Canada's Report on HIV/AIDS 2004

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3c Advancing the Science of HIV/AIDS

Canada continues to contribute to the world's understanding of HIV/AIDS. Through promising new work in the growing domain of HIV/AIDS-related social and behavioural science, as well as the biomedical and clinical fields of research, Canadians are investigating the physical, psychological and societal impacts of this devastating disease.

Working individually and in collaboration with others at the local, regional, national or international levels, the goals of HIV/AIDS scientists and researchers are to stop the spread of HIV, develop better treatments and a cure for AIDS, and improve the quality of life of people living with HIV/AIDS. Despite the frequent emergence of new and difficult challenges, scientific advancements continue to offer hope for success in achieving these goals.

Canadian Partners in HIV/AIDS Research

About 30 per cent of the CSHA's annual budget - or approximately $13 million - was dedicated to HIV/AIDS research in 2003-2004. Most of this money supported extramural research at universities, hospitals and other institutions (see Table 1), with about $1 million being used to support epidemiological research within CIDPC. Over and above this amount, CIHR, which administers the majority of the CSHA's extramural research program, contributes at least $3.5 million per annum from its own budget to HIV/AIDS research. In 2003-2004, CIHR's investment in HIV/AIDS research was larger than ever, with $8 million committed to HIV/AIDS research and an additional $7.3 million committed to research related to HIV/AIDS.

Table 1:
Federal HIV/AIDS Extramural Research Funding Streams - ($M)

	CSHA		CIHR
Community-Based Research		1.0
Aboriginal Community-Based Research		0.8
Biomedical/Clinical*		4.6		6.3
Health Services/Population Health*		2.4		0.6
Canadian HIV Trials Network*		3.2		1.1
Total		12.0		8.0

* Administered by CIHR

Canadian advances in health research are facilitated through open competitions sponsored by CIHR that provide opportunities for researchers to conduct creative and significant projects across the full spectrum of health research, including HIV/AIDS. CIHR also offers unique opportunities for Canadian scientists to engage in interdisciplinary and targeted research through its 13 institutes, which are setting the Canadian health research agenda and offering strategic programs to address important health research challenges. Two CIHR institutes - the Institute of Infection and Immunity and the Institute of Aboriginal Peoples' Health - have specifically identified HIV/AIDS as a priority and have offered strategic funding opportunities in relation to HIV/AIDS. In 2003-2004, 10 new HIV/AIDS research projects were approved through strategic requests for applications launched by CIHR institutes. Six pilot project grants were approved under the Global Health Research Initiative requests for applications, and three pilot project grants were approved under the Institute of Infection and Immunity's pilot project requests for applications, targeted specifically toward new investigators. Pilot project grants provide the opportunity for researchers to test innovative ideas and to determine the viability of new research directions. One new emerging team in HIV/AIDS was also approved for funding through a CIHR requests for applications.

This combination of strategic and investigator-initiated HIV/AIDS research resulted in CIHR approving a total of 38 new HIV/AIDS research projects in 2003-2004, bringing the number of funded projects to 101 (see Table 2). This was the largest number of HIV/AIDS research projects ever supported by CIHR, surpassing the previous high of 89 projects supported in 2002-2003.

Table 2:
CIHR-Funded HIV/AIDS Research Projects in 2003-2004

Research Program	New Projects	Ongoing Projects
Operating Grants	25	74
Randomized Controlled Trials	1	5
Group Grants	0	3
Institute Strategic Initiatives	10	13
Other CIHR Programs	2	6
Total	38	101

Science Leads to New Knowledge

With funding support from the federal government and other sources, Canadian scientists have contributed substantial new knowledge to the fight against HIV/AIDS.

