Canada's Report on HIV/AIDS 2005

Previous | Table of Contents | Next

Strengthening the Federal Response

The Government of Canada's renewed response to HIV/AIDS will be marked by improved federal coordination and coherence, increased interdepartmental and intergovernmental collaboration, and greater integration of HIV/AIDS with the work of other federal departments and agencies. At the same time, Canada will strive to fulfill its international obligations by working with a range of partners to meet the commitments set out in the UNGASS Declaration of Commitment on HIV/AIDS.

Strengthening Federal Coherence and Collaboration

Increased government collaboration at all levels - federal, provincial/territorial and municipal - is a key element of the Federal Initiative. At the same time, the Federal Initiative aims to engage a broader range of federal departments and agencies in the Canadian response, particularly those that have mandates related to immigration, housing, disability, social justice, employment and other determinants of health.

To achieve greater coherence, complementarity and collaboration across the spectrum of federal HIV/AIDS policy and programming, on World AIDS Day 2004 the Minister of Health announced the creation of an interdepartmental committee comprising assistant deputy ministers of 14 federal departments and agencies with mandates that have an impact on or are related to Canada's HIV/AIDS response. Chaired by PHAC, the Government of Canada Assistant Deputy Minister (ADM) Committee on HIV/AIDS will promote linkages and alignment of policies and programs, particularly as they relate to determinants of health issues such as employment and affordable housing. As an initial step toward developing an integrated approach to addressing the epidemic, the committee has begun to formulate a government-wide position statement on HIV/AIDS, which it expects to release by the summer of 2006.

Interdepartmental discussions are also taking place to identify specific areas for collaboration on issues related to HIV/AIDS. For example, PHAC is undertaking a gender-based analysis of the priority populations identified in the Federal Initiative, with support from Health Canada's Bureau of Women's Health and Gender Analysis. As well, PHAC officials were invited to make a presentation on the Federal Initiative to regional staff of Human Resources and Skills Development Canada in June 2005.

Strengthened federal coordination and collaboration is also evident in the planning that is under way for the XVI International AIDS Conference in Toronto in August 2006. Fourteen departments and agencies are engaged in conference planning through the Federal AIDS 2006 Secretariat (see feature on page 8), which is working closely with the conference organizers, other levels of government and other organizations that have a role to play in making this pre-eminent international AIDS event a success.

Advisory Committees Provide Input and Guidance

The Government of Canada continues to look to national advisory groups for input and direction on HIV/AIDS policy and programming.

They include the Ministerial Council on HIV/AIDS, which provides advice on HIV/AIDS directly to the federal Minister of Health. Among the issues raised by the Ministerial Council in 2004-2005 was the importance of making progress in addressing HIV/AIDS in prisons, including the introduction of a needle exchange program. As well, the Ministerial Council stressed the need to maintain the social justice and determinants-of-health frameworks in all approaches to HIV/AIDS. On the issue of HIV screening for pregnant women, the Ministerial Council expressed its concern about the position adopted by the Canadian Medical Association that all pregnant women should be routinely tested for HIV. Council strongly recommended to the Minister that he champion with the Canadian Medical Association and his provincial counterparts optional testing in all provinces, based on informed consent following pre-test counselling. The Ministerial Council also supported a renewed emphasis on HIV prevention and care for gay men, called for better education in schools on sexual health and sexually transmitted infections (STIs), and met with officials of Citizenship and Immigration Canada to discuss concerns related to the HIV testing of potential immigrants.

The Federal/Provincial/Territorial Advisory Committee on AIDS (FPT AIDS), which advises the Conference of Deputy Ministers of Health, also had a busy year in 2004-2005. In March 2005, FPT AIDS published an article entitled «Persons who fail to disclose their HIV/AIDS status: Conclusions reached by an Expert Working Group» in the Canadian Communicable Disease Report. ⁷ The article focussed on issues around disclosure of HIV status and public health and endorsed a framework developed by the Calgary Health Region for persons who are unwilling or unable to disclose their status, subject to certain recommendations. As well, an FPT AIDS Working Group on Surveillance developed a plan to enhance the role of surveillance and targeted epidemiological studies in improving the understanding of and response to HIV/AIDS in Canada. FPT AIDS also completed a paper that examines the HIV/AIDS epidemic in different Canadian jurisdictions from the perspective of provincial/territorial governments and key stakeholders. The paper summarizes the different jurisdictions' responses to the disease, analyses current issues of concern, and identifies means for a strengthened response. Work was also initiated on a federal/provincial/territorial consensus statement on HIV/AIDS, which will articulate a common policy platform to advance and strengthen Canada's intergovernmental approaches to HIV/AIDS.

