Canada's Report on HIV/AIDS 2004

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3a Coordinating HIV/AIDS Policy and Programming

Canadians are embarking on a hopeful new phase in the collective response to AIDS. Much work has been done in preparing for this new approach, as partners in the CSHA have sought to broaden their thinking to include the full spectrum of public policy issues and to foster greater collaboration with both traditional and new stakeholders.

Planning the Way Forward

As noted earlier in this report, the development of an HIV/AIDS action plan for Canada continued to be the focus of significant effort by CSHA partners throughout 2003-2004. Leading Together, An HIV/AIDS Action Plan for All Canada sets out strategic directions that will guide Canada's collective response to HIV/AIDS over the next five years (see the feature on page 9). The action plan's scope extends well beyond the federal government, calling for contributions by NGOs and AIDS service organizations (ASOs), the provinces and territories, the health care and education sectors, and private industry, to name a few. The action plan is expected to be launched in early 2005.

Development of the action plan, along with the report of the Standing Committee on Health in June 2003 and the five-year review of the CSHA (completed in August 2003), have informed the development of a renewed federal framework for the CSHA. This renewal, was foretold in the Government of Canada's response to the Standing Committee. Tabled in Parliament on October 31, 2003, the response emphasized the Government's commitment to continue to work with its partners in the CSHA to ensure a compassionate, comprehensive and effective Canadian response. Consistent with the recommendations of the five-year review, the renewed federal framework will focus on clarifying the federal role in HIV/AIDS.

On May 12, 2004, the Government of Canada, after a thorough review of the evidence - and in response to continued calls for increased funding for HIV/AIDS from national NGO stakeholders, supported by a recommendation from the Standing Committee - announced that federal funding for the CSHA would double over five years to $84.4 million annually by 2008-2009. In year one of this commitment (2004-2005), additional funding will be targeted to enhance front-line efforts to address populations most at risk of infection.

Advisory Committees Inform Canada's HIV/AIDS Response

In developing CSHA policy and programming, the Government of Canada looks to a number of national advisory groups for input and direction.

These include the Ministerial Council on HIV/AIDS, which provides advice directly to the federal Minister of Health on pan-Canadian aspects of HIV/AIDS. The Ministerial Council works on a diverse range of issues, including HIV/AIDS-related research, immigration policy, the drug review process and intra- and interdepartmental collaboration. During 2003-2004, at the request of the Minister of Health, the Ministerial Council provided guidance to the Minister of Foreign Affairs Canada on the foreign policy dimensions of HIV/AIDS and their impacts on Canadians at home and abroad, with a particular focus on Africa. Consultants were hired to lead a consultation process and develop a report with input from Ministerial Council members, CIDPC, IAD, the Department of Foreign Affairs and International Trade (now Foreign Affairs Canada), CIDA and the Consultative Group on Global HIV/AIDS Issues. Entitled Meeting the Challenge: Canada's Foreign Policy on HIV/AIDS With a Particular Focus on Africa, the report was submitted to the federal government in early September 2003, in advance of the United Nations General Assembly High Level Meeting on HIV/AIDS. The Ministerial Council subsequently met with a representative from the office of the Minister of Foreign Affairs to discuss the report, which included 61 recommendations for enhanced Canadian involvement and political leadership in the global response.

The Federal/Provincial/Territorial Advisory Committee on AIDS (FPT AIDS) advises the Conference of Deputy Ministers of Health. In 2003-2004, FPT AIDS finalized a paper on the issues surrounding disclosure of HIV status and public health and recommended a framework for persons who are unwilling or unable to disclose their status. As well, an FPT AIDS Working Group on Surveillance was established to develop a plan to enhance the role of surveillance and targeted epidemiological studies in improving both the understanding of and the response to HIV/AIDS in Canada. In 2003, FPT AIDS commissioned a paper on the state of the epidemic in Canada and government responses. The paper, expected to be released in December 2004, examines the HIV/AIDS epidemic in different Canadian jurisdictions from the perspective of provincial and territorial governments and key stakeholders, summarizes the different jurisdictions' responses to the disease, analyses current issues of concern, and identifies means for a strengthened response.