Some of the latest findings were showcased at the 13^th Annual Canadian Conference on HIV/AIDS. Organized by CAHR, the three-day conference in Montréal in May 2004 attracted more than 670 researchers and other stakeholders from across Canada. Abstracts of the 286 oral and poster presentations made at the conference were published in the Canadian Journal of Infectious Diseases (Volume 15, Supplement A, March/April 2004). With funding from CIDPC, CAHR developed a media kit for distribution at the conference to help raise awareness of HIV in Canada and to highlight some key findings and projects.

The CWGHR, with funding from CIDPC, supported a study of impairments, activity limitations and participation restrictions among people living with HIV/AIDS in British Columbia, a collaborative project that involved the British Columbia Centre for Excellence in HIV/AIDS, the University of British Columbia, the University of Toronto and the British Columbia Persons with AIDS Society. This population-based survey, one of the first of its kind in Canada, revealed extraordinarily high levels of disability among people living with HIV. More than 90 per cent of respondents reported experiencing one or more impairments, with one third reporting more than 10 impairments. These findings have important implications for rehabilitation programs and services for people living with HIV across Canada.

CTAC completed the data collection for its Post-Approval Surveillance Study and began working on the project's final report. This study engaged government, the pharmaceutical industry and the HIV/AIDS community, including people living with HIV/AIDS. Initiated in 1999, it involved major sites hosted by ASOs in Toronto, Vancouver and Montréal, as well as Aboriginal focus groups in British Columbia, Alberta, Manitoba and Ontario. The project identified methods for successfully collecting adverse events information directly from people living with HIV/AIDS (as well as methods that are not successful) and confirmed the need for a national consumer-centred, active post-approval surveillance system for HIV/AIDS drugs. Preliminary results of the study were reported at the Ontario HIV Treatment Network's Research Days in November 2003, at the CAHR Conference in May 2004 and at the XV International AIDS Conference in Bangkok.

CIHR supports all disciplines of HIV/AIDS research. The following are examples of CIHR-funded research projects in 2003-2004:

• Adhering to a complex medication regimen such as HAART is difficult, especially when dealing with the psychological, economic and medical challenges of HIV/AIDS. Not adhering, however, can mean more rapid disease progression, the development of drug-resistant strains of the virus and an increase in AIDS-related mortality. V/AIDS have developed a tool - the Antiretroviral Readiness and Motivation Scale (ARMS) - to measure patients' readiness to adhere to HAART. Preliminary results have shown that ARMS possesses excellent psychometric properties, and the team is now exploring the relationship between ARMS scores and actual adherence. The tool could allow physicians and other caregivers to better predict which patients will adjust quickly to HAART and to take steps to help those who will face more challenges in adhering to the regimen.
• In a project led by a researcher at the University of Regina, Aboriginal youth served by community services correctly answered only two thirds of questions about HIV/AIDS in a wide-ranging study of their sexual health behaviours, knowledge, attitudes and beliefs. The study, which surveyed more than 200 Aboriginal youth aged 11 to 20 in Regina, also found that youth in the community are more at risk for sexual health problems than non-Aboriginal youth or Aboriginal youth attending high school. The study concluded that sexual health care services must be provided to youth where they are, must be incorporated with other kinds of care, and must include a strong cultural component.
• A researcher at Université Laval in Québec City is focussing on new ways to circumvent resistance to antiretroviral drugs, which continues to be a problem among people living with HIV infection. This project has found evidence that treatment with statins - drugs currently used to lower cholesterol - can decrease HIV replication and attachment to target cells. The ability of statins to limit the initial steps in virus replication provides a new approach for treating HIV-1 infection.
• A long-term study of both HIV-positive and HIV-negative MSM has generated promising research results and become an important resource for other researchers and trainees. Among its many contributions, the Polaris HIV Seroconversion Study, led by researchers at the University of Toronto, has identified alarming increases in new infection rates in the late 1990s, leading to increased community awareness and new prevention programs; highlighted the fact that contact with pre-ejaculatory fluid alone may be sufficient for HIV transmission; and developed new knowledge about disclosure of HIV status in terms of social and relationship factors, providing new insights for the development of guidelines and counselling around disclosure.

