocates and actors for awareness and prevention of HIV transmission.

- United Nations Security Council, 28 June 2001¹²⁷

War offers a fertile breeding ground for HIV/AIDS, due to the mobilization of young men (already a high-risk group for sexually transmitted infections), and the displacement of refugees. The use of rape and sexual violence as an instrument of war and repression adds a further serious dimension. Children and young people in conflict situations are especially vulnerable to HIV/AIDS due to the higher risk of sexual abuse, forced military recruitment and prostitution.¹²⁸ Armed conflicts strain already poorly equipped medical facilities. Civilians are at greater risk of becoming infected with HIV because of the demographic distortions caused by armed conflicts.¹²⁹

Of the countries in Africa with the highest prevalence of HIV/AIDS, half are engaged in conflict of one kind or another.¹³⁰ The frequency of armed conflict in Africa is unlikely to diminish quickly. African military forces often have a high-incidence of HIV and often engage in high risk behaviour. Thus, these military forces are agents in the spread of the disease. However, with the proper interventions, they could become instead significant agents in the struggle against the spread of HIV. The cooperation of the military is an essential component of the response to HIV/AIDS. Efforts to engage the military should be supported and encouraged.

Because regional forces are often used for peacekeeping and related activities, it is particularly important to outfit these forces to contribute to the effort against HIV/AIDS. To this end, Canada should promote the inclusion of a comprehensive HIV/AIDS strategy in all responses to conflict and emergency situations.¹³¹ This strategy should include prevention education, the availability of condoms, health care (including HIV-related medications) for people infected with HIV/AIDS, more effective treatment of sexually transmitted infections, measures to ensure the safety of the blood supply, and the use of sterile equipment in medical procedures. Canada should also advocate for the provision of HIV/AIDS, gender and human rights awareness and training to all military personnel involved in these situations. The NGO sector should be involved in the development and implementation of these strategies and programs.

Because military forces can and do contribute to the spread of HIV infection, it is also important to ensure that comprehensive HIV prevention and education programs are implemented in communities in which peacekeepers and other military personnel serve.

Canada has been intensely engaged not only bilaterally, but also with African regional bodies such as the African Union and with the New Partnership for Africa's Development (NEPAD) initiative. The Department of Foreign Affairs and International Trade (DFAIT) can use these venues, as well as multilateral fora such as the Commonwealth, la Francophonie and the United Nations (UN), to advocate for a greater priority for HIV/AIDS in interventions in conflict situations in Africa. Similar initiatives should be undertaken in the North Atlantic Treaty Organization, given its intervention in non-North-Atlantic venues. DFAIT should also promote the inclusion of HIV/AIDS issues on the agenda of international meetings that deal with security issues, and in related reports and papers.

The mine action community

Personnel involved in demining operations are also vulnerable to HIV. Many deminers are former combatants. Demining operations often exhibit management and organizational structures and characteristics that are similar to those in the military. Both military and non-military deminers are generally deployed to areas far away from their homes and families, often for extended periods of time. The National AIDS Authority in Cambodia estimates that deminers in that country have an HIV infection rate of 7 percent, which is the same as the rate in the military.¹³²

For these reasons, initiatives similar to those proposed above to address HIV/AIDS in the military should also be implemented in the mine action community.

Conflict, peacekeeping and Canadian participation

The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the UN Department of Peacekeeping Operations (DPKO) are collaborating to address HIV/AIDS in peacekeeping. Among other things, they have produced an HIV/AIDS Awareness Card for Peacekeeping Operations. Recently, the DPKO decided to establish an HIV/AIDS Policy Officer within each major UN peacekeeping operation. DFAIT is funding a study that looks, inter alia, at the effectiveness of DPKO and UNAIDS collaboration in this area.

