A Report on Governments' Responses to the HIV/AIDS Epidemic in Canada

A National Portrait

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1. Introduction

HIV/AIDS remains a significant threat to public health and to both individual and community well-being in Canada in spite of the many scientific, medical, social and human rights advances of the past decades. Since the mid-1980s, the epidemic has been responsible for approximately 18,000 deaths and Health Canada estimates that 56,000 Canadians are today living with HIV/AIDS.¹ Governments in Canada - federal, provincial and territorial - have each responded to the epidemic in a manner appropriate to their own jurisdiction's needs and circumstances.

1.1 Purpose and Objectives

In January 2004, the Federal/Provincial/Territorial Advisory Committee on AIDS (FPT AIDS) initiated this project - a National Portrait - in order:

• to summarize the different jurisdictions' policy and program responses to the epidemic;
• to identify and analyze issues of common concern; and
• to identify means for strengthening the effort to address the epidemic, everywhere in Canada.

FPT AIDS expects the National Portrait to fill an information gap and serve as a foundation for a strengthened, inter-governmental response to the epidemic.

1.2 Methodology

Research for the project took place between January and June 2004 and included a review of both surveillance data and of publications relating to each jurisdiction's efforts to address the epidemic. The methodology also included interviews with approximately 50 key informants associated with various government or community-based organizations involved in the response to HIV/AIDS. The interviews addressed issues pertaining to government organization, cooperation and coordination, prevention, care and treatment, knowledge and measures for strengthening each jurisdiction's response to the epidemic. The reports on the three northern territories were integrated in order to respect the confidentiality of the key informants' remarks. Members of the FPT AIDS Committee reviewed, commented upon and approved the draft and final reports.

This project encountered certain challenges. One was to present similar surveillance data for each province and territory since different jurisdictions collect different levels of detail. Many jurisdictions, for example, do not identify the ethnic status of those diagnosed with HIV. The tables in Section 3 reflect these differences. Similarly, surveillance data published by the different jurisdictions and by Health Canada present certain discrepancies due to different reporting periods and the on-going effort to correct data from previous years.²

This report presents both HIV and AIDS surveillance data and estimates of HIV prevalence and incidence. Surveillance data include a description of positive HIV test reports (new HIV diagnoses) and AIDS diagnoses. Consequently, these data provide only a description of persons who have been diagnosed with HIV and AIDS and do not represent those who are infected but untested and undiagnosed. Other reasons that surveillance data understate the magnitude of the epidemic include the fact that surveillance data are subject to underreporting, delays in reporting and changing patterns of testing behaviour. Furthermore, as HIV is a chronic infection with a long latent period, many persons newly infected with HIV in a given year may not be diagnosed until later years.

As well, the project did not endeavour to document jurisdictions' HIV/AIDS-related expenditures since doing so would be meaningless without a full consideration of each government's policy priorities and fiscal circumstances. Furthermore, different jurisdictions report their HIV/AIDS-related expenditures in different ways or, indeed, not at all.

1.3 Report Organization

This report is organized in five Sections. Following this Introduction, Section 2 sets the context by providing a brief epidemiological overview of HIV/AIDS in Canada³ while Section 3 describes the epidemic in each jurisdiction and each jurisdiction's policy and program response. Section 4 presents and analyzes the key issues that emerge from considering the provincial and territorial pictures and establishes the foundation for Section 5, Conclusions.

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¹ Canada, Health Canada, 2004(a):49 (deaths) and 1 (prevalence). With regard to the prevalence estimate, There is now a greater emphasis on ranges, and Health Canada estimated that between 46,000 and 66,000 people were living with HIV (including AIDS) at the end of 2002. N.B. The Public Health Agency of Canada, created on September 24, 2004 has taken over the responsibility for surveillance data, however, this report relies on Health Canada data produced prior to that date.

² For a description of data limitations, see Canada, Health Canada, 2004:69-71.

³ This section relies upon the most recent Health Canada Surveillance Report, the Canada Communicable Disease Report and the HIV/AIDS Epi Update series. See Canada, Health Canada, 2004; Canada, Health Canada, 2003(a); and Canada, Health Canada, 2003(b), http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/epiu-aepi/index.html.

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