Canada's Report on HIV/AIDS 2003

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About the canadian strategy on HIV/aids

Goals of the CSHA

The CSHA was launched in 1998 with annual ongoing federal funding of $42.2 million. Its goals are to:

• prevent the spread of HIV infection in Canada
• find a cure
• find and provide effective vaccines, drugs and therapies
• ensure care, treatment and support for Canadians living with HIV/AIDS, and their families, friends and caregivers
• minimize the adverse impact of HIV/AIDS on individuals and communities
• minimize the impact of social and economic factors that increase individual and collective risk for HIV

In pursuing these goals, three policy directions guide the implementation of the CSHA:

• enhanced sustainability and integration - New approaches and mechanisms will be put in place to consolidate and coordinate sustained national action in the long term.
• increased focus on those most at risk - Innovative strategies will be devised to target high-risk behaviours in hard-to-reach populations that are often socially and economically marginalized.
• increased public accountability - Increased evidence-based decision making and ongoing performance review and monitoring will ensure that the new strategy continues to be relevant and responsive to the changing realities of HIV/AIDS.

People living with HIV/AIDS and those at risk of HIV infection are the focus and centre of CSHA efforts. Funding allocations for the CSHA are shown in Table 1.

Table 1: CSHA Annual Funding Allocations (millions of dollars)

Prevention	$ 3.90
Community Development and Support to National NGOs	$10.00
Care, Treatment and Support	$ 4.75
Legal, Ethical and Human Rights	$ 0.70
Aboriginal Communities	$ 2.60
Correctional Service Canada	$ 0.60
Research	$ 13.15
Surveillance	$ 4.30
International Collaboration	$ 0.30
Consultation, Evaluation, Monitoring and Reporting	$ 1.90

Canada's Approach

The CSHA is a Canadian approach that enables the engagement of non-governmental and voluntary organizations, communities, the private sector and all levels of government.

Health Canada, the lead federal department for issues related to HIV/AIDS, administers the CSHA. Several responsibility centres within Health Canada contribute to this work, including the Centre for Infectious Disease Prevention and Control (CIDPC), the Departmental Program Evaluation Division (DPED), the First Nations and Inuit Health Branch (FNIHB), regional offices and the International Affairs Directorate (IAD). Correctional Service Canada (CSC) and the Canadian Institutes of Health Research (CIHR) are the other federal departments participating in the CSHA.

Major national non-governmental stakeholders are also partners in the implementation of the CSHA. They include:

• the Canadian Aboriginal AIDS Network (CAAN)
• the Canadian AIDS Society (CAS)
• the Canadian AIDS Treatment Information Exchange (CATIE)
• the Canadian Association for HIV Research (CAHR)
• the Canadian Foundation for AIDS Research (CANFAR)
• the Canadian HIV/AIDS Information Centre, Canadian Public Health Association (CPHA)
• the Canadian HIV/AIDS Legal Network
• the Canadian HIV Trials Network (CTN)
• the Canadian Treatment Action Council (CTAC)
• the Interagency Coalition on AIDS and Development (ICAD)
• the International Council of AIDS Service Organizations (ICASO)

Several federal departments and agencies provide additional funding from their departmental budgets to address HIV/AIDS. CSC invests $3 million annually in HIV/AIDS programming in federal penitentiaries. Similarly, FNIHB invests $2.5 million annually to provide HIV/AIDS education, prevention and related health care services to Inuit and on-reserve First Nations peoples. CIHR is also committed to contributing at least $3.5 million per annum to HIV/AIDS research, and in 2002-2003 invested a total of $4.8 million.

CIDA's HIV/AIDS Action Plan, which articulates CIDA's approach to helping to control and prevent the spread of the disease in developing countries and countries in transition, was launched in June 2000 as part of the global response to the HIV/AIDS epidemic. The plan includes a commitment to a five-year investment totalling $270 million, beginning with $22 million in 2000-2001 and increasing to $80 million in 2004-2005. CIDA is also contributing:

• US$100 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria
• $50 million through the Canada Fund for Africa to support HIV vaccine research ($45 million to the International AIDS Vaccine Initiative and $5 million to the African AIDS Vaccine Program)
• $12 million, again through the Canada Fund for Africa, to a Canadian HIV/AIDS Coalition (comprising Care Canada, World Vision, Foster Parents Plan and Save the Children) in support of African young people, with a focus on the social issues surrounding AIDS

Provincial and territorial governments are key partners in the CSHA. Their collaboration and contributions play an important role in achieving the goals of the CSHA.