Canadian peace support operations are increasingly diverse, as internal conflicts and civil wars have become more common. Increasingly, the international community "is asked to create the elementary structures of peace and security and take on responsibilities that used to be the internal affairs of the states involved."¹³³

Canada's peacekeeping operations are the responsibility of the Department of National Defence (DND). DFAIT should work with DND to ensure that a comprehensive HIV/AIDS strategy is built into all Canadian peacekeeping missions. Armed forces personnel and appropriate Canadian NGOs should be involved in the development of this strategy. Canadian military personnel currently receive HIV/AIDS education and gender training prior to deployment. It would be useful for an evaluation of the Canadian training programs to be conducted.

Finally, DFAIT should ensure that any people that its send into a country in conflict are fully briefed on HIV/AIDS issues.

Recommendations

37.	We recommend that in its bilateral and multilateral relationships, DFAIT promote the inclusion of a comprehensive HIV/AIDS strategy for military personnel involved in all responses to conflict and emergency situations. This strategy should include:
	prevention education; the availability of condoms; health care (including HIV-related medications) for people infected with HIV/AIDS; more effective treatment of sexually transmitted infections; measures to ensure the safety of the blood supply; the use of sterile equipment in medical procedures; and HIV/AIDS, gender and human rights awareness and training.
38.	We recommend that DFAIT work with Department of National Defence to ensure that a comprehensive HIV/AIDS strategy is built into all Canadian peacekeeping missions.
39.	We recommend that in its bilateral and multilateral relations, and with the Department of National Defence, DFAIT promote the development and implementation of HIV prevention and education programs for communities in which peacekeepers and other military personnel serve.
40.	We recommend that in its bilateral and multilateral relations, and with the Department of National Defence, DFAIT promote the involvement of armed forces personnel and the NGO sector in the development and implementation of HIV/AIDS programs and strategies for conflict and emergency situations.
41.	We recommend that in its bilateral and multilateral relations, DFAIT support the implementation in all demining operations of initiatives similar to those proposed above to address HIV/AIDS in the military.
42.	We recommend that DFAIT promote the inclusion of HIV/AIDS issues on the agenda of international meetings that deal with security issues, and in related reports and papers.
43.	We recommend that in its bilateral and multilateral relations, DFAIT highlight the issue of sexual violence committed by military personnel in conflict situations, and promote measures to deal with the problem.
44.	We recommend that DFAIT work with the Department of National Defence to evaluate the HIV/AIDS education and gender training programs for Canadian peacekeepers; and that that DFAIT support the involvement of Canadian HIV/AIDS organizations in the evaluation.
45.	We recommend that DFAIT ensure that any people that it sends into a country in conflict are fully briefed on HIV/AIDS issues.

6.2 Humanitarian Crises, Post-Conflict and Refugee Challenges

HIV/AIDS can dramatically aggravate a humanitarian situation in populations affected by conflict. Humanitarian operations in emergency and post-conflict settings can place both relief workers and local populations at greater risk of HIV infection. The uncertainty and insecurity of refugee camps encourage earlier sexual activity, typically in the absence of sexual health education and related services. The increased likelihood of sexual violence and prostitution among refugee populations broadens and accelerates the spread of HIV.¹³⁴

Post-conflict situations

The Canadian International Development Agency (CIDA) and other Canadian agencies, including NGOs, are frequently called upon to contribute to post-conflict situations, which may involve a variety of elements, including demobilization and re-integration of combatants, community reconstructions and economic development. Further, Canada is a member of multilateral agencies, such as the UN, the UN High Commissioner for Refugees (UNHCR) and the World Bank, as well as situation-specific coalitions that organize responses to post-conflict situations.

HIV/AIDS awareness, prevention and care programs should be included in the planning and implementation of all post-conflict initiatives. These programs should target not only combatant personnel but also their families and communities, as well as the victims - often women and children - of sexual, physical and psychological violence. The overall objective must be to mitigate risk and to increase the immune-ability of the post-conflict communities and societies.

Canada is instrumentally involved in such situations as that in the Great Lakes area of Africa and the Democratic Republic of the Congo, not only through the diplomatic activity which has contributed to movement toward peace, but also through the engagement of CIDA in initiatives like the Multi-Country Demobilization and Reintegration Program. Because of the many HIV/AIDS related dimensions which characterize these situations, priority attention is required to information and education, prevention, care and treatment, as well as to measures to restore the capacity of health systems to deal with HIV/AIDS and other threats.

