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

A National Portrait

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3. HIV/AIDS by Jurisdiction (cont)

3.10 Prince Edward Island

Surveillance Highlights

Surveillance data from Prince Edward Island are included with those from Nova Scotia in order to protect confidentiality and as a result of an agreement between the two jurisdictions. Highlights from these data include the following.

• in Prince Edward Island and Nova Scotia together, 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 resulting from IDU 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

Organization

Prince Edward Island has both a small population (135,300) and a small number of people living with HIV/AIDS, both contributing to the epidemic not being high on the "public radar screen." Its strategy for addressing HIV/AIDS was developed 10 years ago and has not been updated. The Communicable Diseases and Immunization Programs in the Office of the Chief Health Officer, Department of Health and Social Services, is responsible for HIV/AIDS-related policy and coordination in addition to its other responsibilities. Four regional health authorities (West Prince Health, East Prince Health, Queens Health, Kings Health) and the Provincial Health Services Authority are mandated to deliver all health services and supports.

There is only one community agency specifically focused on HIV/AIDS, i.e. AIDS PEI. It is a registered charity that began as a community-based support group for those living with HIV/AIDS. Currently, it operates a Speakers' Bureau and food bank, distributes educational information and condoms, and administers both an Emergency and a Health Maintenance Fund. It has also been involved in three projects addressing hepatitis C. The province does not fund AIDS PEI but the organization does receive approximately $110,000 annually for operational funding and approximately $35,000 for project funding from ACAP.

The AIDS PEI client base remained steady for a decade but then doubled in the past year. The organization estimates that there are many people living with HIV/AIDS in Prince Edward Island who are not accessing their services, perhaps because of confidentiality concerns. Other organizations, such as those focused on addictions, play some role in the provincial effort to address the epidemic.

Coordination and Cooperation

AIDS PEI enjoys a strong working relationship with the regional ACAP office. The Government of Prince Edward Island does not have an interdepartmental committee addressing HIV/AIDS-related issues although representatives of different departments sit on various AIDS PEI committees. The province does participate with the other Atlantic provinces in the FPT-AIDS Atlantic Regional Committee. This committee brings together representatives of both the provincial and federal governments in an effort to collaborate across provinces and to compensate for the small number of staff people in each jurisdiction involved directly with HIV/AIDS-related policy and programming. At this time, the committee does not include representatives of community-based organizations.

The committee works collaboratively on various prevention initiatives and is endeavouring to adopt a common approach to harm reduction. It is currently planning to host a conference on that issue and to involve a variety of non-traditional partners such as pharmacists from the region. It also hopes to explore alternate funding models in which federal and provincial funds are pooled. The committee has recently drafted a Work/Action Plan for 2004-2005 and is now in the process of identifying timelines and resource needs for each activity.

Table 4, FPT-AIDS Atlantic Regional Committee Work/Action Plan 2004-05

Objective	Action/Activities	Indicators/Outputs
Increase awareness of harm reduction initiatives and issues facing people who inject drugs in the Atlantic region.	Disseminate information (new research, best practices, etc) from community-based organizations and the federal and provincial governments through the IDU master stakeholder list.	New research and relevant best practices are shared across sectors in the Atlantic region.
	On FPT teleconferences and at FPT meetings, share information on harm reduction and issues facing people who inject drugs.	FPT members share informationon relevant initiatives at meetings and on quarterly teleconferences.
	Develop committee of multi-sectoral stakeholders to organize and plan regional harm reduction conference.	Multi sectoral committee is established.
		Harm reduction conference is organized.
	Hold regional harm reduction conference.	Regional harm reduction conference is held.
Increase profile of harm reduction and IDU issues on federal/provincial agenda in the Atlantic region	Coordinated and more frequent briefings on harm reduction and current IDU issues across federal and provincial government departments.	Deputy Ministers and Health Canada's Regional Director General are briefed in a coordinated manner on issues relating to harm reduction and IDU.
	Collaborate/increase dialogue with other branches of Health Canada and provincial departments of health to bring important information and evidence to senior government officials.	Important information about harm reduction and IDU is shared with senior level officials in the federal and provincial governments.
Enhance and support information sharing/knowledge development around harm reduction and IDU issues in the Atlantic region	Conduct environmental scan/profileof IDU in the Atlantic region.	Scan completed.
	Develop and pilot standardized data collection tools for needle exchange programs in the Atlantic region.	Standardized data collection tool for NEPs is created by multi-stakeholder group and piloted.
	Compile inventory of harm reduction stakeholders in the Atlantic region.	Inventory of Atlantic harm reduction stakeholders is created.
	Develop linkages with Corrections in the Atlantic region.	Linkages with Corrections are established.