Reporting on Progress

Canada's Report on HIV/AIDS 2003 describes the activities and progress of CSHA partners in five key areas:

• coordinating HIV/AIDS policy and programming
• increasing Canadian involvement, participation and partnership in the HIV/AIDS response
• advancing the science of HIV/AIDS
• increasing the use of reliable information
• building Canada's capacity to address HIV/AIDS

As in previous years, most of the information presented in this section of the report is directly related to activities funded through the CSHA. However, efforts have been made to also include information on activities and achievements that are not funded by the CSHA but that constitute an important part of the Canadian response. This is intended to reflect the concept of pan-Canadianism - the work of many participants from many different sectors is needed to ensure an effective response to HIV/AIDS.

Additional information on the CSHA, and specifically on Health Canada's HIV/AIDS policies and programs, can be found on the CSHA website. Similarly, information on other CSHA partners' programs and initiatives can be found on their respective websites, which are listed in Section 4 of this document (see page 51).

Coordinating HIV/AIDS Policy and Programming

The direction-setting meeting at Gray Rocks in the fall of 2000, attended by more than 125 individuals representing the full range of CSHA partners, was a turning point in the evolution of the CSHA. At this meeting, participants began to reflect on Canada's domestic and international responses to the HIV/AIDS epidemic and to consider developing a more strategic, long-term approach. This work has continued over the past year and, in fact, has moved forward significantly.

Partners in the CSHA continue to develop new and innovative approaches to foster collaboration across the spectrum of public policy issues, municipal, provincial, territorial and federal governments and all sectors of society. There is a growing recognition of the need for multiple and complementary contributions to the response. Progress is being made on many fronts to fully achieve the "pan-Canadianism" envisioned when the CSHA was announced in 1998.

Canada's Action plan

The development of a national action plan for addressing the HIV/AIDS epidemic in Canada was one of 10 strategic directions identified at the Gray Rocks direction-setting meeting. The follow-up meeting in Montréal expanded on the idea, proposing a five-year operational/action plan that builds SMARTER (specific, measurable, attainable, realistic, time-limited, effective, relevant) objectives for each CSHA component. Time lines were established and a working group was formed to design a process for developing this plan.

As a first step, more than 30 key people from various sectors of Canada's HIV/AIDS response were invited to attend an intensive, five-day retreat in Ste-Adèle, Quebec, to consider how to optimize Canada's response to HIV/AIDS. Held in December 2002, the retreat provided vital guidance on the major components of a draft five-year action plan, which was then further developed under the direction of a small steering committee. In November, 2003, the draft plan was released and national consultations were initiated on several fronts: with participants in the Canadian response; with people living with HIV/AIDS, with vulnerable Canadians; with provincial/territorial governments; and with those not currently involved in the response but who may have a role to play.

The draft action plan proposes to make the concept of "pan-Canadianism" explicit in a model that identifies all of the required participants, expands on the strategic directions identified at Gray Rocks and sets measurable targets. 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.

Government Reviews

In September 2002, Health Canada launched a five-year review of the federal government's role in the Canadian response to HIV/AIDS. This review, which was undertaken with the assistance of a stakeholder advisory committee, was intended to document lessons learned, identify current gaps and recommend directions for the next five years. The review also fulfilled a Treasury Board requirement to report by July 2003 on activities and achievements related to the $42.2 million in annual federal funding for the CSHA for the period from 1998 to 2003.

The five-year review highlighted the following key areas:

• an expansion of the federal role and increased collaboration with provincial, territorial and municipal governments;
• a strengthening of federal interdepartmental capacity to address the determinants of health as they relate to HIV/AIDS, especially in the areas of housing and homelessness, disability, employment, regulatory and voluntary sector issues;
• a focus on populations most vulnerable to HIV/AIDS and on new approaches for involving people living with HIV/AIDS in Canada's response to the epidemic;
• a need to reach more than 15,000 Canadians who are unaware that they are infected and to develop strategic public education and awareness initiatives;
• an approach that links HIV/AIDS with other diseases and the development of integrated responses where appropriate;
• an increase in the international collaboration component of the CSHA.