Humanitarian crises: Refugee challenges

Africa has 4.17 million of the world's more than 19 million refugees. It also has large and fluctuating numbers of internally displaced people. Canada is involved in humanitarian assistance with both populations through its membership in the UNHCR, through its support for other humanitarian agencies, and through the work of CIDA and Canadian NGOs.

Through Canada's membership in, and support of, key humanitarian agencies, DFAIT and CIDA can demonstrate leadership in defining the "rules of the game" that guide humanitarian assistance and govern the employment and protection of humanitarian workers. HIV/AIDS awareness, prevention and care programs should be included in the planning and implementation of all humanitarian interventions. The UNHCR, for example, has developed a Strategic Plan on HIV/AIDS and Refugees. The plan includes anti-discrimination measures, protection training and awareness, and capacity building initiatives for local communities and refugees.¹³⁵

The expertise and experience embodied in multilateral humanitarian agencies, particularly the UN and its operational agencies working on the ground, are a vital and often under-appreciated element in post-conflict and humanitarian responses.¹³⁶ A number of these agencies - including UNAIDS, UNHCR and the United Nations Development Fund for Women - have been instrumental in developing appropriate and effective responses to the limit of their often-confined resources. Canada has provided financial support and experienced personnel to these agencies. These important contributions must be maintained and enhanced.

Recommendations

46.	We recommend that in its bilateral and multilateral relationships, DFAIT, in cooperation with the Canadian International Development Agency (CIDA) and the Department of National Defence, promote the inclusion of HIV/AIDS awareness, prevention and care programs in post-conflict initiatives and humanitarian interventions. In post-conflict situations, these programs should target not only combatant personnel but also their families and communities, as well as victims of sexual, physical and psychological violence. Where appropriate, DFAIT, in cooperation with CIDA, should also promote and support the restoration of health systems to enable them to deal with HIV/AIDS and other threats.
47.	We recommend that DFAIT advocate for and support the integration of HIV/AIDS awareness, prevention and care programs into post-conflict initiatives and humanitarian interventions in which Canada is involved as a sponsor, funder or participant.
48.	We recommend that DFAIT, in cooperation with CIDA and Finance Canada, work to ensure that the United Nations operational agencies involved in post-conflict and humanitarian work have adequate resources to enable them to play an effective role in the response to HIV/AIDS.

6.3 Food Security

Safe sex is no match for an empty stomach.

- BBC World documentary on the relationship
between HIV/AIDS and food security

As HIV infection rates continue to escalate around the world - particularly in countries with large rural populations and widespread small-scale agriculture - the epidemic is having a significant impact on food security and nutrition, thus creating a deadly cycle. For example:

• HIV/AIDS typically strikes the household's most productive members first. When these people become ill, there is an immediate strain on the family's ability to work, feed themselves and provide care.
• As the disease progresses, it can become even harder for a family to cope, especially as resources are drained and poverty advances. For example, valuable assets, such as livestock and tools, may need to be sold in order to pay for food and medical expenses.
• Without food or income, some family members may migrate in search of work, increasing their chances of contracting HIV - and bringing it back home. For others, commercial sex may be their only option to feed and support their family.
• Food insecurity also leads to malnutrition, which can aggravate and accelerate the development of AIDS. Likewise, the disease itself can contribute to malnutrition by reducing appetite, interfering with nutrient absorption and making additional demands on the body's nutritional status.¹³⁷

In the six countries most affected by the current food crisis in southern Africa - Zimbabwe, Malawi, Zambia, Lesotho, Swaziland and Mozambique - about 15 million people are in need of food assistance.¹³⁸ These are all countries with very high rates of HIV infection.