The FPT Heads of Corrections Working Group on Health, a subcommittee of the FPT Heads of Corrections, has a mandate to promote policy and program development that is informed and sensitive to the complex issues surrounding the health of inmates and to advise the FPT Heads of Corrections on trends and best practices as they relate to health in a correctional setting. The Working Group on Health meets twice yearly and is co-chaired by CSC and a provincial corrections representative. At a joint meeting with FPT AIDS in February 2005, it was agreed that FPT AIDS members would visit correctional facilities in order to more fully understand the context in which correctional health personnel work and the environment in which care and programs are provided. The visits took place in October 2005.

The CIHR HIV/AIDS Research Advisory Committee (CHARAC) acts as a voice for those involved in HIV/AIDS research in Canada. Made up of researchers and community representatives, CHARAC makes recommendations to the Institute of Infection and Immunity and to CIHR's Research Priorities and Planning Committee on research priorities for HIV/AIDS. It also informs the CIHR Institute of Infection and Immunity Advisory Board of strategic initiatives in HIV/AIDS research. CHARAC met three times in 2004-2005 to discuss the current state of HIV/AIDS research and identified a number of areas where further work is required, including combining training awards with research grant funding to build capacity; establishing programs for health services and population health researchers specializing in HIV; creating programs to address existing gaps in HIV research; and strengthening prevention technology research. Based on advice and input from a small group of researchers in the areas of health services and population health, CHARAC further refined these key areas and provided valuable input for requests for applications for HIV/AIDS research launched in June 2005. Also in 2004 -2005, CHARAC met with the International Partnership for Microbicides to explore possible areas of collaboration.

Engaging in the Global Response

The Federal Initiative calls for a strong, coherent health sector response as part of Canada's contribution to global efforts to address HIV/AIDS. As well, the new International Policy Statement outlines Canada's commitment to help countries improve health outcomes, particularly among the poorest, by:

• focussing on high-burden, communicable, poverty-linked diseases, especially HIV/AIDS
• strengthening health systems and capacity building in developing countries as part of the global response to the epidemic
• supporting research and development, including the development of an HIV/AIDS vaccine

Through the Global Engagement Component of the Federal Initiative, Health Canada's International Affairs Directorate (IAD) leads a number of international initiatives, including convening the Consultative Group on Global HIV/AIDS Issues, a regular forum for consultation and discussion on the international HIV/AIDS activities of federal departments and civil society. Participants in the group include Health Canada, PHAC, CIHR, CIDA, Foreign Affairs Canada, the Canadian AIDS Society (CAS), the Canadian HIV/AIDS Legal Network, the Canadian Public Health Association (CPHA), the Interagency Coalition on AIDS and Development (ICAD), the International Council of AIDS Service Organizations and the Canadian Association for HIV Research (CAHR). A representative of the Ministerial Council on HIV/AIDS also attends the group's meetings.

The Consultative Group met on a quarterly basis throughout 2004-2005, 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. For example, input was provided on Foreign Affairs Canada's strategic plan on HIV/AIDS (see page 14) and on meetings of the board of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Consultative Group also contributed to the development of the UNAIDS Policy Position Paper: Intensifying HIV Prevention, which was endorsed in June 2005 by the UNAIDS Programme Coordinating Board. As chair of the Programme Coordinating Board from June 2004 to June 2005, Canada played a key role in the development of this document and worked to ensure that it reflected the importance of a human rights approach to HIV prevention.

In October 2005, the 3 ^rd International Policy Dialogue on HIV/AIDS was held in Toronto. The Dialogue, which focussed on the issue of HIV/AIDS in prisons, was co-sponsored by the Government of Canada, UNAIDS, the United Nations Office on Drugs and Crime, and the Open Society Institute. Participants included national policy makers and senior officials from prison authorities and public health programs in approximately 11 countries, as well as academic experts. New international policy guidelines were used to stimulate the discussion and development of effective policy and legislation to address HIV/AIDS prevention, care, treatment and support in prison. As well, the Dialogue provided an important opportunity for participants to share information, ideas and experiences and to develop relationships that will strengthen domestic and global responses to the epidemic.