In March, 2003, Health Canada, CSC, CIHR, non-governmental organization (NGO) partners in the CSHA, researchers and AIDS service organizations (ASOs) also participated in a special study undertaken by the Standing Committee on Health that focussed on Canada's response to HIV/AIDS.

Entitled Strengthening the Canadian Strategy on HIV/AIDS, the report recommended a strengthened federal role in areas of leadership, coordination, prevention and research. To ensure an effective process of evaluation and accountability, the Committee called for the establishment of clear, measurable five-year goals and objectives for the CSHA and emphasized the need for greater coordination among federal government partners.

The report, along with Canada's action plan and the results of the five-year review, will guide the development of future federal government policies and programs in the area of HIV/AIDS.

Committees and ongoing dialogue contribute to policy and coordination

National advisory groups continue to provide government with valued advice on HIV/AIDS issues. These committees bring a broad range of perspectives to bear on CSHA policy and programming, including the views of people living with HIV/AIDS. They include:

• the Ministerial Council on HIV/AIDS, which provides advice directly to the Federal Minister of Health on pan-Canadian aspects of HIV/AIDS. During 2002-2003, the Ministerial Council developed and began implementing work plans to address long-range issues identified in its strategic plan. For example, in recognition of the important links between Canada's domestic and international responses to HIV/AIDS, the Ministerial Council established a new committee with a particular focus on international affairs. The Ministerial Council also continued to encourage interdepartmental collaboration on HIV/AIDS, by promoting its policy discussion paper entitled HIV/AIDS and Health Determinants: Lessons for Coordinating Policy and Action.
   
• the Federal/Provincial/Territorial Advisory Committee on AIDS (FPT AIDS), which advises the Conference of Deputy Ministers of Health. During 2002-2003, FPT AIDS developed a three-year strategic plan with key objectives to promote further development of public policy on issues related to HIV/AIDS at the federal, provincial and territorial levels; to promote increased inter-governmental, inter-jurisdictional and multilevel collaboration on issues related to HIV/AIDS in Canada; and to promote the use of epidemiological data and community information in the development of policy, programs and services in Canada. FPT AIDS' Working Group on Emerging Issues held two expert round tables on the issue of failure to disclose HIV/AIDS status and developed recommendations for a graduated public health response that will be used by individual jurisdictions in developing their own frameworks. As well, FPT AIDS initiated work on a detailed report about the state of the epidemic in Canada and the various responses that are under way.
   
• the National Aboriginal Council on HIV/AIDS (NACHA), which advises Health Canada on policy and programmatic responses to address HIV/AIDS in Aboriginal communities. A framework was developed for evaluating both the work done to date by NACHA and NACHA's structure and ability to respond to the needs of the Aboriginal community and Health Canada. The evaluation itself will be completed in 2003-2004. NACHA has also been involved in the five-year review of the CSHA and the transfer of the Community-Based Research (CBR) program from Health Canada to CIHR. NACHA will soon release its 2002-2003 annual report.
   
• the Federal/Provincial/Territorial Heads of Corrections Health Services Committee (FPT Corrections), works with other health sectors and NGOs to address a wide range of issues related to infectious diseases within a correctional environment. In 2002-2003, FPT Corrections continued to consider how to respect the confidentiality rights of HIV-positive inmates while taking into account the rights, needs or fears of their spouses or partners, corrections staff and other inmates. Committee members continued to share information on the management of infectious diseases and on best practices across jurisdictions.
   
• CAS, CATIE, CAAN, CTAC, ICAD, the Canadian HIV/AIDS Information Centre (CPHA) and the Canadian HIV/AIDS Legal Network continue to meet with CIDPC's HIV/AIDS Policy, Programs and Coordination Division regularly to engage in discussions, consultations and information exchange on issues related to the CSHA.
   
• the Working Group on International HIV/AIDS Issues, which provides a regular forum for consultation on and discussion of the international HIV/AIDS activities of federal departments and civil society, leading to improved priority setting and policy coherence. Working group members have provided valuable input to a number of CIDA and Health Canada policy papers, including CIDA's Guidelines for Supporting HIV/AIDS Care, Treatment and Support in Resource Limited Settings, and IAD's annual work plan. In the coming year, the mandate of the group will be formalized as the Consultative Group on HIV/AIDS and International Issues. Priorities will include planning for Canada's hosting of the 2006 International AIDS Conference in Toronto.