PHAC has also assigned one of its Field Surveillance Officers to Prince Edward Island and Nova Scotia, to assist with the collection and analysis of surveillance data.

Testing, Prevention, Care and Treatment

There is a strong "culture of caring" in Prince Edward Island but at the same time very considerable stigma and discrimination still associated with HIV/AIDS. As a result, confidentiality is always a significant issue and, it has been suggested, that it "is not easy to be HIV positive in PEI" because of these concerns. Much of the assistance provided to individuals occurs in informal ways. The culture of caring, for example, has resulted in the provincial Department of Health using what flexibility exists within provincial policies and programs to provide care and support to people who may not otherwise be able to access the necessary care and treatment for HIV/AIDS.

Both nominal and non-nominal testing are available through physicians in PEI. Anonymous testing is not available and there is no policy concerning prenatal screening for HIV. Such screening depends upon the woman involved and her physician. Concerns about confidentiality would compromise efforts to promote more extensive testing for HIV.

Treatment is available on the island although those living with HIV/AIDS may go to Moncton or Halifax for more specialized services. In some cases, the Department of Health and Social Services may provide some financial assistance to those leaving the province for such treatment. It will also pay for any medications required as long as they are listed on the provincial formulary.

PEI does not have a sexual health clinic and sexual health education is offered only in Grade 9 in the school system, for those youth and families who wish to participate.

 

Knowledge

The regional ACAP office goes to great lengths to share knowledge with the province and with community-based organizations that are endeavouring to address the epidemic. This may include efforts to inform them of funding opportunities as well as recent studies concerning the epidemic and best practices for addressing the epidemic.

Strengthening the Effort

Key informants suggested the following initiatives to strengthen the provincial response to the epidemic:

• vigorous efforts to promote public awareness of HIV/AIDS, to educate the public on transmission, prevention and harm reduction issues, and to reduce stigma and discrimination.

• enhance the level of cooperation that exists among community-based organizations and the provincial government.

• enhanced funding and resources committed to communicable disease prevention.

• improve accessibility to testing, treatment and care so as to reduce the need for people to leave PEI for these.

3.11 Newfoundland and Labrador

Surveillance Highlights

• Newfoundland and Labrador had 11 newly reported cases of HIV infection in 2003 compared to one in 2002, five in 2001, three in 2000 and seven in 1995. Before 2003, virtually all these cases were in the MSM exposure category. In 2003, however, five of the 11 cases were in this exposure category and another five were ascribed to heterosexual contact.

• nine of the eleven newly reported cases in 2003 occurred among men.

• the number of newly diagnosed cases of AIDS is very small - in 2003 for example, there was only one such case - although there have been 88 cases diagnosed since 1985. Eighty percent of these were among men and 20% among women.

Newfoundland and Labrador¹⁰⁵

Indicator	Year
	2003	2002	2001	2000	1995
AIDS Cases
Number of AIDS cases reported by year	1	1	3	2	6
Cumulative number of AIDS cases reported	88	87	86	83	59
Newly reported AIDS cases by sex
male	1	1	3	2	6
female	0	0	0	0	0
Newly reported AIDS cases by exposure category
MSM	1	1	3	1	2
IDU	0			1
MSM/IDU	0				1
Blood products	0				1
Heterosexual contact	0				1
Not Identified	0				1
AIDS-related deaths	N/A	0	0	4	10
HIV Infection
Total number of reported HIV cases	11	1	5	3	7
Newly reported cases of HIV Infection by exposure category
MSM	5	1	4	2	4
IDU	1	0	0	1	0
Heterosexual contact	5	0	1	0	1
HIV/AIDS-endemic countries	2	0	0	0	0
Not identified	0	0	0	0	2
Newly reported cases of HIV Infection by sex
Men	9	1	5	3	5
Women	2	0	0	0	2
Newly reported cases of HIV Infection by age	Cumulative to 2003
0-14	8
15-19	11
20-29	89
30-39	83
40-49	20
50-59	6
60+	1
ANS	4
Total	222

Organization

In 1993, the Government of Newfoundland and Labrador responded to the epidemic with a report entitled "Towards the Development of a Comprehensive HIV/AIDS Strategy for Newfoundland and Labrador." Useful at the time for providing direction and enhancing awareness, the document is now dated and work is underway on a new strategy, with completion expected in the Fall of 2004. The Steering Committee responsible for developing the new strategy consists of a representative group of stakeholders.

