Canada's Report on HIV/AIDS 2003

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Responding to a Changing Epidemic

HIV/AIDS continues its relentless march across Canada and around the world. Each year, warnings about the long-term impact of the global epidemic become more dire and the present-day devastation of the disease more alarming. Yet Canadians have lost their sense of the seriousness of HIV/AIDS. This section of the report presents an overview of the current realities of the HIV/AIDS epidemic and future directions of the CSHA.

Global Numbers are Shocking

AIDS claimed another 3.1 million lives in 2002, according to estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS). New HIV infections were estimated at 5 million, bringing to 42 million the number of people now believed to be living with HIV around the world. More than 95 per cent of new infections were in developing countries; as noted in last year's report, the devastation has been particularly brutal in sub-Saharan Africa and the Caribbean. UNAIDS predicts that more than 50 million people will be living with HIV/AIDS by 2005.

HIV/AIDS does not discriminate by age or sex. In 2002, UNAIDS estimated that 800 000 of the newly infected were children under the age of 15 years. More than half a million deaths attributed to HIV/AIDS in 2002 were among this age group. Worldwide, an estimated 3.2 million children are now living with HIV/AIDS. To add to the suffering, more than 13 million children have lost one or both parents to the epidemic, a number that is expected to reach 40 million by 2010. Beyond childhood, youth continue to be at the centre of the HIV epidemic - they are the most affected and infected population. Due to a lack of education, awareness and power, youth are more likely to engage in risky sexual behaviours and injection drug use (IDU). UNAIDS estimates that every 14 seconds, a person between 15 and 24 is infected with the virus.

As noted by UNAIDS, "... the scale of the AIDS crisis now outstrips even the worst-case scenarios of a decade ago."¹ The epidemic is more than a health crisis. It denies developing countries much-needed human capacity and depletes scarce financial resources and expertise. It undermines human rights and human security and impedes social and economic development. The global community will continue to be challenged to ensure that people have the knowledge and capacity to protect themselves against infection while at the same time providing adequate and affordable treatment and care to people living with HIV/AIDS.

Canada's Epidemic: Disturbing Trends

The epidemic in Canada is serious and continues to grow in scope and complexity despite the availability of information, services and resources that are lacking in many other parts of the world. According to Health Canada's Centre for Infectious Disease Prevention and Control (CIDPC), at the end of 2002 an estimated 56 000 people in Canada were living with HIV infection - more than ever before.² Men who have sex with men (MSM) continue to be the most affected group, representing 40 per cent of new infections, a slight increase from the 38 per cent estimated in 1999. The proportion of new infections among users of injection drugs is declining slightly but still remains unacceptably high. Aboriginal persons are still over-represented among HIV infections in Canada. The number of women testing positive continues to rise. An increasing proportion of AIDS cases occur among people from countries where HIV is endemic, mainly African and Caribbean communities. A large number of people in Canada remain unaware that they are infected with HIV.

Something startling is happening: the increased spiral of adult deaths [attributed to HIV/AIDS] in so many countries means that the numbers of children orphaned each day is expanding exponentially. Africa is staggering under the load.

Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa, at the 13th International Conference on AIDS and Sexually Transmitted Infections in Africa, September 2003

A trend noted in last year's report - a perceived change in public perceptions about HIV/AIDS - has been supported through new research. The Canadian Youth, Sexual Health and HIV/AIDS Study, coordinated by the Council of Ministers of Education, Canada (CMEC), revealed that two thirds of Grade 7 students and half of Grade 9 students in Canada do not know that there is no cure for HIV/AIDS. An attitudinal survey funded by Health Canada in early 2003 provided additional troubling results.³ Close to 20 per cent of adult Canadians believe that HIV/AIDS can be cured if treated early. Although most Canadians view HIV/AIDS as a serious problem, they perceive their own personal risk of HIV infection to be low.

These studies reveal the extent of complacency, lack of information, and misinformation about HIV/AIDS in Canada. They provide further evidence that Canadians, particularly youth, have lost their sense of urgency about HIV/AIDS.