Collaborative Policy and Program Development

There are many examples of collaboration between CSHA partners and others on the development of HIV/AIDS policies and programs.

FNIHB, CIDPC and CAAN have jointly developed the Aboriginal Strategy on HIV/AIDS in Canada (ASHAC). Entitled Strengthening Ties - Strengthening Communities, it offers a vision for Inuit, Métis and First Nations people to respond to HIV/AIDS. More than 170 stakeholders were consulted on ASHAC, which was released at CAAN's annual general meeting in October 2003. ASHAC identifies nine strategic areas of activity to ensure that a range of programs and services are in place to meet the needs of Aboriginal people living with HIV/AIDS: coordination and technical support; community development, capacity building and training; prevention and education; sustainability, partnerships and collaboration; legal, ethical and human rights issues; the engaging of Aboriginal groups with specific needs; the support of broad-based harm reduction approaches; holistic care, treatment and support; and research and evaluation.

CSC collaborates with local public health authorities on infectious disease prevention and control (including HIV/AIDS) and other cross-jurisdictional public health initiatives. CSC is also an ad hoc member of the Council of Chief Medical Officers of Health. CSC is in the process of developing discharge planning guidelines to ensure that health needs, particularly those of the population affected by HIV/AIDS and other infectious diseases, are met during transition to another institution or to the community. The guidelines will provide consistent procedures and clear direction on steps to be initiated by health care professionals prior to an inmate's discharge. The team members will ensure that social, emotional and physical needs are taken into consideration in the overall discharge plan.

CTAC, CAS and CATIE have been working with other partners, including the Best Medicine Coalition and Advocare, to move Canada forward on the federal drug review process and on the issue of common drug reviews. These three organizations have also been engaged in public consultations on how to make the drug review process more efficient, announced in the last federal budget. This also included a commitment of $190 million for faster drug reviews.

The CTN partnered with the HIV/AIDS community, provincial officials, the Canadian Liver Foundation and physicians in a joint effort to change the definition of who can receive a liver transplant. As a result of this work, transplant officials in Ontario and British Columbia have agreed to begin considering people living with HIV/AIDS who may need new livers, due to co-infection with hepatitis C, as candidates for transplants.

The Canadian HIV/AIDS Legal Network collaborated with CAAN, CAS and local HIV/AIDS organizations that work with vulnerable populations to design and implement a three-year project on stigma and discrimination, which continues to be a barrier to people living with HIV/AIDS accessing care, treatment and support, and prevention services in Canada. Launched on April 1, 2003, the project builds on the Legal Network's previous work in this area. Specifically, the Legal Network is preparing an update on HIV/AIDS-related stigma and discrimination in Canada, revising its information sheets on this topic, preparing a draft action plan to address selected priorities, and consulting and collaborating with other organizations in finalizing and implementing the action plan.

In June 2002, the Legal Network published a document calling on the federal government to develop an HIV vaccine plan for Canada. The document aimed to increase awareness across Canada of the need for such a plan from a legal, ethical and human rights perspective and to encourage the HIV/AIDS community to become more fully engaged on the issue. Health Canada subsequently hosted a two-day planning meeting involving other government departments and stakeholders from community organizations and the research community.

Canada on the International Stage

Canada continues to show progress in the area of HIV/AIDS policy and programming. At the federal level, Health Canada, CIDA and DFAIT are increasingly addressing the global epidemic as a multi-dimensional issue, requiring action on many fronts (for example, as a health issue, a development issue, a human rights issue, a human security issue, a trade issue, etc.). They are collaborating to represent Canada in multilateral fora, including the World Health Organization (WHO), the United Nations (UN) General Assembly High Level Meeting on HIV/AIDS, UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Canadian NGOs have also strengthened their involvement globally, both on their own and in partnership with others in Canada and internationally.

Canada is currently the vice-chair of the Programme Coordinating Board of UNAIDS and will assume the role of chair in June 2004. CIDA, DFAIT and Health Canada comprise the Canadian delegation to UNAIDS, and the three departments work closely to ensure consistent, coordinated Canadian representation on this important body. Canada's relationship with UNAIDS was further strengthened with the signing in June 2003 of a renewed and strengthened partnership agreement between Health Canada and UNAIDS. This partnership will expand the focus of surveillance and laboratory science to include new areas of policy and programming.