The Department of Health and Community Services is responsible for policy and intergovernmental issues, various surveillance and other matters as appropriate while the Regional Health Boards are responsible for delivering HIV/AIDS-related services and programs. Unlike in some other jurisdictions, there is not a specific bureau that is responsible for HIV/AIDS-related matters which is a reflection of the small number of cases in Newfoundland and Labrador.

In general, public concern relative to HIV/AIDS is not high, again because of the small number of people infected with or directly affected by the condition. In essence, the epidemic "has fallen off the public radar," an example of which is the declining number of people participating in the annual AIDS Walk.

The province does not specifically identify funds for HIV/AIDS but rather includes these resources within its larger health services budget. It does provide annual funding of approximately $9,000 to an AIDS service organization in St. John's to maintain a 1-800 information line. The ASO receives the majority of its funds through the PHAC AIDS Community Action Program and fund raising. That ASO, however, has only three staff in spite of assuming some responsibility for hepatitis C education with additional funding from the federal Hepatitis C Program. It also manages a small needle exchange program.

Coordination and Cooperation

The 1993 strategy envisioned an interdepartmental committee responsible for the strategy's administration. This committee was never established although ad hoc committees have been organized for specific purposes as required. Inter-agency cooperation is evident within the Steering Committee overseeing the new strategy's development. It consists of representatives from a variety of departments in the provincial government, community agencies and consumer groups.

Government, community agencies and health authorities are well-connected and communicate openly and frequently in part because of:

• the province's relatively small population and cohesive nature; and

• the commitment of those in government and in the community most directly responsible for HIV/AIDS-related issues.

The current initiative to develop a new HIV/AIDS Strategy was jointly proposed by the Department of Health and Community Services and the AIDS Committee of Newfoundland and Labrador (ACNL). Representatives of the Regional Health Boards, meanwhile, sit on the ACNL Board. A provincial representative from the Department of Health and Community Services sits on the national FPT AIDS Committee as well as on the FPT-AIDS Atlantic Region Committee.

There are also relationships, both formal and informal, between the province's HIV/AIDS-related activities and its other health and social initiatives.

Testing, Prevention, Care and Treatment

There are fourteen Regional Health Boards providing the vast majority of health and community services within the Province of Newfoundland and Labrador. Services vary between boards depending, first, on need and, second, on whether the board directs community or institutional services. Generally, HIV/AIDS services are delivered in the common basket of health services with some boards devoting considerably more attention to the epidemic than others. The Health Care Corporation of St. John's, for example, offers clinics specifically for people with HIV/AIDS due, in part, to its role as a tertiary care centre. However, Department of Health and Community Services policy ensures some measure of consistency across the regions.

The province generally targets the general population for its educational efforts although some of the health boards target specific groups. The province has a provincial drug program that covers HIV/AIDS-related pharmaceuticals. Additionally, prenatal testing for HIV, employing an opt-out model, is provided to all pregnant women, with participation rates being over 90%. There is some concern that this testing is not always accompanied by the pre and post test counselling that was to be available.

Knowledge

As in other jurisdictions, epidemiological information is gathered regularly and shared with PHAC. There is a specific contribution to other AIDS-related research through Memorial University of Newfoundland.

Strengthening the Effort

Key informants in Newfoundland and Labrador suggested that the following measures would strengthen the provincial response to HIV/AIDS:

• provide additional information through the school system.

• complete and implement the new provincial strategy.

• provide AIDS Service Organizations, including the Native Friendship Centre in Goose Bay, with the resources needed to reach out to isolated communities such as those in Labrador.

3.12 Nunavut, the Northwest Territories (NWT) and Yukon¹⁰⁶

Surveillance Highlights

• the number of people living with HIV/AIDS is small in these three jurisdictions. In total, there have been only two HIV positive tests reported in Nunavut along with 36 in the Northwest Territories and 37 in Yukon. At the same time, however, these jurisdictions also have very small populations.

Table 5, Nunavut, NWT and Yukon Population, 2001¹⁰⁷

	Nunavut	Northwest Territories	Yukon
Total Population	26,745	37,360	28,675
Total Population, Age 15+	16,820	27,250	22,640

• the two Nunavut cases were diagnosed in 2002 and 2003. The NWT reported one new HIV positive case in both 2002 and 2003 while Yukon reported three cases in 2002 and four in 2003.

• the male to female ratio for HIV infection, November 1985 - to December 2003, is 2:1 in Yukon, 5:1 in the Northwest Territories and 6:1 in Canada as a whole.¹⁰⁸ Both Nunavut cases have been men.

