Ministerial Council on HIV/AIDS

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Towards a Broader View of Health:
Strengthening Inter-Ministerial Collaboration on HIV/AIDS in Canada

Potential Barriers to Collaboration

This section discusses some of the barriers to inter-ministerial collaboration at the federal level in Canada that were identified by the key informants. Some strategies for overcoming these barriers are included in Section 6.0 Strategies for Successful Collaboration.

There are numerous barriers that prevent or weaken inter-ministerial collaboration on HIV/AIDS. At times, they can deter people from taking on the issue in a meaningful way. Understanding the barriers can help people avoid some of the problems and find ways to overcome the barriers. Below, the barriers are listed and explained.

People have become com placent about HIV/AIDS.

HIV/AIDS is less visible now than it once was. With the epidemic nearing its third decade, and with people living longer, many people no longer see HIV/AIDS as an urgent issue. This makes it more difficult to engage other departments and agencies.

Stigma and discrimination based on HIV/AIDS get in the way.

The stigma around HIV/AIDS continues to affect the environment for collaborative work. As it has since the beginning of the epidemic, HIV/AIDS continues to hit people in our society who are most vulnerable and who are already marginalized - for example, drug users; gays, lesbians and transgendered people; Aboriginal people; the homeless; and people with backgrounds of abuse. The impact of this is two-fold: (a) some people in government are uncomfortable with the issue and do not want to be involved; and (b) the people who are marginalized are not able to command a government response.

Other departments and agencies see HIV/AIDS as just a health issue.

Although Health Canada understands that HIV/AIDS is more than just a health issue, other departments and agencies have different paradigms. When they think AIDS, they think condoms. They do not understand the role of the determinants of health in HIV/AIDS, how the activities of their departments and agencies impact on the determinants of health, and how HIV/AIDS impacts on their activities. Until now, there has not been much work done to develop an analysis and a rationale for the involvement of other departments in HIV/AIDS.

Other departm ents and agencies have m any priorities.

The federal government deals with issues that are large in scope and enormously complex. Departments and agencies have a lot of programmes to deliver. There are many competing demands on their time. They would have to find room for activities related to HIV/AIDS and they may not be anxious to do so, particularly if they see HIV/AIDS as secondary to their mandate. People can be resistant to taking on another issue.

The structures and culture of government m ake collaboration difficult.

Government is compartmentalized. For the most part, departments and agencies work in isolation. They are like independent corporations. It is hard for them to think outside of their jurisdiction. As well, departments and agencies have to compete with one another for funding and so they are understandably protective of their resources. The resulting turfism and territorialism can frustrate attempts at collaboration.

The complex decision-making processes of government departments and agencies also make collaboration difficult. It can take a long time to get a decision in one organization, but when several organizations are involved timelines tend to get stretched.

HIV/AIDS is not seen as a government-wide priority.

HIV/AIDS has not been identified by the Prime Minister, the Privy Council Office or other central agencies as a government-wide priority (unlike, for example, the deficit). This makes it more difficult to engage other departments and agencies in the fight against HIV/AIDS.

There is insufficient funding available to do collaboration.

Although dedicated funding may not be required for every HIV/AIDS project in another department or agency - the Department of Justice, for example, has done HIV/AIDS work in the past without any extra funding - funding would certainly facilitate collaboration. Some departments and agencies may not be prepared to spend money on HIV/AIDS if it has to come from their own budgets. Currently, the Canadian Strategy on HIV/AIDS includes funding for only one department outside Health Canada (Correctional Service Canada). It would be difficult to find more money in the current Strategy budget for collaboration because any such funding would have to be diverted from other critical programmes. In fact, many HIV/AIDS stakeholders are arguing that the current allocation of $42.2 million a year is insufficient to meet today's needs and should be significantly increased.

For the most part, the community is not engaging other departm ents and agencies.

The community-based HIV/AIDS movement has historically been a catalyst for change. However, its resources are stretched. Community leaders often have multiple commitments; many are volunteers, and many also live with HIV/AIDS. As a result, with the exception of Correctional Service Canada (CSC), community organizations have not interacted significantly with departments and agencies outside Health Canada. (Some national and local community-based organizations have dealt with CSC on prison issues.) Where government departments and agencies are not being pressured by the community, they are less likely to become engaged.

Collaboration within Health Canada is not always effective.

There are difficulties in communication, coordination and collaboration within Health Canada that get in the way of effective collaboration with other departments and agencies.

Based on some of the interviews with key informants, it is evident that a lack of effective coordination within Health Canada can hinder comprehensive policy development. One example of this is the recent revelation that Health Canada advised Citizenship and Immigration Canada (CIC) that potential immigrants should be tested for HIV infection (and denied entry to Canada if found to be HIV+) for reasons of public health. This reversed a long-standing policy. Key informants indicated that the new position was not well-coordinated or fully resolved among the different divisions of Health Canada that are involved in HIV/AIDS before advice was provided to CIC. Nor were any other departments and agencies consulted (other than CIC). If a collaborative culture existed, it would have been assumed that HIV/AIDS players, both within HC and other departments, would have been interested in contributing their perpective on the issue and that their persepective would be valuable. The Canadian International Development Agency (CIDA) is a good example of this. Although CIDA has no direct responsibility for immigration, its role in human rights internationally and its signficant HIV/AIDS profile in other countries would have made it a good candidate for consultation.

Within Health Canada, much of the HIV/AIDS programming has remained separate from other programming. To be able to credibly approach other departments to undertake HIV/AIDS-related work, Health Canada will need to ensure that HIV/AIDS is integrated into its other health-determinant-related programmes. Furthermore, staff in some of these other programme areas in Health Canada have contacts with other departments and agencies that would be useful in any attempt to expand inter-ministerial collaboration. For example, three programmes - mental health, family violence and children - deal with the issue of housing. If these programmes were more involved in HIV/AIDS, this would make it easier for Health Canada to approach other departments and agencies that deal with housing (such as the Department of Labour) and to work with them on HIV/AIDS-related housing issues.

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