As well, Canada, the U.K. and Switzerland form a constituency representation at the Global Fund to Fight AIDS, Tuberculosis and Malaria. Canada will represent this constituency by assuming a seat on the board of the Global Fund in January 2004.

CIDA has increased its core funding to UNAIDS from $3.4 million to $5.4 million annually. CIDA also provides core funding for HIV/AIDS initiatives to other multilateral organizations, such as the United Nations Children's Fund, the United Nations Population Fund and the United Nations Development Programme. Bilateral funding is provided for programs in numerous countries and regions of the world where CIDA is working with governments and civil society to mitigate the impact of HIV/AIDS. Many Canadian partners/stakeholders working internationally in the field of HIV/AIDS also receive funding from CIDA. For example, CIDA funds the Zambia Family and Reproductive Health Project, a five-year initiative of the CPHA that aims to improve the quality and increase the use of integrated reproductive health services in parts of Zambia. Among other activities, the project provides training for institutional health care providers in the area of HIV/AIDS counselling.

In September 2003, the Prime Minister participated in a round table discussion panel at the UN General Assembly High Level Meeting on HIV/AIDS, the first follow-up meeting to the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) in June 2001. The Prime Minister's opening remarks highlighted how stigma and discrimination continue to fuel the epidemic, both in Canada and around the world. Fear of stigma and discrimination deters people from being tested for HIV infection, which in turn serves as a barrier to prevention efforts. The Prime Minister called on all those present to work together to ensure that affordable and effective treatment is available to those who need it.

In November 2003, IAD, CIDA, UNAIDS and the Open Society Institute cosponsored the 2nd International Policy Dialogue on HIV/AIDS in Warsaw. Policy makers and senior officials of drug- and HIV/AIDS-control programs in approximately 15 countries attended the session, which transferred knowledge between regions on the development and implementation of harm reduction strategies. In preparation for the Warsaw meeting, IAD commissioned a series of background papers on HIV/AIDS and IDU and HIV/AIDS treatment maintenance challenges.

Canada also provided input to the WHO's Global Health Sector Strategy on HIV/AIDS, the draft WHO Global Strategy on Sexual and Reproductive Health, the UN Commission on the Status of Women and the UN Commission on Human Rights. Canada hosted visitors from UNAIDS; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the International AIDS Vaccine Initiative (IAVI); the Pan-American Health Organization; and the International Partnership for Microbicides. In each case, round tables were held to inform Canadian officials about the work of these organizations and to identify opportunities for increased collaboration on global health issues.

Treatment helps those living with HIV to lead productive lives, with dignity, as full members of our communities. Canada will continue to make contributions to alleviate AIDS suffering.

Prime Minister Jean Chrétien at the UN General Assembly, High Level Meeting on HIV/AIDS, September 2003

As the epidemic grows and changes internationally, DFAIT has assumed a stronger role in HIV/AIDS policy and programming issues. For example, DFAIT is currently working on a comprehensive HIV/AIDS policy that will link the many aspects of its work that touch on the HIV/AIDS epidemic, such as the G8's Africa Action Plan, human security, the promotion and protection of human rights and good governance, and support for Canadian business interests internationally. DFAIT is also collaborating with Health Canada and CIDA to better coordinate Canada's international response to HIV/AIDS and to more clearly define the relationship between the global and domestic responses.

ICAD and the Canadian HIV/AIDS Legal Network were among eight organizations that jointly sponsored the National Civil Society Summit in Ottawa in May 2003. Organized around the theme of "Global Health is a Human Right," the summit brought together representatives of a wide range of Canadian and international organizations interested in promoting the human right to the highest attainable standard of health in developing countries as a human right. In particular, the summit focussed on developing a common front for addressing the global crises of communicable diseases, such as HIV/AIDS, tuberculosis and malaria.

The House of Commons' Subcommittee on Human Rights and International Development issued its report entitled HIV/AIDS and the Humanitarian Catastrophe in Sub-Saharan Africa. Although the subcommittee commended the federal government for its commitment to fight the HIV/AIDS pandemic through multilateral and bilateral programming, it also noted that, due to the magnitude and urgency of the HIV/AIDS crisis, additional action and resources were required. Specifically, the subcommittee urged the government to triple its contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Challenges and Opportunities

Canada's HIV/AIDS response is unfolding in an environment that is ever-changing and sometimes chaotic. In these circumstances, identifying and agreeing on priorities for action can be a challenge. Nevertheless, Canada must strengthen its efforts to address HIV/AIDS while remaining flexible in its approach. Canada's action plan identifies common directions for future action and identifies a cohesive set of targets for all stakeholders. It encourages effective partnerships, both within the health care system and with other sectors where determinants of health have an impact on HIV/AIDS, such as social services, education, housing and justice. It also aspires to achieve the greater participation of those most affected by HIV.

