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

A National Portrait

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5. Conclusions

The HIV/AIDS epidemic remains a serious problem in and to all jurisdictions in Canada, if not at present then most certainly in the future. In some jurisdictions with few new reports of HIV infection, for example, the incidence of sexually transmitted infections speaks to unsafe sexual practices that place people at risk of HIV infection. Injection drug use and hepatitis C prevalence in some communities and in both federal and provincial correctional centres speak also to the risk of HIV infection.

It is by no means assured that the decade of declining incidence will continue into the future.

5.1 A Sound Foundation

All jurisdictions in Canada have responded to the HIV/AIDS epidemic and most have laid a sound foundation both for addressing the current epidemic and for responding to it in the future as need arises. Most have articulated a comprehensive, sound and well-considered strategy that provides direction to stakeholders. Some have formal structures in place for managing HIV/AIDS policy and activities while others manage these in a less structured but no less effective manner.

Invariably, the different jurisdictions are monitoring the epidemic and are attempting to improve their surveillance and reporting systems. Public health delivery systems endeavour to ensure partner notification and are promoting an awareness of HIV/AIDS and of sexual health in their schools and among their vulnerable populations. Jurisdictions include HIV testing as part of their prenatal screening programs and have nominal, non-nominal and sometimes anonymous testing available.

Additionally, all jurisdictions have some projects and organizations – some with federal rather than provincial or territorial funds – in place to reduce vulnerability and harm, and to provide care and support. Many of these are the responsibility of local health authorities and, in many jurisdictions, municipal governments have become actively engaged in the effort to address the epidemic. In some jurisdictions, all the different stakeholders are working together within community-based committees to define priorities and to allocate resources. In some jurisdictions also, stakeholders are endeavouring to find ways to transcend the boundaries that currently compromise efforts to bring a seamless array of services and supports to Aboriginal people.

Treatment and appropriate pharmaceuticals are available virtually everywhere in Canada and mechanisms are in place to ensure that physicians have access to the advice and support they need in order to provide quality care. This means that people – marginalized or mainstream – receive good care regardless of whether they live in urban or rural and remote centres. The outstanding problem – and one that has not been resolved anywhere – is the reluctance of many small communities to acknowledge there is a problem and to introduce education and prevention measures.

Furthermore, after two decades of experience, there is a good understanding of what is needed to effectively address the epidemic, for example particular treatment regimens, community partnerships, culturally appropriate services, targeted prevention efforts sustained through the long term, a variety of harm reduction initiatives, a focus on vulnerable populations and efforts to overcome the stigma associated with HIV infection. Most understand the importance of a population health model and a human rights framework for effectively preventing HIV infection through the long term.

This is not to say, however, that this model or framework is in place everywhere in Canada or that all jurisdictions are acting on the knowledge they have. HIV/AIDS advocates highlighted the need for heightened public awareness, increased resources and re-energized leadership to address the epidemic.

5.2 Strengthening the Canadian Response

The provincial and territorial pictures, the national portrait and the project's key informants all suggest means for building on this foundation in order to strengthen the Canadian effort to address the HIV/AIDS epidemic.

First and foremost, efforts are needed to promote public awareness and concern, and "to put HIV/AIDS back on the public radar." Such efforts might include national awareness and education campaigns and the broader dissemination of surveillance and epidemiological information. They could also involve efforts to integrate HIV/AIDS with campaigns directed at other blood-borne pathogens and sexually transmitted diseases even though this approach has both advantages and disadvantages. This approach, at the very least, would serve to help place HIV/AIDS within a broader public health and perhaps population health context.

Second, there is a necessity to continue to increase political commitment and leadership to effectively address the epidemic in a vigorous and comprehensive manner. Political commitment and leadership are vital:

• for promoting public awareness, providing clear direction, dispelling stigma and preventing discrimination;

• for acquiring the resources needed to build, disseminate and apply new knowledge, to effectively prevent the epidemic's spread, and to provide appropriate care, treatment and support; and

• for ensuring that prevention, treatment, care and support efforts are available to all people everywhere in Canada.

Third, there is a need in Canada to shift public awareness and government spending from the treatment of disease to population health, from medical technology to children's well-being, and from short-term palliatives to long-term solutions. Efforts to promote population health – for example, by better protecting children from violence or through adequate housing – are the key to preventing HIV infection in the future.

There is not yet a cure for HIV/AIDS, a vaccine to prevent infection or a way to ensure safe behaviour among all those currently infected. Controlling the epidemic, therefore, requires efforts to address the roots of HIV vulnerability, including poverty and discrimination. This is no small undertaking. It will entail a shift that has eluded governments for many years already. But it is absolutely essential if Canada is ever to get ahead of this and other epidemics.

Fourth, effectively managing the epidemic will require continued efforts to build on existing cooperative mechanisms and partnerships across governments and across sectors, for the purpose of planning, delivering and funding programs. Inherent in this are efforts to strengthen and stabilize the community organizations that, at present, are struggling to cope with ever increasing needs and numbers, and with an increasingly broad range of issues. Inherent in this also is an effort to address the epidemic more effectively within the Aboriginal population in part by addressing the stigma still evident in small communities, in part by overcoming the conservatism surrounding sexual health education, and in part by addressing the jurisdictional issues that provide service on the basis of where people live.

HIV/AIDS is a complex disease and an ever-changing epidemic. Through the past decades, governments in Canada have built a strong foundation for addressing both the disease and the epidemic. But commitment to doing so has faded over time as other priorities emerged. A renewed commitment to effective action and to cooperative partnerships is needed, everywhere in Canada, if Canadians are to effectively address the HIV/AIDS epidemic.

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