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

A National Portrait

Previous | Table of Contents | Next

3. HIV/AIDS by Jurisdiction (cont)

3.7 Quebec

Surveillance Highlights

• there are 18,000 people currently living with HIV/AIDS in Quebec, an increase of 10% since 2000 and of 33% since 1996.
  
• the number of AIDS cases involving people from countries in which HIV is endemic is second only to the MSM exposure category. As of June 30, 2002, there were close to 700 AIDS cases with the endemic country exposure category.⁷⁴ The estimated number of pregnant women of African origin infected with HIV has increased continuously over time, from five in 1997 to 17 in 1999, 23 in 2000 and 32 in 2001.⁷⁵
  
• there has recently been a significant increase (26%) in the number of newly reported HIV infections, from 493 in 2000 to 621 in 2003.⁷⁶
  
• it is estimated that women represented 23% of newly reported HIV infections in 2002.
  
• the Island of Montreal remains the region most affected by HIV/AIDS with a cumulative incidence rate nine times higher than in the rest of the province.⁷⁷ It is estimated that there are more than 600 new cases of HIV infection each year in the Montreal region.⁷⁸

Quebec⁷⁹

Indicator	Year80
	2003	2002	2001	2000	1995
Prevalence	N/A	18,00081		16,300 (1999)	13,500 (1996)
AIDS Cases
Number of AIDS cases reported by year of diagnosis	37	99	91	113	534
Cumulative number of AIDS cases reported	6,098	6,001	5,936	5,859	4,830
Newly reported AIDS cases by sex and year of diagnosis
male	26	83	75	98	473
female	11	13	16	15	61
Newly reported AIDS cases by exposure & year of diagnosis					Total cases
MSM	15	55	44	51	3,754
IDU	9	15	15	27	441
Heterosexual contact	5	9	8	10	411
MSM/IDU	0	2	4	5	282
Endemic country	6	15	16	13	674
NIR	2	2	3	5	180
Other	0	1	1	2	261
Newly reported AIDS cases by age and year of diagnosis					Total cases
children & youth (< 15 years)	0	0	0	0	101
adults	36	95	88	111	5,745
seniors (> 60 years)	1	4	3	2	157
Reported AIDS-related deaths	5682	126	109	124	586
HIV Infection
Minimum number of laboratory confirmed HIV cases83	621	619	526	493	624
	2002	1999
Estimated Incidence of HIV84 by exposure category
MSM	250-450	300-500
MSM/IDU	50-150	50-150
IDU	350-650	450-800
Endemic/Heterosexual contact	150-350	150-350
Blood	<10	<10
Estimated Incidence of HIV by sex
Men	N/A	N/A
Women	N/A	N/A
Estimated Incidence of HIV by age
<15 years	N/A	N/A
15-29	N/A	N/A
30-39	N/A	N/A
40-49	N/A	N/A
50-59	N/A	N/A
60+	N/A	N/A

Organization

In Québec, the Loi sur la santé publique sets the context for the province's public health programs and strategies. In its broadest sense, this law aims to protect population health and to establish conditions favourable to maintaining and improving population health and well-being.⁸⁵ It also seeks:

• to establish measures that prevent diseases, trauma and social problems that impact on population health; and
  
• to have a positive influence on the main factors that determine health, notably by a concerted action involving various partners (government departments, Public Health services, regional and local agencies, community based agencies, etc.).⁸⁶

The development of a National Public Health Program and its companion Regional and Local Action Plans on public health is a mandatory aspect of that law. The National Public Health Program provides the framework for all public health activities undertaken on a provincial, regional and local level.⁸⁷ It must include orientation statements, goals and priorities with regard to:

• monitoring population health and its determining factors;
  
• preventing the disease; trauma and social problems that can impact population health;
  
• promoting measures to enhance population health and well-being; and
  
• protecting and monitoring population health.⁸⁸

The Stratégie québécoise de lutte contre l'infection par le VIH et le Sida, l'infection par le VHC et les infections transmissibles sexuellement - Orientations 2003-2009 complements the National Public Health Program (2003-2012). The Stratégie québécoise encompasses HIV/AIDS, hepatitis C and other STIs given that they affect similar population groups. In addition to reaching vulnerable groups, the Stratégie québécoise also addresses the general population and those living with HIV/AIDS.