• Yukon has six reported cases of AIDS while the NWT has 17 and Nunavut none.¹⁰⁹

  

Nunavut

Indicator	Year110
	2003	2002	2001	2000
AIDS Cases
Cumulative number of AIDS cases reported	0	0	0	0
HIV Infection
Newly-reported cases of HIV Infection	1	1	0	0

Northwest Territories

Indicator			Year
			2003	2002	2001	2000	1995
AIDS Cases
Number of AIDS cases reported			0	0	0	0	3
Cumulative number of AIDS cases reported			17	17	17	14	11
Newly reported AIDS cases by sex
male			0	0	0	0	2
female			0	0	0	0	1
HIV Infection
Total number of reported HIV cases			1	1	2	0	0
Reported cases of HIV Infection, 1987-2003				2003	1987-2003 (36 cases)
Reported cases of HIV Infection by exposure category
MSM				0	16
MSM/IDU				0	2
IDU				0	6
Heterosexual contact				0	8
Perinatal				0	2
Blood Products				0	1
Hetero or HIV-endemic countries				1	1
Reported cases of HIV Infection by sex
Men					30
Women					6
Reported cases of HIV Infection by age
		<15			2
		20-29			7
		30-39			16
		40-49			9
		50+			2

Yukon

Indicator	Year
	2003	2002	2001	2000	1995
AIDS Cases
Number of AIDS cases reported by year	0	2	0	2	2
Cumulative number of AIDS cases reported	6	6	4	4	--
Newly reported AIDS cases by sex
male	0	0	0	1	2
female	0	2	0	1	0
HIV Infection
Total number of reported HIV cases	4	3	4	5	1
Newly reported cases of HIV Infection by exposure category
MSM	0	0	0	0	--
MSM/IDU	0	0	0	1	--
IDU	2	1	2	4	--
Heterosexual contact	2	1	0	0	--
HIV/AIDS-endemic countries	0	0	0	0	--
NIR/NIR-Hetero/Other	0	1	2	0	--
Newly reported cases of HIV Infection by sex	1985-2003
Male	27
Female	13

Organization

The epidemic's defining characteristic in Nunavut, the NWT and Yukon is the small number of people currently living with HIV/AIDS. There were, however, five new HIV+ cases reported in the three jurisdictions in 2003, four of which were in Yukon. There were no new AIDS cases reported in that year. Yukon is unique - in the north and in Canada - in that over 32% of its reported cases of HIV infection since 1985 are among women. In contrast, women in the NWT represent only 12% of all reported cases. The male to female ratio in Yukon for HIV positive test reports, is 2:1 compared to 5:1 in the Northwest Territories and 6:1 for Canada as a whole.

The NWT discussed the potential for an HIV/AIDS strategy in the mid-1990s and is currently finalizing a strategy for addressing Sexually Transmitted Infections more generally. Nunavut and Yukon have not articulated strategies specifically focusing on HIV/AIDS. Instead each incorporates HIV/AIDS as part of broader public health efforts that include other sexually transmitted infections and blood-borne pathogens. In all three jurisdictions, it is suggested that this broader approach may be more effective for addressing the more immediate threat posed by STIs and hepatitis C and for avoiding duplication of effort. This approach could also engage people and enable them to avoid the stigma associated with HIV/AIDS. As such, it may make prevention, care and treatment efforts more palatable to small communities.

Each jurisdiction's health department uses its public health staff to monitor HIV/AIDS and to address HIV/AIDS-related issues as part of their overall responsibilities. Their having the same range of responsibilities as larger public health units in larger jurisdictions - for identifying outbreaks, partner identification, information and prevention - results in considerable pressure. Given the geographic size of each jurisdiction, there is limited capacity at the community level to respond to blood-borne infections.

Coordination and Cooperation

In the NWT, there is some HIV/AIDS-related awareness across departments and officials from a variety of community and government offices are involved in the effort to articulate a new STI strategy. The strategy committee includes staff from the departments of Education, Culture and Employment (ECE) and Justice as well as from the Status of Women organization in Yellowknife, community groups, native youth, community wellness coordinators and people working with street-involved youth. Front line workers in ECE and in the schools are involved in HIV/AIDS-related educational efforts.

Cooperation across departments and agencies in all three northern jurisdictions is enhanced by their small populations and lack of rigid bureaucracy. Public health staff, for example, have ready access to people in other departments. They also have strong working relationships with community agencies addressing HIV/AIDS and hepatitis C although the number of such agencies is very small and their capacity is limited. In Nunavut, for example, only Pauktuutit - the Inuit Women's Association - is engaged in such efforts while in Yukon, only the Blood Ties Four Directions Society is available as a community resource. Since AIDS Yellowknife ceased operations, there is no similar organization in the NWT.