Given the two-way linkages between HIV/AIDS and food insecurity, a food security response to the epidemic, linking short- and long-term interventions, is imperative. Such a response needs to address food production, food access and nutritional aspects. If designed with an HIV/AIDS lens and complemented with HIV-specific interventions, food security policies and programs can contribute to preventing the spread of HIV infection and to mitigating the impact of the epidemic. Governments and donors need to adopt a long-term, development-oriented approach in addressing the effects of HIV/AIDS on food security, rather than merely a disaster relief approach. In particular, governments, international agencies and donors need to ensure a balance in funding short-term, food-based responses and longer-term, non-food based interventions.¹³⁹

The Food and Agriculture Organizations of the United Nations (FAO) is producing guidelines for the integration of HIV/AIDS objectives and strategies into food security programs. The FAO is also helping to bring more-immediate measures to affected countries, including labour-saving practices such as cultivating crops that require less tilling, and conservation farming, a low-cost method that protects against land degradation by using less water and fertilizer.¹⁴⁰

The FAO has proposed the following actions to break the cycle of HIV/AIDS and food insecurity:

• Raise awareness among the public and political leaders about the impact of HIV/AIDS on food security and nutrition, and what needs to be done.
• Secure high-level political commitment to act vigorously.
• Adjust existing policies and programs to (a) review development and emergency strategies using an HIV/AIDS lens; and to (b) incorporate food security and nutrition in HIV/AIDS interventions.
• Ensure that nutritional care is provided to people living with HIV/AIDS to enable them to lead longer, healthier, more productive lives.
• Improve food security among the most vulnerable groups to promote better nutrition and prevent the spread of HIV.

DFAIT can contribute to attempts to address these issues by raising awareness about the impact of HIV/AIDS on food security and nutrition. DFAIT should also raise awareness of the impact of food insecurity on people living with HIV/AIDS. Finally, DFAIT should support initiatives that address these impacts.

Recommendation

49.

We recommend that in its bilateral and multilateral relations, DFAIT raise awareness about the impact of HIV/AIDS on food security and nutrition, and about the impact of food insecurity on people living with HIV/AIDS, and support the initiatives of multilateral agencies and NGOs to respond to these challenges.

6.4 Governance

The Standing Committee on Foreign Affairs and International Trade underlined the importance of good governance; the need to support efforts to build democratic institutions and practices, governance capacity, and effective and independent legal systems; and the need to promote human rights, including the rights of women and children. Its report states that "the meaning of good governance must include social aspects and democratic principles, and should not be reduced to economic management and facilitating private sector development and foreign investment." The report also says that the overall objectives of sustainable development should ensure that "essential public goods and services must be made available to all Africans, rich and poor, rural and urban."¹⁴¹ These objectives cannot be met without strengthening government capacity in sub-Saharan Africa.

Governments in countries most-seriously affected by HIV/AIDS are under considerable stress. Increasingly, studies of HIV/AIDS impacts make references to "state failure." Staff absence due to ill health, together with the non-replacement of staff who die, leave gaps in the functioning of ministries and departments.¹⁴² For instance, a recent study of three central agencies in Swaziland (the Ministries of Finance, Economic Planning and Development, and Public Service and Information), indicates that "solely as a result of HIV/AIDS the three ministries will lose 32 percent of their staff complement" over a twenty-year period. The impact of other costs, such as pensions, sick and compassionate leave and training, will also escalate. In education, for Swaziland to come up with the number of teachers it needs for the period 1999-2016 will require training 13,000 people, instead of the 5,093 who would have had to be trained in normal circumstances. The additional training costs are estimated at US$440 million.¹⁴³ The concentration of infection among young people with a full work-life potentially ahead of them, the additional burden of orphans, the general sense of fatalism and unpredictability that may characterize public attitudes - all these things reinforce the stress on public institutions.