The Stratégie québécoise considers the current context of HIV/AIDS and the illusion that the epidemic is under control. The face and reality of people living with HIV/AIDS has also changed considerably with the advent of HIV medications and the increasing number of IDU, youth, women and members of ethno-cultural communities who are becoming infected. The Stratégie québécoise includes a variety of strategies to reach vulnerable groups, by renewing prevention messages, by adapting care and services to people living with HIV/AIDS and by engaging in partnerships that promote health.⁸⁹ More specifically, the strategy's goals are:

• to reduce the incidence of infections transmitted through sexual contact and blood;
  
• to ensure that quality care and services are readily accessible; and
  
• to create a social environment that supports prevention while respecting human rights.⁹⁰

To achieve these goals, the Quebec strategy outlines eight policy statements:

1. Reinforce the individual's potential so that they change their behaviour.
   
2. Support the most vulnerable groups, for example by facilitating access to testing.
   
3. Encourage the use of clinical practices and measures that emphasize prevention.
   
4. Develop specific prevention measures, for example through the collection of used syringes and by providing easy access to condoms.
   
5. Support the development of vulnerable communities and encourage their empowerment.
   
6. Ensure that adequate care is provided to people living with HIV/AIDS.
   
7. Participate and partner in concerted actions that favour health and well-being.
   
8. Consolidate surveillance and monitoring efforts as well as other support functions.⁹¹

Although provincial in scope, implementing these policy statements has to occur within regional and local realities. HIV/AIDS and hepatitis C, for example, are particularly concentrated in urban and semi-urban areas and within specific population groups, whereas STIs are more widespread among the general population. Consequently, regional and local public health offices and their community partners must adapt the policy statements according to the needs of their populations. Regional Action Plans on public health and Local Action Plans on public health have to reflect their own contexts and realities.⁹²

The Strategy's budget is $21 million. The largest portion of this amount is distributed among the regional public health offices and community organizations. The remainder is directed towards knowledge and expertise development, information campaigns targeting the general population, research and evaluation, and surveillance. The National Program of Public Health for 2004-2005 has received supplementary funding and these funds will be allocated to regional agencies in order to enhance the Strategy's activities.

Coordination and Cooperation

There are many stakeholders and partners in the fight against HIV infection, including the Ministry of Health, other government departments, regional and local public health offices, health care professionals and administrators, community based organizations and researchers. The Loi sur les services de santé et les services sociaux, the Loi sur l'Institut national de santé publique du Québec, Quebec's Law on Public Health and its National Public Health Program, specify each stakeholder's responsibilities in this regard.⁹³

Working from a provincial perspective, the Ministry of Health, for example, is responsible for:

• informing stakeholders about the National Public Health Program and the Strategy;

• putting in place the conditions necessary to implement the policy statements described in the Strategy;

• supporting regional agencies to apply the orientations, for example by developing specific tools;

• ensuring the evaluation of the strategies, approaches and interventions; and

• ensuring financial accountability.

The Institut National de Santé Publique du Québec, meanwhile, supports the Ministry of Health and regional agencies with their public health missions by:

• providing assistance in the form of advice, training, information, research, evaluation, specialized laboratory services and international cooperation;

• helping to develop knowledge and expertise;

• planning and coordinating national training programs; and

• overseeing the Strategy's evaluation process.

  

Other partners in this effort include:

• the regional public health departments who are responsible for carrying out the strategy within their jurisdictions. While considering their population's needs and realities as well as available resources, they develop Regional Action Plans based on the content of the National Public Health Program and the Strategy. With regard to HIV infection, they plan and coordinate programs, provide care and other services, and undertake health promotion, prevention, research and monitoring activities.

• hospitals, private specialized clinics and the Unités Hospitalières de Recherche, d'Enseignement et de Soins Spécialisés sur le Sida (UHRESS) provide care and services through multidisciplinary teams of specialists at the regional level and, on a supra-regional level, disseminate their expertise, notably through the Programme national de mentorat for doctors and nurses (ongoing training, mentoring, workshops, internships).

• at the local level, specialized clinics provide direct care to people living with HIV/AIDS. They share their expertise by training interns and by undertaking various research activities.

• at the local level, the Centres locaux de services communautaires (CLSC) provide front line care and services as well as undertaking primary prevention efforts targeted at youth and vulnerable populations. Their HIV/AIDS activities are integrated within the Local Action Plan on public health, all the while considering activities undertaken by community-based agencies.

• community-based agencies are autonomous in determining their missions and activities. In terms of HIV infection, they attend to many vulnerable population groups and offer a wide range of prevention, care, housing and other support services. They work in cooperation with the regional and local authorities and are partners in the effort to achieve the regional and local action plans.