During 2003-2004, an environmental scan was completed for FNIHB's Community Health Nurse HIV/AIDS Clinical Guidelines, which are intended to ensure appropriate and adequate information for community health nurses to deliver HIV/AIDS education, care, testing, counselling and support.

Community-Based Research

Interest and participation in community-based HIV/AIDS research continues to grow. For example, researchers at the University of Alberta in Edmonton completed a two-year study entitled "Challenging Lifestyles - Aboriginal Men and Women living with HIV." The goals of the project were to examine the experiences of Aboriginal men and women living with HIV; identify culturally and situation-relevant HIV prevention interventions for Aboriginal individuals with HIV; design, apply and assess an intervention approach to promote healthier lifestyles for Aboriginal people living with HIV; and model a research process that is based on respect and that involves and is accessible to the community. The project has improved knowledge of the factors that limit or enhance the risk behaviour of Aboriginal people living with HIV.

Researchers at Mount Saint Vincent University in Halifax completed a project entitled "Learning about HIV/AIDS in the Meshwork: The Nature and Value of Indigenous Learning Processes in Community-Based HIV/AIDS Organizations." The goal was to develop a better understanding of the nature and value of the indigenous learning processes of community-based organizations and a deepened awareness of the social and cultural processes that regulate the exchange of knowledge between community-based agencies and academic, medical, corporate and government organizations. The findings of this study are being incorporated into health policy frameworks at the local, provincial and national levels to improve the capacity of community-based organizations to generate new and effective responses to the evolving challenges of HIV/AIDS.

Finally, with the support of a community-based research scholarship from the AIDS Calgary Awareness Association, a student pursuing a Master of Science degree at the University of Calgary undertook an evaluation of the mental health needs of people living with HIV/AIDS, with a particular focus on the gay male community. The findings have provided community-based organizations with valuable information about their program efficiency and potential ways to improve service availability.

A Letter of Agreement was signed by Health Canada and CIHR in 2003-2004 regarding the planned transfer of the Community-Based Research Program to CIHR. The transfer took place in spring 2004.

Clinical Trials An Important Component of HIV/AIDS Research

The CTN - the principal organization conducting HIV/AIDS clinical trials in Canada - is a partnership of researchers and research institutes committed to developing treatments, vaccines and a cure for HIV/AIDS. Through CIHR, the CTN received $3.1 million in CSHA funding in 2003-2004 to work with clinical investigators, people living with HIV/AIDS, the pharmaceutical industry, physicians, specialists and laboratories to assess experimental HIV/AIDS therapies. CIHR also provided an additional $1.1 million from its own budget to support the CTN's work.

In 2003-2004, the CTN facilitated 14 HIV clinical trials, four of them new, involving more than 649 Canadians with HIV/AIDS. The CTN also reviewed nine new trial protocols and approved five. CTN trials for which results were presented in 2003-2004 include:

• CTN 158: This study looked at adding a synthetic DNA compound to a hepatitis B (HB) vaccine to improve the immune response of HIV-infected persons to hepatitis B vaccination. Participants with no prior HB vaccination reached a protective level of HB antibody significantly more rapidly, and they maintained higher HB antibody response. Among people with prior HB vaccine failures, significantly more participants maintained durable HB antibody response.
• CTN 161: This study was designed to evaluate simplified protease inhibitors (PI) regimen. It showed that a once-daily regimen of saquinavir soft gel capsule (SGV)/ritonavir with two reverse transcriptase inhibitors (RTIs) is as effective as a twice-daily regimen of indinavir/ritonavir with two RTIs in suppressing viral load at
  24 weeks in patients with PI-susceptible HIV virus. However, a higher rate of discontinuation for adverse events was observed among participants taking indinavir/ritonavir.