The mandate of the National Aboriginal Council on HIV/AIDS (NACHA) is to advise Health Canada, the Public Health Agency of Canada and other stakeholders about the HIV/AIDS-related needs of Aboriginal people in Canada. The Council consists of four caucuses, with equal representation of First Nations, Inuit and Métis peoples as well as Aboriginal community-based organizations and Aboriginal people living with HIV/AIDS. NACHA held three teleconferences and a face-to-face meeting in Halifax in 2003-2004. The Council also organized the third Aboriginal Summit on HIV/AIDS, which took place in Vancouver in April 2004, with more than 60 people in attendance. Participants adopted a number of recommendations arising from an evaluation of NACHA completed in the spring of 2004, including a recommendation to reduce membership on the Council from 24 to 16. Additional recommendations are under consideration, and revised terms of reference are being developed for NACHA.

The Federal/Provincial/Territorial Heads of Corrections Working Group on Health meets in person twice yearly, and holds conference calls as required, to exchange information, share best practices and collaborate on projects related to inmate health issues in correctional environments.

National partners in the CSHA continued to meet with CIDPC to consult and exchange information on issues related to the CSHA.

The Consultative Group on Global HIV/AIDS Issues (formerly the Working Group on International HIV/AIDS Issues) is a regular forum for consultation and discussion on the international HIV/AIDS activities of federal departments and civil society. IAD convened quarterly meetings of the Consultative Group during 2003-2004, providing a forum for NGOs to advise participating government departments on the global epidemic and for all parties to discuss issues of collaboration and policy coherence to ensure a more effective Canadian response.

CIHR's capacity to deliver a strategic HIV/AIDS research program that is responsive to the shifts in the epidemic was enhanced in 2003-2004 with the establishment of the HIV/AIDS Research Advisory Committee. A subcommittee of the Institute of Infection and Immunity Advisory Board, the Advisory Committee comprises representatives of five CIHR institutes, researchers, community organizations, CIDPC and the Ministerial Council on HIV/AIDS. It will advise on priorities for HIV/AIDS research, the design and delivery of strategic research funding programs, and the allocation of CSHA funding to HIV/AIDS research.

HIV/AIDS Policy and Program Development

CSHA partners continued to influence the development of HIV/AIDS policies and programs by governments and others.

CTAC has been monitoring the creation and implementation of the Common Drug Review Process housed in the federal Canadian Coordinating Office for Health Technology Assessment. The purpose is to provide a single process for reviewing new drugs and providing recommendations on formulary listings to participating provincial/territorial drug reimbursement plans across Canada so that Canadians can access quality treatment and care in a timely manner. CTAC also partnered with the Best Medicines Coalition and the Consumer Advocare Network to provide written comments and recommendations about process-related issues that are a barrier to meeting stated goals. They also shared their concerns with Health Canada and provincial ministries of Health. CTAC continues to monitor the progress of drugs as they proceed through the Common Drug Review Process.

In recognition of the fact that HIV-positive people are often co-infected with hepatitis C and tuberculosis, CAS participated in the development of a draft hepatitis C strategy for Canada that was led by the Hepatitis C Action Group and presented at the 2nd Canadian Hepatitis C Conference in March 2004. CAS also participated in a conference hosted by Stop Tuberculosis Canada with the goal of establishing better linkages between groups working in these two areas.

The CWGHR organized a dialogue with Human Resources Development Canada (now Human Resources and Skills Development Canada) and CIDPC on disability and rehabilitation issues, submitted a brief on HIV and episodic disability issues to the Parliamentary Subcommittee on the Status of Persons with Disabilities, and participated in the federal government's consultations on the Canada Pension Plan - Disability Program.

In April 2003, CIDPC hosted a two-day consultation on the HIV/AIDS Information Services Initiative (HISI). Twenty stakeholders from across Canada who are involved in HIV/AIDS information services - either as users or as deliverers - came together to articulate the goals of and identify key objectives, outcomes and activities for a national HIV/AIDS information service. The meeting resulted in a new description of HISI as a flexible, supportive service that empowers people living with HIV/AIDS and people at risk by promoting, collecting, developing and disseminating information that is accessible, accountable, meaningful, collaborative, accurate and appropriate for the consumer. As a follow-up to the meeting, the program and funding guidelines for both the HISI Fund and the National Non-governmental Organization Operational Fund were redesigned to better reflect the goals of the CSHA. Requests for proposals were issued for the two funds, and the successful applicants were announced in early 2004.