• universities and other learning centres contribute to the Strategy through research, knowledge transfer, evaluation and other developmental activities.

Other partners participate in the effort to address HIV/AIDS, for example education and public safety agencies, municipalities, school boards, youth centres, detention facilities and transition houses.

Testing, Prevention, Care and Treatment

The Quebec strategy encourages individual responsibility with regard to safe behaviour as well as an attitude of tolerance, compassion and solidarity towards vulnerable groups. Prevention activities include:

• ongoing social marketing and communication campaigns to promote condom use, etc.;

• developing effective, evidence-based tools and materials;

• promoting sex education and drug use prevention programs in the educational system at every level; and

• special prevention and harm reduction efforts targeted to people living with HIV/AIDS and to vulnerable populations.

The number of HIV serology tests conducted in Quebec increased steadily from 1995 to 2001. This is illustrated in Figure 6. In the six months from January to June 30th 2002, 101,800 tests were conducted.⁹⁴ As elsewhere, testing is voluntary. Quebec also includes HIV testing, using the opt-out model, within the array of blood tests given pregnant women. In 2002, 58 pregnant women in Quebec tested positive for HIV. Of these, 31% were Caucasian, 43% were African, 19% were Haitian and 3% were Latin American. In the first six months of 2003, there were 48 reported cases among pregnant women of whom 23% were Caucasian, 52% were African and 21% were Haitian. Figure 7 illustrates the exposure categories associated with those pregnant women testing HIV positive in 2002.⁹⁵

 

In order to improve access to testing and to encourage testing, SIDEPs (Services intégrés de dépistage et de prévention) have been developed, most notably within the services provided at the CLSC level. These integrated services for testing and prevention offer counselling, testing and information both to the general population and to vulnerable groups. There are currently 70 SIDEPs in the province of Quebec and they are in the midst of expanding their services to STI and hepatitis testing and vaccination (HAV, HBV). They also encourage prevention among the partners of people living with HIV/AIDS. Importantly, the SIDEPs are encouraged to offer their services in places where vulnerable clients are located, for example in correctional centres or community organizations.

The Quebec Strategy emphasizes that every person living with HIV/AIDS must have access to quality care and services as well as the best available treatment. One component focuses on improving the integration of care and service networks, including UHRESS.⁹⁶ A variety of means have been implemented to support physicians who treat HIV positive clients, for example the Programme national de mentorat. There is also the Comité consultatif sur la prise en charge clinique des personnes vivant avec le VIH which brings together a panel of specialists from various fields to provide advice to the Department and publish guidelines for health care professionals on the use of HIV drug therapies.⁹⁷ Finally, the community-based housing for people living with HIV/AIDS model presently in use is considered to be unique anywhere.

Knowledge

Decision making, as well as the creation, planning and implementation of Strategy activities rely upon HIV surveillance and monitoring, research and evaluation. Many organizations are involved in the effort to build knowledge through research. The Fonds de recherche en santé du Québec (FRSQ) conducts epidemiological, clinical and basic research on public health. Recently, the FRSQ initiated a psychosocial research program on HIV and the Réseau Sida et maladies infectieuses of the FRSQ favours an integrated approach in regards to HIV research. Additional research is conducted by clinicians, universities or public health researchers, the INSPQ and UHRESS.

Moreover, a funding program jointly implemented by the Ministry of Health and the Fonds québécois de la recherche sur la société et la culture (FQRSC) for HIV research gave rise to a number of HIV research projects.

At the community level, research is being conducted by COCQ-sida on persons living with HIV/AIDS outside of urban centres, on adapting approaches for cultural groups, on assessing the quality of different interventions, and on developing training programs for pharmacists and counsellors. CPAVIH is working with pharmaceutical companies to assist clients with medications and the regimes they must follow, and to work towards combating the secondary effects caused by prolonged use of these medications.

Quebec also places considerable emphasis on evaluation as a means of improving program efficacy. The INSPQ is currently assessing prevention, care and services programs while the FQRSC is evaluating prevention initiatives as well as the impact of inter-sectoral actions.

Lastly, the province has encouraged skills development initiatives, including:

• Outillons-nous, by COCQ-Sida;

• seminars organized by the FRSQ HIV and STI prevention team;

• seminars organized for psychologists and social workers; and

• training for pharmacists in regards to methadone use.

Strengthening the Effort

The Stratégie québécoise de lutte contre l'infection par le VIH et le SIDA, l'infection par le VHC et les Infections transmissibles sexuellement is the Ministry of Health's position on strengthening the effort to address HIV/AIDS in Quebec.

