Canada's Report on HIV/AIDS 2004

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1 Setting a New Path for Canada's HIV/AIDS Response

HIV/AIDS is a disease of terrible global proportions and appalling human and socio-economic impacts. It robs children of their parents, men and women of their loved ones, and society of the untapped potential of millions of people each year. Fuelled by stigma and discrimination, HIV/AIDS leads to the loss of human rights and untold distress and suffering by people living with the disease and those who care for them. While medical and social science advances are leading to more effective treatments and responses on some fronts, new challenges continue to arise. The repercussions of the epidemic are made all the more frustrating by the knowledge that the transmission of HIV is preventable. This section of the report presents an overview of the current realities of the HIV/AIDS epidemic and the future directions of the Canadian response.

A Devastating Global Epidemic

According to revised HIV/AIDS estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS), almost 5 million people became newly infected with HIV in 2003 - more than in any other year since the beginning of the epidemic.¹ Around the world, the number of people living with HIV was estimated at 38 million. About 3 million people died of AIDS-related illnesses last year, bringing the total number of AIDS-attributed deaths to more than 20 million worldwide since the disease was identified in 1981.

Almost two thirds of all HIV-positive people live in sub-Saharan Africa, a region that claims only 10 per cent of the world's population. In 2003, 75 per cent of AIDS deaths globally occurred in sub-Saharan Africa, where access to care, treatment and support is meagre or non-existent. At the same time, the epidemic appears to be gathering momentum in other parts of the world - notably Eastern Europe and Asia.

As was noted in Canada's Report on HIV/AIDS 2003, children are among those most affected by the disease. In addition to the millions of children worldwide who are now living with HIV/AIDS, a significantly larger number have lost one or both parents to the epidemic, with no signs of a slowing or reversal of this trend in sight. Still, teens and young adults continue to be the most affected and infected population at the global level, due in part to their increased likelihood to engage in risky sexual behaviours and injection drug use (IDU).

As evidenced by the theme for the 2004 World AIDS Campaign "Have you heard me today?," women and girls are particularly vulnerable to HIV/AIDS in the global context. According to UNAIDS, young women and girls can be 2.5 times more likely to be HIV-infected than their male counterparts. "Their vulnerability is primarily due to inadequate knowledge about AIDS, insufficient access to HIV prevention services, inability to negotiate safer sex, and a lack of female-controlled HIV prevention methods, such as microbicides. At the same time, all over the world women do not enjoy the same rights and access to employment, property and education as men. Women and girls are also more likely to face sexual violence, which can accelerate the spread of HIV."²  

In the face of this staggering global epidemic, it is clear that efforts must be strengthened to halt the spread of HIV and diminish the impact of HIV/AIDS on individuals, families, communities and entire nations. Canada must be part of this expanded and reinforced global response and must provide the needed leadership, expertise and resources.

Canada's Epidemic is Growing and Changing

In Canada, the HIV/AIDS epidemic continues to grow despite the efforts of governments, community-based organizations, national non-governmental organizations (NGOs), the health care sector, researchers and a legion of committed and dedicated volunteers across the country.

The Centre for Infectious Disease Prevention and Control (CIDPC) estimates that 56 000 people in Canada were living with HIV infection at the end of 2002 - a 12 per cent increase from previous estimates in 1999.³ Men who have sex with men (MSM) continue to be the most affected group, accounting for an estimated 58 per cent of all infections. IDU comprise an estimated 20 per cent of infections, with the heterosexual exposure category accounting for 18 per cent, combined MSM-IDU 4 per cent, and the remaining exposure categories less than 1 per cent. Aboriginal persons account for a disproportionately high number of HIV infections in Canada, and the epidemic appears to be growing among women of all age groups. Disproportionate rates of infection have also been noted among African and Caribbean communities in Canada. CIDPC estimates that 17 000 HIV-positive individuals across all exposure categories and population groups are unaware of their infection.