The survey also confirms that stigma and discrimination associated with HIV/AIDS are still pervasive in Canadian society. Thirty per cent of adult Canadians would be uncomfortable working in an office with a person with HIV, 40 per cent would be uncomfortable if their child was attending a school where one of the students had HIV/AIDS, and more than 50 per cent would be uncomfortable if a close friend or relative were dating someone with HIV/AIDS. Almost half of Canadians believe that people living with HIV/AIDS should not be allowed to serve the public in positions such as cooks and dentists.

Smaller local studies provide more information about the kinds of discrimination that people with HIV/AIDS experience. A survey of 50 people with HIV/AIDS in New Brunswick found that a third of those surveyed still reported being rejected by family and friends in 2000.⁴ In a recent survey of 34 people with HIV/AIDS in Alberta, almost one third reported being treated unfairly by employers or co-workers as a result of their HIV status.⁵ Women who participated in an in-depth study in Vancouver of the conditions that increase their risk of HIV infection and disease progression described, among other things, discrimination from health care providers and other institutions.⁶

In many ways, public perceptions do not match the reality of the epidemic in Canada. There is still no cure for AIDS - prevention is the only viable answer at this time. For people living with HIV/AIDS, treatment failures are becoming more commonplace as new strains of the virus appear and the human body develops resistance to HIV/AIDS drugs. According to a recent study by Dutch researchers, up to 10 per cent of newly diagnosed HIV-positive people may carry a form of HIV that can resist the effects of treatment.

Focussing the Response: New Approaches and Directions

Progress continues to be made on many fronts; however, new approaches and innovative initiatives must be pursued to put HIV/AIDS back on the public agenda and to strengthen and revitalize Canada's efforts to combat the epidemic, both domestically and internationally.

Much work has been done in this regard. In September 2002, the Minister of Health initiated a review of the current federal government role in the CSHA. The review examined the lessons learned over the past five years, identified current challenges and proposed new directions and related funding.

In March 2003, the Standing Committee on Health initiated a study that focussed on Canada's response to HIV/AIDS. Key CSHA governmental and non-governmental partners provided much needed information to the Committee on the current situation and potential future directions. Consistent with the results of the five-year review, the Committee's report, tabled in the House of Commons in June 2003, called for a strengthened federal role in areas of leadership, coordination, prevention and research. It also emphasized the need for greater coordination among federal government partners in responding to HIV/AIDS.

The development of an action plan to guide Canada's HIV/AIDS response has also been the focus of significant effort by CSHA partners over the past 18 months. A draft of the plan was released for public consultation in the fall of 2003. Based on the premise that governments alone cannot successfully tackle the epidemic, the plan provides a framework for broader, more strategic and more vigorous engagement by many sectors in the Canadian response. It proposes nine strategic directions:

• Raise public/political awareness of the impact of HIV on society, and of the social factors that contribute to the epidemic.
• Address the social, economic, environmental and health factors that contribute to the epidemic.
• Optimize the voice, involvement and meaningful participation of people living with or vulnerable to HIV.
• Increase capacity to monitor and track HIV and to develop, share and apply knowledge.
• Reinvigorate primary prevention efforts.
• Provide comprehensive, integrated prevention, diagnosis, support, care and treatment services.
• Strengthen organizations that provide HIV-related services and increase their capacity to meet increasingly complex needs.
• Ensure appropriate, sustainable investment in HIV services.
• Provide leadership in global efforts to combat the epidemic.

Building on these directions, the results of the five-year review and the recommendations of the Standing Committee on Health, and taking into account the current realities of the epidemic, a renewed framework for the CSHA is being developed.

Not only does Health Canada need to work with organizations like the Canadian AIDS Society, it must also work collaboratively with other federal departments, provincial and territorial governments and individual Canadians.

Hon. A. Anne McLellan, Minister of Health, at the Canadian AIDS Society Annual General Meeting and People Living with HIV/AIDS Forum, June 2003

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