Key informants outside of the Ministry of Health have proposed the following issues in order to strengthen the effort to address HIV/AIDS in Quebec, for example:

• expediting the process for adding new pharmaceuticals to the provincial formulary;

• increasing the level of funding committed to the epidemic and providing operational funding to community organizations;

• working together with other jurisdictions at the national level on common themes and encouraging increased partnerships;

• speaking more frankly with the general public in an effort to reduce the stigma and discrimination associated with HIV/AIDS;

• investing more heavily in research aimed at improving clinical practice;

• committing more effort to assisting persons with HIV/AIDS to re-enter the workplace;

• building a stronger human rights framework for persons living with HIV/AIDS; and

• getting the federal government to simplify the requirements of the AIDS Community Action Program, as the program's paper burden is onerous for community organizations in consideration of the funds available.

  

3.8 New Brunswick

Surveillance Highlights

• the number of newly diagnosed AIDS cases has declined significantly, from 17 in 1995 to two in 2002 and six in 2003. In total from 1979 to December 31, 2003, there have been 160 reported AIDS cases in New Brunswick, 90% of whom have been males. Fifty-seven percent of these cases have been attributed to the MSM exposure category, 6% to IDU, 17% to blood products and 8% to heterosexual contact with a person at risk.⁹⁸

• the number of newly reported cases of HIV infection has also declined although not as dramatically, from 16 in 1995 to eight in 2002 and 10 in 2003. Since 1985 there have been 313 positive HIV reports of which 87% were among men.

• in 2001 there were five newly reported cases of HIV infection attributed to injection drug use, representing 50% of all new infections in that year. In 2003, there was one IDU case (10%) along with three attributed to MSM (30%), two attributed to endemic country (20%) and three to heterosexual contact (30%).⁹⁹

New Brunswick¹⁰⁰

Indicator	Year
	2003	2002	2001	2000	1995
AIDS Cases
Number of AIDS cases reported by year	6	2	3	4	17
Cumulative number of AIDS cases reported	160	154	152	149	116
Newly reported AIDS cases by sex
Male	5	2	3	3	16
Female	1	0	0	1	1
Newly reported AIDS cases by exposure category
MSM	2	2	3	3	9
IDU	1	0	0	0	3
Heterosexual contact	0	0	0	1	0
NIR-Het	1	0	0	0	2
Recipient of clotting factor	0	0	0	0	3
Newly reported AIDS cases by age
0-19	1	0	0	0	1
20-59	5	2	3	4	16
60+	0	0	0	0	0
AIDS-related deaths	1	0	0	0	8
HIV Infection
Total number of reported HIV cases	10	8	10	14	16
Newly Reported Cases of HIV Infection by exposure category
MSM	3	1	3	9	8
MSM/IDU	0	1	0	0	1
IDU	1	0	5	2	3
Heterosexual contact	3	1	1	0	1
HIV/AIDS-endemic countries	2	4	0	1	0
NIR-Hetero	0	1	1	2	2
NIR	1	1	0	0	1
Newly Reported Cases of HIV Infection by gender
Men	7	7	7	12	14
Women	3	2	3	2	2
Newly Reported Cases of HIV Infection by ethnicity
Aboriginal people
men	0	0	0	1	2
women	0	0	0	1	0
Asian	0	0	0	0	0
Black	2M/1F	2M/2F	0	1M	0
White	4M/2F	5M	7M/2F	9M/1F	11M/2F
Unspecified	1M	0	1F	1M	1M
Newly Reported Cases of HIV Infection by age
Perinatal	0	0	0	0	0
1-14	0	1	0	0	0
15-24	2	2	0	1	1
25-39	6	5	6	8	11
40-59	2	1	4	5	4
60+	0	0	0	0	0

Organization

The Government of New Brunswick has chosen not to articulate a provincial strategy on HIV/AIDS although some work on such a strategy had been undertaken. It has been suggested that the province assigns a higher priority to hepatitis C given that it is affecting a larger number of people. In 2002, for example, there were 172 newly reported cases of hepatitis C and only 8 of HIV infection.¹⁰¹ In the future, there may be interest in developing a strategy that addresses the full range of blood-borne pathogens.

The Department of Health and Wellness has one staff person, situated within the Project Management Section of the Public Health and Medical Services Division, who manages HIV/AIDS-related matters in addition to other responsibilities. The eight newly established Regional Health Authorities also have some role to play in addressing HIV/AIDS although their responsibilities in this regard are not yet defined and both access and consistency issues have not yet been addressed.