A very recent impact study by the United Nations Population Fund notes that until recently, governments and business leaders have been slow to respond to the weakening of their own capacity and to civil society advocacy, "in part because of the denial by the leaders that HIV/AIDS is of concern to them, their organizations or their countries."¹⁴⁴

There is evidence that this situation is changing. The interaction between African leaders and leading donors in the G8, and the emergence of the G8 Africa Action Plan, have resulted in a commitment by the donors to "strengthening institutions and governance," as well as to promote human rights.¹⁴⁵ In February 2003, a Commission for HIV/AIDS and Governance in Africa, based in the UN Economic Commission for Africa, was convened by UN Secretary-General Kofi Annan. The 20-member Commission is mandated to provide advice and analysis for African policy makers as they deal with the long-term development challenges of HIV/AIDS, policy and program development and the marshalling of adequate and sustained resources to support policies and programs. The creation of the Commission demonstrates recognition of the need for "a deeper understanding of the relationship between HIV/AIDS and the state capacity to maintain economic, social and political stability despite high prevalence levels." The Commission is primarily geared to providing research on four issues: (a) the impact of HIV/AIDS on macroeconomic indicators and economic policies; (b) the impact of HIV/AIDS at household level; (c) the challenge of scaling up treatment; and (d) the impact of HIV/AIDS on state capacity including service provision and the security sector.¹⁴⁶

The essential first step in ensuring continued governance capacity is to prolong and save lives, a central part of the leadership strategy recommended in this report. Supplementary initiatives are suggested by the case of Uganda, where studies indicate that behavioural change leading to reduced infection is possible. One study identified two elements that were essential to the success of the Ugandan response:

• a combination of community and political leadership, including an emphasis on community-based, face-to-face communication, and the use of a strong network of non-governmental organizations committed to the cause; and
• the empowerment of women and girls - female condom use virtually trebled among women and increased from 16 percent to 40 percent between 1995 and 2000 among men.¹⁴⁷

Political leadership at a high level in Uganda was a major factor in these successes. The creation of a multi-sectoral Uganda AIDS Commission and a National Operational Plan encouraged the establishment of AIDS control programs in various ministries, so that by 2001 there were at least 700 governmental and non-governmental agencies working on HIV/AIDS reaching into all districts in Uganda. Nevertheless, a great deal remains to be done. in Uganda. The abuse of women, including women being forced to have sex with their husbands, continues to be widespread. Discrimination and repression against homosexuals, sanctioned at the highest levels, continues.¹⁴⁸ These problems are also occurring in other countries in the region. Addressing them will require stronger government leadership.

The Uganda case illustrates an approach in which increased and coordinated government initiatives against HIV/AIDS led to a contemporary situation where the threat of infection, and thus of weakened government, is significantly reduced. It also illustrates, as do elements of official policy in Zimbabwe and Namibia, the continued urgency of strengthening governmental leadership in the defence of human rights and the eradication of discrimination and persecution.

Further steps involve the strengthening of public institutions and governmental capacity, the encouragement of democratic practices, and the promotion of human rights. The erosion of state capacities must be reversed. Donor support is key. Resource provision and a commitment to strengthening public services and public administration, as well as human resource planning and provision of training, must all be elements of the donor response. Canada has provided more than CAN$40 million for capacity building at national and municipal levels and the strengthening of parliaments.¹⁴⁹ This type of contribution should be sustained and expanded.

With a view to implementing an effective strategy against HIV/AIDS, emphasis should be placed on strengthening public service delivery capacity in education, health systems, clean water and sanitation, in addition to the legislative, judicial and human rights dimensions of government. Strengthening governmental capacity for policy research and planning should also be a priority.¹⁵⁰

Finally, levels of resource provision for capacity-building and training as well as other elements of governance support will have to be significantly increased to meet the public service replacement needs created by HIV/AIDS.

Recommendations

50.

We recommend that DFAIT, through its bilateral relations and its relations with African regional organizations, including the African Union and the New Partnership for Africa's Development (NEPAD) initiative, support the further development of national strategies for HIV/AIDS that address the need to sustain and strengthen the capacity of government and the public provision of services, that are based on effective community-level engagement, and that embody implementation of a human rights approach to the disease; and that DFAIT encourage the exchange and study of "best cases," and champion increased resources for the implementation of these strategies.

51.

We recommend that DFAIT, in collaboration with the Canadian International Development Agency and Human Resources Development Canada, undertake an assessment of how and where Canada might most effectively reinforce public service human resource training in countries most seriously affected by HIV/AIDS illness and death among public employees.