In partnership with the CTN, CATIE publishes an on-line database of currently enrolling clinical trials across Canada. This information helps inform people living with HIV/AIDS and their caregivers about experimental treatment options and how they can participate.

HIV/AIDS Surveillance Data Updated

In May 2004, CIDPC released new national HIV/AIDS surveillance data for the period up to December 31, 2003.⁵

The data reveal that since HIV testing began in Canada in 1985, 55 180 positive HIV tests had been reported to CIDPC. The annual number of new positive HIV tests declined from 2 996 in 1995 to 2 127 in 2000, and has since increased to 2 504 in 2002 and 2 482 in 2003 (see Figure 1). The increase in the number of positive HIV test reports in the past two years may be partly attributed to changes in immigration policies, including the introduction in 2002 of HIV screening of immigrants and reduced restrictions on certain groups of immigrants who would previously have been considered medically inadmissible.

Figure 1:
HIV Positive Test Reports and AIDS Diagnoses by Year of Diagnosis, 1993-2003*

* Positive HIV test report data prior to 1995 are not available by year.

Females represent a growing proportion of positive HIV test reports. For the past three years, females have accounted for approximately one quarter of positive HIV test reports with known gender, compared to 8.9 per cent during the period between 1985 and 1992. This pattern is seen in all age groups and most notably in the 15 to 29 and 30 to 39 age groups.

MSM continue to account for the largest number and proportion of positive HIV test reports. This proportion decreased from close to 75 per cent in the 1985-1994 period to 37 per cent in the mid- to late 1990s, but has increased to 44.4 per cent in the past three years. The diverse heterosexual exposure category has steadily increased from 7.5 per cent of new infections before 1995 to 36.9 per cent in 2003. This exposure category is made up of three subcategories: heterosexual contact with a person who is either HIV-infected or at increased risk of HIV, heterosexual as the only identified risk, or origin in a country where HIV is endemic. From 1998 to 2003, the proportion of positive HIV test reports attributed to the third subcategory increased from 2.9 per cent to 10.2 per cent.

CIDPC's new surveillance data also reveal that a total of 19 344 AIDS diagnoses in Canada had been reported to the end of 2003. The annual number of reported AIDS diagnoses (adjusted for reporting delays) increased throughout the 1980s and early 1990s, peaking at 1 953 in 1993, and has since declined to about 500 to 600 diagnoses per year. This pattern of declining AIDS diagnoses has been reported in other industrialized countries, including the United States, Australia and the United Kingdom. The decline has been largely attributed to the widespread use, beginning in 1996, of highly effective antiretroviral therapy among people infected with HIV; however, there is a growing concern that AIDS diagnoses are becoming increasingly under-reported.

The largest proportion of reported AIDS cases is among those aged 30 to 44 years (60.4 per cent), followed by the 45 to 59 (19.4 per cent) and 15 to 29 (15.9 per cent) year age groups. Over the past decade, the proportion of AIDS diagnoses among adult females has increased from 7.0 per cent in 1993 to 24.2 per cent in 2003 (among AIDS diagnoses with reported age and gender). In 2003, females represented 42 per cent of AIDS diagnoses among those aged 15 to 29 years, 25.4 per cent among those aged 30 to 44 years, and 18.2 per cent among 45 to 59 year olds. During the same period, the proportion of reported AIDS cases among MSM has declined from 73.8 per cent in 1993 to 35.3 per cent in 2003. AIDS diagnoses among the heterosexual exposure category increased from 13 per cent in 1993 to 43.8 per cent in 2003.

The proportion of reported AIDS cases attributed to White Canadians has been decreasing over time, from 86.8 per cent prior to 1993 to 54.3 per cent in 2003. Conversely, increases in reported AIDS diagnoses have been noted among both Black Canadians (rising from 8.4 per cent of cases in 1993 to 21.5 per cent in 2003) and Aboriginal Canadians (rising from 1.2 per cent of cases in 1993 to 13.4 per cent in 2003).