All regions of the province have established Sexual Health Programs with proactive Public Health nurses who involve themselves in community partnerships, including the Department of Education.

Coordination and Cooperation

The Department of Health and Wellness participates in a variety of activities that will have some influence on the epidemic's course. Its HIV/AIDS coordinator, for example, has a strong relationship with the Department of Education. As an example of this partnership's strength, two public health nurses - in their capacity with the Sexual Health Program and the Healthy Learner Program - recently participated with the Department of Education in revising and rewriting the Middle School Health Curriculum.

The provincial effort to address HIV/AIDS at the community level has benefited from the PHAC AIDS Community Action and Hepatitis C programs. The former provided some operational funding to AIDS service organizations in the province while the latter has funded a number of innovative projects in the federal and provincial correctional institutions located in New Brunswick. These projects addressed both hepatitis C and HIV vulnerability particularly with regard to injection drug use. Provincial organizations have also worked cooperatively with researchers at McGill University to establish a "Safe Spaces" project in Moncton to support gay youth, ages 15-24 years. This is one of four such pilot projects underway in Canada.

AIDS service organizations appear to have a limited relationship with the province but a strong relationship with regional public health staff. Public health nurses, for example, provide educational workshops for these organizations. The ASOs are also engaged in efforts to build partnerships at the community level to meet the full range of service needs, for example the Saint John Sex Trade Committee and the partnered but ultimately unsuccessful effort to introduce a methadone maintenance program in that city.

Certain key informants spoke highly of the PHAC regional office and in particular of its commitment to community development and population health. The federal office ensures that the ASOs are aware of funding opportunities as they arise through any federal department, and shares information and research as these become available. New Brunswick also participates in the FPT-AIDS Atlantic Regional Committee.

Testing, Prevention, Care and Treatment

The Government of New Brunswick is addressing the HIV/AIDS epidemic in a number of ways, for example by:

• funding a toll-free hotline managed by AIDS New Brunswick;

• maintaining anonymous testing centres in seven of the province's regions;

• providing some support, through its public health network, for needle exchange programs. The number of needles distributed has increased from 700 in 1999 to 80,000 in 2003, with 60,000 being distributed in Saint John and almost 20,000 in Fredericton. Figure 8 illustrates this increase for the Fredericton program. The Department of Health and Wellness does not provide operational funding for this service but does supply all the needles, syringes and condoms for these community programs; and

• using its public health nurses for HIV testing in provincial correctional facilities and at one of the federal institutions for a pilot project offering anonymous testing.

In 1998 the province introduced anonymous testing - in addition to non-nominal and nominal testing - through Sexual Health Centres in Moncton, Saint John, Fredericton, Edmundston, Campbellton, Bathurst and Miramichi. It is now considering a comprehensive prenatal HIV testing program for pregnant women. The New Brunswick Medical Society, in partnership with the Department of Health and Wellness, is proposing an "opt-out" but informed consent model.

The province also has what is described as a very strong prescription drug program that ensures these are widely accessible. Certain drugs can be obtained through the mail from the provincial office rather than through local pharmacies so as to ensure privacy and confidentiality in small communities. There are also two methadone programs in the province, one in Fredericton with 50 people enrolled and another 50 on a waiting list, and one in Moncton with 127 people enrolled and another 175 on a waiting list.

Knowledge

Little research is undertaken locally beyond project and accountability reporting.

Strengthening the Effort

Key informants identified the following measures as means for strengthening the provincial response to HIV/AIDS:

• recognize that HIV/AIDS poses a threat in New Brunswick as it does elsewhere, regardless of the relatively small number of people currently infected.

• commit additional resources to the epidemic and to support the province's ASOs.

• develop an HIV/AIDS strategy to enhance public awareness and to provide direction to the Regional Health Authorities.

• devote more attention to prevention and health promotion rather than focus so exclusively on the critical care system.

3.9 Nova Scotia

Surveillance Highlights

• in Prince Edward Island and Nova Scotia together,¹⁰² the number of people diagnosed with HIV/AIDS is relatively small and considerably lower than in the mid-1990s. In 1995, for example, there were 32 newly reported cases of HIV infection compared to 16 in 2002 and four in 2003.

• for the entire period to December 31, 2003, MSM accounted for 74% of all AIDS cases. It also accounted for one of the four newly reported cases of HIV infection in 2003 and for nine of the sixteen cases in 2002.