6.5 Sharing and Promoting Best Practices

DFAIT can play a role in promoting best practices in the global response to HIV/AIDS and in helping Canadians to share their best practices with people in other countries.

Harm reduction

Injection drug use is a major component of the global spread of HIV, particularly in Eastern Europe, Central Asia and parts of the Asia/Pacific region. Traditional approaches to drug use, based on tough law-enforcement measures and an abstinence model for drug treatment programs, have not been effective in combating HIV/AIDS. Nor are they respectful of the rights of injection drugs users. Many experts also argue that these approaches have not even been effective in reducing drug use.

Harm reduction strategies, on the other hand, have proven effective in reducing the spread of HIV among injection drug users and in improving their health. Harm reduction strategies attempt to reduce the specific harms associated with using drugs without requiring abstinence from all drug use. Thus, they seek to reduce the likelihood that drug users will contract or spread HIV, hepatitis and other infections, overdose on drugs of unknown potency or purity, or otherwise harm themselves or other members of the public. They are based upon a hierarchy of goals, and stress short-term, achievable, pragmatic objectives rather than long-term, idealistic goals.¹⁵¹

Examples of harm reduction strategies are needle exchange programs and supervised injection sites. Canada has had some very positive experiences with needle exchange programs and has recently authorized, on a trial basis, the establishment of two supervised injection sites. Therefore, Canada is well positioned to champion the use of harm reduction strategies by other countries and to share with them the results of the Canadian experience in this area.

Other best practices

There are other aspects of the Canadian response to HIV/AIDS that are laudable and that could be shared. One example is the provision of comprehensive treatment information to people living with HIV/AIDS and their caregivers. Another example is the participation of civil society and people living with HIV/AIDS in the development and implementation of the Canadian Strategy on HIV/AIDS.

Recommendations

52.	We recommend that in its bilateral and multilateral relations, DFAIT champion the use of harm reduction strategies to address HIV/AIDS among injection drug users.
53.	We recommend that in its bilateral and multilateral relations, DFAIT identify opportunities and facilitate efforts to share Canadian best practices on HIV/AIDS with people in other countries.

6.6 Research

Research in all of its forms, including basic science, clinical science, behavioural research, operational research and evaluation research, is an essential component of the fight against HIV/AIDS. The UNGASS Declaration of Commitment on HIV/AIDS commits UN member states to:

• increasing investment in, and accelerating research on, the development of HIV vaccines;
• accelerating access to prevention, care and treatment technologies for HIV/AIDS (including treatments for HIV infection, vaccines and microbicides);
• supporting and encouraging the development of national and international research infrastructures; and
• strengthening international and regional cooperation with respect to research.¹⁵²

Although much of the research is conducted in a domestic context, there are some international research efforts, particularly with respect to vaccines and microbicides. For example:

• International AIDS Vaccine Initiative (IAVI). IAVI is a global organization working to accelerate the development and distribution of preventive AIDS vaccines. IAVI invests directly in research projects, including innovative vaccine development partnerships, which bring together researchers and scientists in industrialized and developing countries in an effort to move promising vaccine candidates toward clinical testing. Some of these vaccine development partnerships involve industry, government and civil society. One such partnership involves researchers at the University of Nairobi, the University of Oxford, and two private sector pharmaceutical companies, as well as government and civil society partners in Kenya and the United Kingdom. In 2002, CIDA contributed CAN$50 million to IAVI.¹⁵³

• HIV Vaccine Initiative (HVI). The mission of HVI, a joint project of the World Health Organization (WHO) and UNAIDS, is to promote the development, facilitate the evaluation, and address the future availability of, preventive HIV vaccines, with a focus on the needs of developing countries.¹⁵⁴

• International Partnership for Microbicides (IPM). The mission of the IPM is to accelerate the discovery, development and accessibility of microbicides to prevent transmission of HIV. The IPM aims to increase the efficiency of the development and delivery of a microbicide by expanding the breadth and level of public and private sector funding; identifying critical gaps in research and development, access, and advocacy; leveraging partnerships with both new and existing public and private players; and helping to raise awareness of microbicides worldwide.¹⁵⁵