The rising proportion of positive HIV test reports among Aboriginal and Black Canadians, as well as among females in each age group (especially in the younger years), are important findings that have implications for prevention and treatment programs. Similarly, the increasing proportion of positive HIV test reports and AIDS diagnoses attributed to the heterosexual exposure category demands further analysis.

Enhanced Surveillance

UNAIDS, the WHO and other organizations have recently developed a new framework for HIV surveillance. Known as "second generation HIV surveillance," the framework emphasizes the need for individual countries to centre their surveillance resources on population groups where HIV infection is most likely to be concentrated. Consistent with this approach, CIDPC, in partnership with provincial, regional and local health authorities, researchers and other stakeholders, is implementing second generation surveillance systems for MSM and IDU populations. These new systems combine behavioural surveillance with biological surveillance in these groups by gathering information using repeated, cross-sectional studies to supplement routine HIV/AIDS surveillance. Phase I of a surveillance system for HIV- and hepatitis C-associated risk behaviours among IDUs has now been completed in Victoria, Sudbury and Toronto, is ongoing at sites in Quebec and Ottawa, and will soon be launched in Edmonton, Winnipeg and Regina. In the case of MSM, a surveillance system for risk behaviours associated with HIV, viral hepatitis and sexually transmitted infections (STIs) is being established in response to recent evidence suggesting that rates of STIs are increasing among this population group in certain parts of Canada. Phase I of the survey is expected to take place in Montréal starting in late 2004. These enhanced surveillance systems will provide critical information for planning and evaluating the response to HIV, viral hepatitis and STIs among IDUs and MSM. Used in combination with existing national surveillance data and national incidence and prevalence estimates, the behavioural trend data will also enhance CIDPC's monitoring of the course of the HIV and hepatitis C epidemics among these population groups.

In addition to this work in Canada, CIDPC is collaborating with the Ministry of Health in Bulgaria to develop second generation HIV/AIDS surveillance systems for IDUs, MSM and other at-risk communities in Bulgaria. CIDPC also continues to work with UNAIDS and the WHO on a variety of epidemiology and surveillance working groups and to offer technical advice in support of Health Canada's Partnership Agreement with UNAIDS.

As Canada and other countries increase the availability of HIV/AIDS drugs in support of the WHO's 3 by 5 Initiative, drug resistance will begin to emerge. Systems that are put in place to monitor and support patient treatment must also be able to monitor drug resistance. As part of this work, CIDPC is developing methodologies for time-sensitive analysis of blood samples for mutations associated with drug resistance from a single sample of dried blood that can be quickly collected, stored, shipped and analysed. Such a system would be of benefit not only for international shipments of blood samples but also for communities within Canada where physical distance is an ongoing challenge (for example, remote northern communities).

CIDPC is also partnering with other federal departments and public health organizations in a national, multi-centre, cross-sectional surveillance system that is examining rates of STIs, blood-borne pathogens and associated risk behaviours among Canadian street youth aged 15 to 24. The Enhanced Surveillance of Canadian Street Youth (ESCSY) surveillance system is the first of its kind in Canada and is generating data that will contribute to a better understanding of the issues facing this target population. In turn, ESCSY will support the development of more effective programs and services to help prevent the spread of infectious diseases, including HIV/AIDS, among Canadian street youth.

Understanding Issues of Co-Infection

As of December 1999, an estimated 11 194 HIV-positive individuals in Canada were also infected with hepatitis C.⁶ Understanding issues of co-infection is therefore an important goal of researchers in both fields.