New national HIV/AIDS surveillance data for the period up to December 31, 2003, confirm that the epidemic is growing in Canada. Since HIV testing began in Canada in 1985, 55 180 positive HIV tests had been reported to CIDPC, including 2 482 new HIV infections in 2003. A total of 19 344 AIDS diagnoses in Canada had been reported to the end of 2003, with the largest proportion of these among people aged 30 to 44 years. Although the number of new AIDS diagnoses has declined considerably since the mid-1990s, due to the introduction of highly active antiretroviral therapy (HAART), CIDPC is also concerned that AIDS diagnoses are becoming increasingly under-reported.

This continued growth in the epidemic appears to corroborate a change in public perceptions about HIV/AIDS that has been noted in previous reports. The 2003 Canadian Youth, Sexual Health and HIV/AIDS Study - coordinated by the Council of Ministers of Education, Canada - revealed that half of Grade 9 students in Canada are unaware that there is no cure for HIV/AIDS. Other research has disclosed that close to 20 per cent of adult Canadians believe that HIV/AIDS can be cured if treated early.⁴ Most Canadians view HIV/AIDS as a serious problem but perceive their own personal risk of HIV infection to be low. Levels of discomfort about HIV/AIDS are also high: as reported last year, 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.

Clearly, greater vigilance is needed to control Canada's HIV epidemic, including more effective strategies to prevent new infections among vulnerable groups, improved services for the increasing number of Canadians living with HIV infection, and increased awareness across society that stigma and discrimination only serve to worsen the situation.

A Strengthened Nationwide Approach Takes Shape

Canada is about to embark on a new approach to HIV/AIDS that envisions unprecedented engagement across society and that will be underpinned by a renewed framework for federal involvement in the response.

Stakeholders in the CSHA have come to the conclusion that a more strategic approach is needed to get ahead of the epidemic. Although HIV/AIDS policy and programming must be broad-based and flexible, encompassing all elements of a social justice approach, there is also a need for a more consolidated and planned response.

To this end, a draft action plan was developed by a broad cross-section of organizations and individuals involved in the HIV/AIDS response, setting out a bold vision that "By 2010, the end of the HIV/AIDS epidemic is in sight." The draft was released for broad national consultations in late 2003 and early 2004. A number of consistent messages emerged from these consultations, which included people living with HIV/AIDS, vulnerable Canadians, provincial/ territorial governments and others:

• participants supported the concept of having a common, visionary plan and felt that such a plan could prove useful on many fronts
• the document's focus on a social justice framework resonated strongly with organizations and individuals involved in the HIV/AIDS response, who felt that this was the proper approach for addressing the epidemic
• participants supported the inclusion of specific measurable actions and targets in the plan

Based on these comments and other feedback from the HIV/AIDS community, the document was further refined. Entitled Leading Together, An HIV/AIDS Action Plan for All Canada, it sets out desired outcomes, targets and recommended actions to achieve the following goals:

• prevent HIV infection
• contribute to global efforts to fight the epidemic and find a cure
• provide timely, safe and effective care, treatment and support for all Canadians with HIV/AIDS
• reduce the social inequities, stigma and discrimination that threaten people's health and well-being

At the same time that the HIV/AIDS community was drafting the action plan, the federal government was developing a renewed federal framework for the future in response to the report of the Standing Committee on Health (tabled in June 2003) and the five-year review of the CSHA (completed in August 2003). The new framework will identify federal priorities to be undertaken over the next five years. The doubling of federal funding to $84.4 million over five years, announced in May 2004, signals the federal government's increased commitment to addressing HIV/AIDS.

Leading Together, An HIV/AIDS Action Plan for All Canada, together with the renewed federal framework and increased federal funding for HIV/AIDS, points to a new beginning for Canada's HIV/AIDS response. Nevertheless, a number of challenges will need to be addressed as we move forward together. Implementing the action plan will require:

• the engagement and involvement of additional players and sectors, where and as appropriate
• sufficient commitment and resources to support the work proposed in the action plan
• clear roles and responsibilities to move forward
• a mechanism to champion the action plan so that it continues to describe the best and right work to be done, captures and aligns existing responses, and proves useful as a shared planning tool
• continued input from individuals and population groups that are most affected by HIV/AIDS

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