As Canada moves from developing its action plan to implementing it, the next five years will be a period of rejuvenation for the CSHA and for those dedicated individuals who work in this challenging field. Collaborative relationships already exist, both domestically and globally, but they will need to be strengthened and expanded to achieve the vision set out in the action plan. More work needs to be done to encourage and facilitate interdepartmental collaboration at the federal level.

Dr. Alan Li: A Voice for Access and Equity

As a gay Asian immigrant, Alan Li had experienced racism and homophobia first-hand since moving to Canada at the age of 16. This became the driving force behind his work in fighting injustices and building safe spaces for marginalized and vulnerable groups: people of colour, immigrants and refugees, and especially people of Asian descent.

Dr. Li was a young medical student active in the gay community of Toronto in the 1980s when he was introduced to the world of HIV/AIDS. Because of his work in organizing the group Gay Asians Toronto, he was called upon by the AIDS Committee of Toronto to help provide services and counselling to a Vietnamese-Canadian client.

"Tong was a factory worker who did not speak much English and was very isolated," recalls Dr. Li. "He was afraid to seek help from Asian social services because of the stigma and AIDS phobia and was unable to get help from mainstream AIDS service organizations (ASOs) because they did not understand his culture and the barriers he faced. I was his support buddy for only a short time before he died, but the experience really shook me up and made me realize we had to do something very quickly as a community."

Tong's case was the tip of the iceberg. Cases of HIV/AIDS among Asian Canadians grew rapidly in the late 1980s, with many individuals coming down with AIDS before they tested positive for HIV and had a chance to get treatment. Racism and homophobia forced many Asian people living with HIV/AIDS to feel alienated and remain isolated. Dr. Li realized that treating AIDS requires more than just medicine - a holistic strategy, with supportive community infrastructures and accessible services, is essential to improve the health of these individuals.

Thanks in large part to his efforts, the situation has improved for Asian Canadians in Toronto. Working with allies and other activists, Dr. Li co-founded Asian Community AIDS Services (ACAS) to provide education and support services to people of east and southeast Asian-Canadian descent.

With funding from the CSHA, the provincial government and other sources, ACAS has significantly increased the HIV/AIDS capacity and resources of Toronto's Asian communities. Trained staff and volunteers provide outreach services to many at-risk groups, in addition to peer and case management support. Last year, ACAS developed a web-based HIV/AIDS treatment information resource in English and three southeast Asian languages, the only such resource in the world.

Still, the situation is far from ideal. "On many levels, the challenges have not been reduced. In many ethnocultural groups, AIDS is still very stigmatized, more so than in the general population. People still lack awareness of the treatments available, so they remain in a state of helpless despair. This and the fear of exclusion prevent many people from getting tested, getting support and accessing treatment. That's why we still see HIV/AIDS cases rising in vulnerable groups and witness people dying untimely and often unnecessary deaths," says Dr. Li passionately.

Dr. Li believes the key to effective prevention is maximizing the human context. "I have been stressing the need to link the face of AIDS with people. Communities need to know that this is affecting their own people. Otherwise, we are just perpetuating invisibility and denial."

Dr. Li is now focussing his energy on immigrants, refugees and people living with HIV/AIDS without health care coverage. Having completed community-based research on the barriers these populations face, Dr. Li has been working with a coalition of health and social service organizations to develop legal and health information on HIV and immigration and a training curriculum for service providers on service accessibility for marginalized groups. Currently, Dr. Li is working with ACAS, other ethnocultural ASOs and the Canadian AIDS Treatment Information Exchange to spearhead a peer treatment counsellor training program for people living with HIV/AIDS from linguistically diverse communities.

These are the challenges that keep Dr. Li involved. "HIV/AIDS has huge significance for me. I have lost many close, dear friends to the epidemic. What keeps me going is the continuing injustices I see, the many barriers that still need to be broken down. What recharges me is the synergy of working with other partners who share my belief that we can make a difference."

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