The Public Health Agency of Canada's Hepatitis C Program, through a funding agreement with CIHR, continued to support epidemiological, clinical and biomedical research into HIV and hepatitis C co-infection in 2003-2004, with a particular emphasis on at-risk populations, such as IDU and prison inmates. To address the complexities involved in managing hepatitis C and co-infections such as HIV, the Hepatitis C Program partnered with other federal departments and NGOs representing medical and science specialists to host "Management of Viral Hepatitis: A Canadian Consensus Conference" in Ottawa in November 2003. The Hepatitis C Program also engaged at-risk youth by empowering them to coordinate a symposium on hepatitis C as an adjunct to the 2^nd Canadian Conference on Hepatitis C, held in Vancouver in March 2004. IDU was a prominent theme at the one-day symposium, which provided participants with opportunities to build prevention capacity, network with other youth from across Canada and share best practices. Also at the conference, issues of HIV and hepatitis C co-infection among inmates were discussed during a presentation by Correctional Service Canada on the prevention, care and treatment of hepatitis C in federal penitentiaries.

CTAC collaborated with local ASOs, hemophilia and hepatitis groups to organize community fora on HIV and hepatitis C co-infection in Toronto, Halifax, Vancouver and Montréal. These sessions explored barriers and solutions for co-infected people to improve their access to treatment and care. With funding support from CIDPC, CTAC also organized a national consensus-building meeting in Montréal in January 2004, bringing together physicians, researchers, community members, government and the pharmaceutical industry to discuss further research and clinical work on co-infection. The meeting resulted in the publication of a blueprint for future initiatives entitled Roadmap for Improving Access to Treatment and Care for Persons Co-infected with HIV/HCV.

Vaccine and Microbicide Development Continues

Vaccine development is a key focus of HIV/AIDS research. CANVAC, which brings together leading Canadian scientists specializing in the fields of immunology, virology and molecular biology, continues to work toward the development of an HIV vaccine. CANVAC spent approximately $1.2 million on HIV/AIDS projects in 2003-2004. It is one of 20 networks supported by the federal Networks of Centres of Excellence Program.

A team of researchers at the University of Manitoba has discovered that cytotoxic T cells (CTL) that are reactive to HIV are present in both the blood and genital mucosa of HIV-resistant women, supporting the belief that a mucosal-based vaccine is the best hope. The researchers have also discovered that CTL can be elicited by single or infrequent exposures to HIV, suggesting that a single- or low-dose vaccine that elicits CTL responses may be possible. In other research, the team has discovered that women who are resistant to HIV have unique types of human leukocyte antigens (HLA) that may allow them to better respond to HIV infection. Identifying HIV targets that are recognized by these HLA types may also help in vaccine development.

Researchers in Ottawa and Montréal are undertaking the first Canadian-led controlled trial of a therapeutic HIV vaccine (that is, a vaccine intended to n the first place). The trial, led by a researcher at the University of Ottawa, combines products from two companies, both of which have been shown in separate tests to more effectively induce different aspects of the immune response.

CIDA invested $15 million in vaccine research in 2003-2004 as part of a three-year, $45 million commitment to IAVI announced at the G8 Summit in Kananaskis, Alberta, in June 2002. This contribution makes Canada the largest government donor to IAVI. Canada is also contributing $5 million to the African AIDS Vaccine Programme, for a total commitment to international vaccine development of $50 million over three years.

In addition to vaccines, microbicides may offer another effective method of preventing HIV infection in the future. Research on microbicide development is currently under way in Canada. A researcher at Université Laval, with support from CIHR's Randomized Controlled Trials Program, is testing the safety and acceptability of a vaginal gel containing the microbicide sodium lauryl sulfate. The product is being tested on healthy young African women in Cameroon. If proven effective, the gel may provide a new method of HIV/AIDS prevention that can be controlled by those who need it most.

Challenges and Opportunities

In the face of an exploding global epidemic and ever-changing and growing challenges on the domestic front, research continues to offer hope of a vaccine to prevent the spread of HIV and a cure for AIDS. While Canadian spending on HIV/AIDS research reached new levels in 2003-2004, additional resources - human and financial - are needed to continue to expand the scope and breadth of study in the biomedical, clinical and social science fields. Enhanced surveillance efforts are also called for to support properly targeted and effective prevention programming. For many CSHA partners and stakeholders, the challenge of translating research into practice remains key. CSHA partners will pursue innovative surveillance, research and knowledge transfer activities to overcome these challenges.