The Alberta Community HIV Fund is a joint community/provincial/federal funds disbursement model that demonstrates a shared long-term commitment to the prevention of HIV infection and the care and support of those affected by HIV/AIDS. In 2003-2004, the Fund supported 15 community-based organizations in Alberta for time-limited, specific activities to address unmet needs and priorities around HIV. For example, a project was undertaken to break down cultural barriers to the prevention of HIV/AIDS in the Southern Sudanese community in Calgary. Volunteers were recruited and trained to help mobilize and organize the community, and parents and youth were brought together in a safe and supportive environment to discuss HIV/AIDS prevention-related issues. As a result, families in the Southern Sudanese community increased their understanding of HIV/AIDS and enhanced their awareness of healthy lifestyle choices and the services available in their community.

Pauktuutit Inuit Women's Association's HIV/ AIDS project - the Canadian Inuit HIV/AIDS Network (CIHAN) - developed an advocacy strategy to promote regional adoption of the Inuit Plan of Action on HIV/AIDS. The strategy outlined a series of promotional activities and a two-year work plan to move regional Inuit organizations and communities forward in implementing the Plan of Action. CIHAN's steering committee approved the advocacy strategy in October 2003, and a training session was held to equip steering committee members with the knowledge and tools needed to implement its activities.

In 2003, FNIHB hired an external consulting firm to conduct a five-year formative evaluation of its HIV/AIDS program. The evaluation highlighted community success with the prevention of HIV/AIDS and resulted in recommendations to improve program administration. An action plan for 2004-2005 was developed for the program in response to these recommendations. FNIHB established an internal HIV/AIDS working group with regional representation to increase national-regional dialogue and collaboration within the Branch on HIV/AIDS issues, priorities and programming for First Nations on-reserve and Inuit people. The working group met in June 2004 to review the current state of FNIHB's HIV/AIDS program and to discuss potential new directions and initiatives. FNIHB also began to develop an inventory of available resources as a first step toward creating a national database of comprehensive, evidence-based programs and strategies that could inform the future development of HIV/AIDS programs for First Nations on-reserve and Inuit populations.

Correctional Service Canada continued to develop an HIV/AIDS strategy for Aboriginal inmates. Correctional Service Canada Health Services, in collaboration with Aboriginal stakeholders, organized a two-day consultation meeting to review the proposed strategy and to seek additional direction and input. The strategy, which was in its final consultative stage at the time of this report, will place increased emphasis on implementing the educational program, "Circle of Knowledge Keepers," in federal institutions.

Action was taken to defend the human rights of people living with HIV/AIDS when implementing mandatory HIV testing was proposed, which goes against previous policy statements that HIV testing should be undertaken on a voluntary basis with fully informed consent and accompanied by pre- and post-test counselling. Working in partnership with the Coalition des organismes communautaires québécois de lutte contre le sida (COCQ-sida), the Legal Network issued press releases, published op-ed pieces in the Toronto Star and Le Devoir, and wrote to Montréal's Catholic archbishop, the City of Montréal and the Quebec Minister of Health to protest statements and proposed policies regarding mandatory HIV testing of candidates for the priesthood, surgeons and police officers in Quebec. The Archdiocese of Montréal subsequently rescinded its plan to require applicants for priesthood to undergo HIV testing.

After developing a Chronic Illness and HIV/AIDS in the Workplace Policy for Canadian organizations, ICAD hosted a series of workshops for interested organizations and government departments. Each workshop covered topics such as workplace policy development, employee rights, employer obligations, policy implementation and evaluation.

Policy Development for HIV Vaccines and Microbicides

The Canadian HIV Vaccines Plan Steering Committee, which has been mandated to develop a strategy to intensify the development of HIV vaccines and to plan for their effective and equitable distribution in Canada, developed an initial draft of a proposed action plan. The draft Canadian HIV Vaccines Plan addresses the issues of coordination and leadership; public engagement, education and communications; research, development and clinical trials; and best practices for vaccine development and delivery. The Steering Committee, which includes representatives from CAS, the research community, IAVI, CIDPC and IAD, and a person living with HIV/AIDS, has consulted broadly on the document and will incorporate the feedback received in future drafts of the plan. To mark World AIDS Vaccine Day - a global observance of the urgent need for vaccines against HIV/AIDS - on May 18, 2004, CAS, the Canadian HIV/AIDS Legal Network, the Canadian Network for Vaccines and Immunotherapeutics (CANVAC), CTAC and ICAD issued a press release praising Canadian leadership on this issue and calling for the commitment of specific resources to develop and implement the plan.