• there were two newly reported cases of HIV infection in the IDU exposure category in 2003. There had not been any in this exposure category in 2002.

Nova Scotia and Prince Edward Island

Indicator	Year
	2003	2002	2001	2000	1995
AIDS Cases
Number of AIDS cases reported by year	2	5	3	7	32
Cumulative number of AIDS cases reported	300	298	293	290
Newly reported AIDS cases by sex
male	2	5	3	6	30
female	0	0	0	1	2
Total number of reported AIDS cases by exposure category	To Dec. 31, 2003
MSM	223
MSM/IDU	8
IDU	14
Blood/Blood products	20
Endemic country	9
Heterosexual contact/NIR	24
NIR	2
HIV Infection
Total number of reported HIV cases	4	16	15	16	32
Reported HIV cases, by gender	To Dec. 31, 2003
Male	534
Female	80
Newly-reported cases of HIV Infection by exposure category
MSM	1	9	2	4
MSM/IDU	0	0	0	1
IDU	2	0	5	1
Heterosexual contact	0	1	0	6
HIV/AIDS-endemic countries	1	2	2	2
NIR/NIR-Hetero/Other	0	2	2	5
Recipient of clotting factor	0			1
Perinatal	0	1

 

---

⁷⁴ Quebec, Portrait, 2003:5.

⁷⁵ HIV was not a reportable condition in Quebec until 2002.

⁷⁶ Quebec, Sante et Services sociaux, 2003:17.

⁷⁷ Quebec, Portrait, 2003:9.

⁷⁸ "HIV/AIDS among Natives, an adapted training." FNQLHSSC/CSSSPNQL 2003.

⁷⁹ See Québec, 2003; Québec, 2002; and Quebec, Portrait, 2003.

⁸⁰ As of December 31 2003. Surveillance des cas de syndrome d'immunodéficience acquise (sida) cas cumulatifs 1979-2003. Mise a jour No 2003-2 au 31 décembre 2003. Ministère de la Santé et des Services sociaux du Québec. Disponibles à : http://www.msss.gouv.qc.ca/sujets/prob_sante/mts_vih_sida.html.

⁸¹ Estimated prevalence (14,000-22,000) in Quebec at the end of 2002, as estimated by the Division of HIV/AIDS Epidemiology, Health Canada. See also Québec, Portrait des infections transmissibles sexuellement et par le sang, de l'hépatite C, de l'infection par le VIH et du sida au Québec - décembre 2003. Available at http://www.msss.gouv.qc.ca/sujets/prob_sante/mts_vih_sida.html.

⁸² First 6 months of 2003, as of February 2004. Institut national de la statistique du Quebec.

⁸³ Minimum number based upon confirmed laboratory results. The actual number of persons with a positive result is higher, but duplicates cannot be totally eliminated. The laboratory result does not include information relating to age group or risk exposure category.

⁸⁴ Collection of epidemiological information on Laboratory confirmed HIV cases began in April 2002. To date, no official release of data on this subject has been made. The only available data to date on HIV prevalence and incidence are based on estimates produced for 2002 and 1999 by the Division of HIV/AIDS Epidemiology, Health Canada.

⁸⁵ Loi sur la santé publique, Chap. 1, art. 1.

⁸⁶ Loi sur la santé publique, Chap.1, art. 3.

⁸⁷ Loi sur la santé publique, Chap.2, art.7.

⁸⁸ Loi sur la santé publique, Chap. 2, art. 8.

⁸⁹ Québec, 2004:27.

⁹⁰ Québec, 2004:11.

⁹¹ Québec, 2004:31-42.

⁹² Québec, 2004:30.

⁹³ Québec, 2004:46-48.

⁹⁴ Quebec, Portrait, 2003:19.

⁹⁵ Québec, 2003:19.

⁹⁶ Québec, 2004:39.

⁹⁷ Québec, 2004:44.

⁹⁸ Canada, Health Canada, 2004:44.

⁹⁹ Canada, Health Canada, 2004:24.

¹⁰⁰ Data provided by the Provincial Epidemiology Service, N.B. Department of Health and Wellness.

¹⁰¹ Communicable Diseases Reported in New Brunswick by Health Region, 2002. http://www.gnb.ca/0208/cd2002-e.asp.

¹⁰² Given the small number of people involved and the need to preserve confidentiality, data from Prince Edward Island and Nova Scotia are blended as a result of an agreement between the two governments. See Canada, Health Canada, 2004.

Previous | Table of Contents | Next