Community-Based Social Marketing Campaign Challenges Assumptions

After several years of declining numbers, HIV infection rates are on the rise among gay men in Canada.⁷ Evidence also suggests that an increase in risky sexual behaviours is the cause.

AIDS Vancouver is one of many organizations that has paid heed to the epidemiological data. In response to a request for proposals from the National HIV/AIDS Community-based Social Marketing Fund, the Vancouver AIDS service organization (ASO) successfully applied for funding for a social marketing campaign targeted at gay men. Early results from the campaign are challenging the notion that gay men are no longer receptive to HIV prevention messages.

"We are still tabulating data from Phase I of the campaign, but the importance gay men have attributed to this type of campaign appears to be quite high," notes Phillip Banks of AIDS Vancouver. "There is a lot of support among respondents for this type of initiative."

"Assumptions - How do you know what you know?" is encouraging gay men to challenge their assumptions about the HIV status of their partners, with the goal of reducing the incidence of risky sexual behaviour between gay men who do not have the same HIV status. Launched in June 2004 under the direction of a national advisory committee that includes community-based ASOs from across Canada, Phase I of the three-year campaign is using materials adapted from a similar initiative in San Francisco.

"The recall rate for the campaign was pretty high - more than 70 per cent, based on our preliminary survey data," reports Mr. Banks. "Gay men could remember seeing campaign materials, and many have said it made them think about their behaviour."

Phase I of the Assumptions campaign brought the complex issues of sexual assumptions and sexual silence into the open using billboards, posters, postcards, public service announcements, a web site, chat lines and a multi-channelled advertising and public relations campaign delivered through community press and local venues, such as bars, bathhouses, clubs, community centres and campuses.

Initially intended to target six major urban centres - Vancouver, Edmonton, Winnipeg, Toronto, Montréal and Halifax - the campaign in fact reached a much broader audience across Canada, thanks to the national advisory committee's ability to leverage funding from other organizations. For example, the Ontario Ministry of Health and Long-Term Care provided funding to expand the Assumptions campaign to 16 other cities in Ontario. Support from Quebec's Ministry of Health and Social Services allowed the campaign to be delivered in Québec City as well as Montréal. In British Columbia, the Coastal Health Authority and the British Columbia Centre for Disease Control provided funding that enabled expansion of the program to other communities.

AIDS Vancouver is now analysing data collected through various response mechanisms. It will then work with the national advisory committee and public relations consultants to develop Phase II - a new campaign, with new messages and materials - for delivery in the summer of 2005. In the meantime, the Assumptions campaign web site will remain on-line to provide prevention messages and information to gay men across Canada.

After collecting additional qualitative and quantitative data from Phase II, AIDS Vancouver will undertake a comprehensive evaluation of the campaign and report on the extent to which gay men were exposed to and affected by its messages. Lessons learned and best practices from the campaign will also be documented and shared with stakeholders.

"There's no doubt that Phase I of the campaign built momentum as it went along," concludes Mr. Banks. "With a small investment, our funding partners were able to become part of quite a large campaign. And the advice and direction we received from other community-based ASOs has been vital. We still have a lot of work to do, but the results to date have been very encouraging."

Members of the national advisory committee include the AIDS Coalition of Nova Scotia, Action Séro Zéro, AIDS Community Care Montreal, the AIDS Committee of Toronto, Two Spirited People of the First Nations, the Nine Circles Community Health Centre, HIV Edmonton, the Asian Society for the Intervention of AIDS, CAS and the British Columbia Community-Based Research Centre. More information on the Assumptions campaign is available at http://www.think-again.ca .

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