CAS completed a project to examine the legal, ethical and human rights issues surrounding microbicide development and testing. In addition to serving as the Canadian affiliate of the Global Campaign for Microbicides, CAS coordinates the Microbicides Advocacy Group Network (MAG-net). MAG-net continued to provide opportunities for members to become involved in awareness raising and advocacy around issues such as the continued use of Nonoxynol-9 and Canadian contributions to microbicides research.

To strengthen collaboration among microbicides, treatment and vaccine advocates, the Canadian HIV/AIDS Legal Network, with support from IAD, held an international expert consultation in Montréal in November 2003. Community advocates and researchers from 12 countries attended the meeting, which resulted in an agreement by all three movements to pursue a common agenda based on human rights principles and a shared commitment to a comprehensive, global response to HIV/AIDS. Further discussions led to the preparation in early 2004 of a joint Statement of Commitment and a 12-point Plan of Action to help governments, industry and civil society accelerate research, development and access across a prevention-treatment-care continuum. The Statement of Commitment and Plan of Action were officially launched at the XV International AIDS Conference in Bangkok and have been endorsed by advocates from all fields. 

Canada on the International Stage

The Jean Chretien Pledge to Africa Act (Bill C-9), the Government of Canada's legislation to help provide lower-cost pharmaceutical products to address public health problems such as HIV/AIDS, tuberculosis and malaria in least-developed and developing countries, received Royal Assent in May 2004. Bill C-9 is Canada's response to a decision of the World Trade Organization that allows developed countries to authorize someone other than the patent holder to manufacture a lower-cost version of a patented medicine in order to export it to a developing country with insufficient or no pharmaceutical manufacturing capacity. Canada was the first country to enact legislation to implement this decision; this was the result of the mobilization of many concerned groups, individuals and federal government departments. Bill C-9 will come into effect once the regulations necessary to complete the legislative framework have been passed.

Canada assumed the role of chair of the UNAIDS Programme Coordinating Board in June 2004. The Canadian delegation to UNAIDS comprises CIDA, Foreign Affairs Canada, Health Canada and the Public Health Agency of Canada; the departments and agencies work closely to ensure consistent, coordinated Canadian representation on this important body. As well, Canada assumed a seat on the board of the GFATM in March 2004, representing a constituency comprising Canada, the United Kingdom, Germany and Switzerland.

As noted earlier in this report, CIDA's core funding to UNAIDS was $10.4 million in fiscal year 2003-2004, including a one-time additional contribution of $5 million. CIDA's five-year cumulative investment in HIV/AIDS for the period 2000-2001 to 2004-2005 is projected to be almost $500 million. CIDA's HIV/AIDS policy and programming are now focussing on contributing to the scaled-up global effort to provide care, treatment and support to people living with HIV/AIDS; to harm reduction initiatives among injection drug users; to cross-sectoral themes between HIV/AIDS and agriculture; and to multi-donor HIV/AIDS initiatives in countries such as Tanzania, Mozambique and Malawi and in the Caribbean.

Through CIDA, Canada is also a leading donor to the WHO's 3 by 5 Initiative, which seeks to provide antiretroviral drug treatments to 3 million people living with HIV/AIDS by the end of 2005. Antiretroviral therapies can dramatically reduce death rates, prolong lives and improve the quality of life of those living with HIV/AIDS. The 3 by 5 Initiative provides front-end technical assistance to help developing countries build health systems that are capable of treating large numbers of people and to make it possible for other initiatives, such as Bill C-9 and the GFATM, to work most effectively.

In recognition of the exceptionally high rates of HIV infection among inmates in Canada and many other countries, advocacy for prisoners continued to be a priority for the Canadian HIV/AIDS Legal Network in 2003-2004. For example, the Executive Director of the Legal Network participated in the drafting of the Dublin Declaration on HIV/AIDS in Prisons in Europe and Central Asia. Launched in February 2004, the Declaration provides a framework for mounting an effective response to HIV/AIDS in prison systems based on international best practices, scientific evidence and the obligations of states to ensure the fundamental human rights of people in prison. The Legal Network subsequently became one of the first organizations to endorse the Dublin Declaration.