• International Working Group on Microbicides (IWGM). The IWGM is a group of experts who operate as an influential network. It was established in 1994, with initial support from the World Health Organization, to ensure closer coordination of a number of separate research programs. The role of the IWGM is to facilitate the development and approval of safe, effective, affordable and acceptable microbicides. The IWGM's membership is global and includes individual members from 21 governmental and non-governmental organizations, from both the North and the South. The IWGM provides a mechanism for the independent expert assessments of significant issues.¹⁵⁶

• The Population Council. The Population Council is an international, non profit, NGO with staff in 18 developing countries, whose mission is to improve the well-being and reproductive health of current and future generations. The Council has developed a candidate microbicide, which is presently in trials in South Africa and Thailand. It also administers and participates as a research partner in the Microbicides Basic Science Network.¹⁵⁷

Canada should be contributing more to international HIV vaccine and microbicide efforts. DFAIT can help to promote these international research efforts through its bilateral and multilateral relationships.

An international workshop on strategies for providing HIV/AIDS treatments in resource-poor settings, held recently in the Netherlands, identified a number of operational research needs, including:

• determining an appropriate CD4 count for initiating treatment in asymptomatic patients;
• evaluating the safety and efficacy of antiretroviral therapies for the prevention of HIV infection in, and for the treatment of, breast-feeding women and their infants;
• determining the best methodology for identifying tuberculosis in HIV co-infected patients; and
• evaluating the effectiveness of current adherence support programs.¹⁵⁸

There is a also a particular need for more research on simplified treatment regimens for use in resource-poor settings. DFAIT should support research initiatives designed to address these and other needs related to efforts to scale up the provision of antiretroviral therapies in developing countries.

There are several international NGOs doing advocacy work to promote accelerated access to HIV vaccines, microbicides and treatments, including the AIDS Vaccine Advocacy Coalition, Médecins Sans Frontières, and the International Council of AIDS Service Organizations. The efforts of these organizations deserve support.

Several countries have developed national plans to promote the development and availability of vaccines, microbicides and HIV treatments. For example, Brazil has a National Vaccine Plan, a Microbicide Plan and an AIDS Drug Policy. Thailand has a National Plan for HIV/AIDS Vaccine Development. Uganda has produced a Guidance Document for HIV/AIDS Research, Development and Evaluation for Uganda. DFAIT should promote the development of national plans to accelerate research and development of HIV vaccines, microbicides and treatments.

Recommendations

54.	We recommend that Canada, in addition to strengthening support for Canadian HIV-related research, including through developing a national HIV vaccine plan and strengthening research into microbicides, increase its contribution to international HIV vaccine and microbicide research efforts; and that DFAIT advocate for this to happen.
55.	We recommend that DFAIT, through its bilateral and multilateral relations, promote international HIV vaccine and microbicide research efforts.
56.	We recommend that DFAIT, through its bilateral and multilateral relations, promote international research initiatives designed to assist efforts to scale up the provision of HIV/AIDS treatments in resource-poor settings, including, in particular, research on simplified treatment regimens.
57.	We recommend that DFAIT, through its bilateral and multilateral relations, promote the advocacy work of international NGOs to accelerate access to HIV vaccines, microbicides and treatments.
58.	We recommend that DFAIT, through its bilateral and multilateral relations, promote the development of national plans to accelerate research and development of HIV vaccines, microbicides and treatments.