Reporting systems are in place in all three jurisdictions with the results being shared with PHAC as part of the national surveillance system. PHAC provides direction and assistance as required to these three jurisdictions although it has not placed a Field Surveillance Officer in any of the northern public health offices.

Through a partnership with health authorities in northern Alberta, the GNWT provides extra training to local physicians so as to ensure that treatment is available in the communities themselves. Turnover among physicians, however, makes it imperative that this training take place on an on-going basis.

Testing, Prevention, Care and Treatment

Addressing, identifying and treating HIV in the three jurisdictions is compromised by most communities having very small populations. People are concerned about their condition becoming public knowledge.

Nurses in most of the smaller northern communities are responsible for most testing. Anonymous testing is not available in any of these jurisdictions although all include HIV tests in their prenatal screening. Since 2000, the NWT has employed the opt-out model while Yukon and Nunavut use the opt-in model. In 1996, the NWT also began offering HIV, tuberculosis, hepatitis C and STI testing to all people entering the correctional system. These tests have indicated that hepatitis C is currently a more significant problem. New cases identified in this way are referred for care and treatment and the NWT is experimenting with a new team-based, integrated health care system in nine pilot project sites.

In Nunavut, Pauktuutit, has sponsored a series of community education and awareness youth fairs addressing both hepatitis C and HIV/AIDS, with funding from the federal government's Hepatitis C Program.

The geographic size of each northern jurisdiction combined with their very small populations and communities pose a formidable treatment and care barrier. Treatment, for example, can be very costly because of medical travel and the need for some people to travel south for this treatment. Efforts are made to inform local physicians on treatment issues through partnerships with universities and hospitals in the south.

Needle exchange programs are not in place in either the NWT or Nunavut in part because the injection drug problem is not very significant at present. In Whitehorse, the Blood Ties Four Directions Society operates a small needle exchange program with funding from the Yukon Government. This organization has four staff people offering a range of programs, for example the needle exchange, a "living room group" to provide support, and some youth and health promotion activities. It also provides training to service providers in other agencies, hosts workshops and brings an educational message to various schools. Its funding is very limited, however, particularly in light of the high cost of travel in the north.

Although caring is characteristic of people and communities in the north, volunteerism within the HIV/AIDS sector specifically is not well developed. This may be due to the stigma associated with HIV/AIDS and to the AIDS service organizations not having the resources necessary to develop a volunteer network or to train volunteers.

Knowledge

Epidemiological information is gathered and shared with PHAC. Both Pauktuutit and the Blood Ties Four Directions Society have prepared evaluations and reports on their PHAC and Health Canada funded projects although largely for accountability purposes.

Strengthening the Effort

It has been suggested that efforts to address HIV/AIDS in the three northern jurisdictions could be strengthened by:

• committing additional financial resources to build knowledge and awareness before HIV incidence rates increase.

• funding formula and funding levels that recognize the inordinately high costs associated with community-based measures in the north and with medical travel.

• working proactively, particularly in light of high STI rates, to prevent HIV from becoming rooted in the north. This will depend upon developing both public awareness and a political commitment to address HIV/AIDS.

• efforts to develop health promotion and infection-prevention models that are well suited for communities in the northern regions.

• introducing measures to strengthen public health generally, to capture the attention of community leaders, and to overcome both the stigma associated with HIV and the tendency to deny its threat.

---

¹⁰³ Nova Scotia, 2003:10.

¹⁰⁴ Nova Scotia, 2003:1.

¹⁰⁵ Source: Disease Control and Epidemiology Division, Department of Health and Community Services, Government of Newfoundland and Labrador. HIV/AIDS Cumulative Statistics, Newfoundland and Labrador, 1984 - December 31, 2003. See also Canada, Health Canada, 2004.

¹⁰⁶ These three jurisdictions are being reviewed together because of the small number of key informants available for discussion and the need to respect the confidentiality of their remarks.

¹⁰⁷ See 2001 Census of Canada. http://www12.statcan.ca/english/census01/home/index.cfm.

¹⁰⁸ The male/female ratio for Nunavut is not available. See Canada, Health Canada, 2004:22.

¹⁰⁹ Although data from those jurisdictions indicate six (Yukon) and 17 (NWT) AIDS cases, the Health Canada Surveillance Report to December 31, 2003, indicates eight and 19 cases respectively. See Canada, Health Canada, 2004:41.

¹¹⁰ Nunavut was created in April 1999. Data for the period prior to that date are not available.

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