During a mission to Russia and Ukraine in March 2004, Legal Network officials negotiated an agreement to help the Ukrainian prison system implement pilot studies on methadone maintenance treatment and needle exchanges. In September 2003, in collaboration with International Harm Reduction Development, the Legal Network initiated a multi-year HIV prevention project involving prisons in several countries in Eastern Europe and the former Soviet Republic. Specifically, the Legal Network will provide program development, research, evaluation and advocacy assistance to support the establishment of prison-based harm reduction programs in participating countries.

Canada continued to host visitors from organizations involved in the global response to HIV/AIDS. In 2003-2004, visits were made by representatives of the International AIDS Society (IAS), the International Partnership for Microbicides, the Canada AIDS Russia Project, UNAIDS and the WHO. In each case, round tables were held to inform Canadian officials of the work of these organizations and to identify opportunities for increased collaboration on global health issues.

Challenges and Opportunities

The challenge of reinvigorating HIV/AIDS programming during a time when complacency and prevention fatigue appear to be commonplace will require innovative, community-specific models. Program coordination and coherence are required in both the domestic and international responses to HIV/AIDS as well as between the two. Similarly, given the complex nature of the HIV/AIDS epidemic and its socio-economic influences and implications, efforts must be strengthened to improve collaboration between governments and across jurisdictions. The development of a new national action plan for HIV/AIDS, a renewed federal framework and the additional funding for HIV/AIDS announced in May 2004 will provide opportunities for better alignment of work and a more effective response in the years ahead.

Canada's HIV/AIDS Community Helps Plan for AIDS 2006

Almost two years before the first delegates will set foot in the Metro Toronto Convention Centre in August 2006, planning is well under way for the XVI International AIDS Conference. And community-based organizations - front-line workers in the Canadian response - are at the centre of the process.

Toronto was named as host of the next biannual conference more than a year ago, but local organizers were already setting the stage for AIDS2006 when the official announcement was made by the International AIDS Society (IAS) and its partners: the International Council of AIDS Service Organizations, the Global Network of People Living with HIV/AIDS, the International Community of Women Living with HIV/AIDS and the Joint United Nations Programme on HIV/AIDS.

"Community-based organizations are expected to play a big role in AIDS2006," says Glen Brown, a Toronto-based consultant assisting with communications and community relations for the conference. "In the latter part of 2003, we hosted consultations with community organizations and other stakeholders. We got a very enthusiastic response and lots of good ideas on everything from transportation to billeting to what the theme of the conference might be."

The local organizing committee has been using every opportunity to inform potential visitors from around the world that AIDS2006 will be an interesting, diverse and welcoming conference. Who better to convey that message than people working at the local level?

With that in mind, representatives of community-based organizations were among the many volunteers who took shifts at the Canada Booth at the XV International AIDS Conference in Bangkok, Thailand, in July 2004. More than 8 000 delegates from around the world visited the booth, a joint venture of the Government of Canada, the Government of Ontario, the City of Toronto, Toronto Tourism and various partners in the Canadian Strategy on HIV/AIDS. In addition to receiving information on Canada's HIV/AIDS response, they were encouraged to start thinking about attending AIDS2006.

Senior officials from all three levels of government also promoted AIDS2006 to more than 250 guests who attended the official Canada Reception, hosted jointly by Health Canada, the Canadian International Development Agency, the Province of Ontario and the City of Toronto. Tourism Toronto sponsored a video at the closing ceremony in Bangkok inviting delegates to AIDS2006.

Mr. Brown notes that many community-based organizations will be represented on the Local Host Advisory Committee for AIDS2006, along with governments, national non-governmental organizations, the research community and other stakeholders. "This is where a lot of the nuts and bolts thinking will take place. Lots of ideas are already percolating on how we can turn this into a real cultural event as well as a working conference."

The conference in Toronto is expected to attract more than 12 000 participants to share knowledge and information on the global HIV/AIDS epidemic. Conference participants will include researchers, clinicians, community organizations, government personnel and people living with HIV/AIDS.

"Toronto is a great host city - and Canada a great host country - because the world is already here," notes Montréal researcher Dr. Mark Wainberg, former IAS president and co-chair of AIDS2006 Toronto with Helene Gayle, president of the IAS. "The conference will showcase the best science from Canada and around the world."

This is the third International AIDS Conference to be held in Canada: Montréal hosted the event in 1989 and Vancouver hosted in 1996. For more information, visit www.aids2006.org .

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