Notes

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128. UNAIDS. AIDS as a Security Issue. Fact Sheet. 2002. www.unaids.org/barcelona/presskit/factsheets/FSsecurity_en.pdf. Accessed 25 July 2003.
129. Elbe. HIV/AIDS. 2002: p 172.
130. World Bank Group. News release 2000/172/S. Washington. 10 January 2000.
131. Elbe. HIV/AIDS. 2002.
132. Interagency Coalition on AIDS and Development. HIV/AIDS and Deminers - Issues and Recommendations. Fact Sheet. June 2002.
133. Canada. DFAIT. "Canada and Peace Support Operations." Government of Canada. Last updated 6 February 2002. www.dfait-maeci.gc.ca/
     peacekeeping/menu-en.asp. Accessed 7 July 2003.
134. UNAIDS. AIDS as a Security Issue. 2002.
135. United Nations. United Nations High Commissioner for Refugees. HIV/AIDS and Refugees: UNHCR's Strategic Plan 2002-2004. www.unaids.org/security/Issues/conflict/docs/
     HCRStrategicPlan021902.doc. Accessed 72503.
136. Wilson. Background. 2003.
137. From the website of the Food and Agriculture Organizations of the United Nations at www.fao.org/es/ESN/nutrition/
     household_hivaids_en.stm. Accessed 25 July 2003.
138. Food and Agriculture Organizations of the United Nations (Committee on World Food Security) (hereafter FAO). Food Security and HIV/AIDS: An Update. May 2003. www.fao.org/DOCREP/MEETING/006/Y9066e/
     Y9066e00.HTM#P112_9039. Accessed 18 August 2003.
139. FAO. Food Security. 2003.
140. BBC World documentary on the relationship between HIV/AIDS and food security. Described at www.fao.org/english/newsroom/focus/2003/aids.htm. Accessed 20 August 2003.
141. SCFAIT. Report ..2003: p. 4, rec.3.3.
142. UNFPA. The Impact. 2003: p.54. UNFPA notes that in the case of Malawi's Ministry of Agriculture and Irrigation, a quarter to a half of all technical and professional positions were vacant in 1996 and the vacancy rate in almost all categories had grown by 2000.
143. Whiteside, Alan et al. What is driving the HIV/AIDS epidemic in Swaziland, and what more can we do about it? National Emergency Response Committee on HIV/AIDS (NERCHA) and UNAIDS. April 2003. See also: Pharaoh. AIDS, Security. 2003: pp. 6-7.
144. UNFPA, The Impact. 2003: p. 55.
145. G8 Summit 2003. Implementation Report by Africa Personal Representatives to Leaders on the G8 Africa Action Plan. Summit Documents. www.g8.fr/evian/english/navigation/2003_g*_summit/
     summit-documents/implementation. Accessed 20 August 2003.
146. Commission for HIV/AIDS and Governance in Africa. Frequently Asked Questions. www.uneca.org/chga/doc/faq.htm.
147. Whiteside. What. 2003.
148. "Domestic Violence Contributes to Spread of HIV in Uganda, Human Rights Watch Report Says." www.kaisernetwork.org/
     daily_reports/rep_index.cfm?R_ID_ID=19361. See also: "Amnesty's Annual Report: Imprisoned for 'indecent behavior.'" http://action.web.ca/home/lgbt/databank.shtml?sh_
     itm=3216044e3153d46aa2011b40cab20. Accessed 27 August 2003.
149. G8 Summit 2003. Implementation. p. 5.
150. UNDP. Making Global Trade Work for People. (London and Sterling, Va. UNDP and Earthscan. 2003): p 335.
151. Canadian HIV/AIDS Legal Network. Injection Drug Use and HIV/AIDS: Treatment. Fact sheet #4 in a series of 12 fact sheets. 2002. www.aidslaw.ca/Maincontent/issues/druglaws/e-info-dla4.htm . Accessed 8 August 2003.
152. UNGASS. Declaration. 2001: Paragraphs 70, 71 and 73.
153. This information was taken from the website of the International AIDS Vaccine Initiative via www.iavi.org .
154. This information was taken from the website of the HIV Vaccine initiative at www.who.int/vaccine_research/diseases/hiv/en/.
155. This information was taken from the website of the International Partnership for Microbicides at www.ipm-microbicides.org/.
156. This information was taken from a draft of a paper being prepared for a meeting scheduled for late 2003 sponsored by the Canadian HIV/AIDS Legal Network.
157. This information is taken from the website of The population Council via www.popcouncil.org.
158. Consensus Recommendations. 2003.

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