In 2004-2005, Canada continued to work with the global community to ensure that the goals set out in the UNGASS Declaration of Commitment were met. The Canadian delegation to UNAIDS, which was led by CIDA, included representation from Foreign Affairs Canada, Health Canada, the Public Health Agency of Canada and civil society. They worked closely together to ensure consistent, coordinated Canadian representation on this important body. As well, Canada continued to occupy a seat on the board of the Global Fund to Fight AIDS, Tuberculosis and Malaria, representing a constituency comprising Canada, the United Kingdom, Germany, Australia and Switzerland. (In September 2005, as a result of increased levels of funding, this constituency was split. Canada, Germany and Switzerland now share a seat). Various federal departments and agencies also collaborated to present uniform Canadian positions at UN commissions, the World Health Assembly, the G8 and other international fora.

The Jean Chrétien Pledge to Africa Act, and its accompanying regulations, came into force on May 14, 2005, making Canada one of the first G8 countries to implement the World Trade Organization's General Council Decision of August 30, 2003, which allows access to lower-cost versions of patented medicines to least-developed and developing countries unable to manufacture their own. The act amends Canada's Patent Act and the Food and Drugs Act to facilitate access to less expensive medicines by developing countries to assist them in combatting public health problems, especially those resulting from HIV/AIDS, tuberculosis, malaria and other epidemics. With the Access to Medicines Program now fully operational, the Government of Canada is relying on the participation of Canadian NGOs and the pharmaceutical industry to avail themselves of this regime.

Through IAD's International Health Grants Program, the Canadian HIV/AIDS Legal Network received funding to develop model legislation in two areas: law related to drug policies that enable harm reduction services and are respectful of the rights of injection drug users, and secondly, a legal framework for respecting, protecting and fulfilling women's rights within the context of HIV/AIDS. Work is ongoing on both legal frameworks, which will eventually serve as a resource for legislators and civil society organizations in developing countries and countries in transition. IAD also supported further work by ICAD and CAS to develop and market the Canadian HIV/AIDS Skills Database (www.skillsforhivaids.ca), an online resource that profiles and promotes the skills, expertise and experience Canadian organizations can bring to the international struggle against HIV/AIDS. A recent addition to the database Web site is the «newsflash,» which provides ongoing information about international development and HIV/AIDS opportunities and calls for proposals.

In April 2005, IAD established a new small-grants mechanism - the HIV/AIDS Global Engagement Grants - to support activities that will increase Canada's contribution at the global level and promote knowledge transfer between the domestic and global responses. In the program's first year of operation, grants were awarded for several projects. These included seminars to be organized by the Canada-Africa Community Health Alliance with a partner in Tanzania to highlight the impact of gender and poverty on HIV/AIDS and the importance of collaboration to the global response. Funding was also awarded to The Teresa Group to support the development of a global coalition of organizations working with AIDS-affected children. Both projects are helping to increase the engagement of Canadians and others in the global HIV/AIDS response.

Foreign Affairs Canada has developed a strategy to effectively address the foreign policy dimensions of HIV/AIDS, including such issues as human security, human rights, multilateral and bilateral advocacy, workplace guidelines and complex humanitarian emergencies. The strategy takes into consideration the recommendations provided to the Minister of Foreign Affairs by the Ministerial Council on HIV/AIDS in a 2003 paper entitled Meeting the Challenge: Canada's Foreign Policy on HIV/AIDS With a Particular Focus on Africa.

Since 2000, CIDA has contributed close to $600 million to the global effort to address HIV/AIDS, including:

• $100 million to the WHO to support the 3 by 5 Initiative
• more than $525 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria
• $67.4 million to the United Nations Population Fund (this funding includes $58.4 million to the Fund's ongoing work in the area of sexual and reproductive health and HIV/AIDS among women and girls, and $9 million to help improve the distribution of reproductive health supplies)
• $15 million to the International Partnership for Microbicides as a support to innovative approaches that protect women and girls from HIV with measures they themselves can control
• $45 million to the International AIDS Vaccine Initiative (IAVI) to help in the development of AIDS vaccines

Canada continued to host visitors from organizations involved in the global response to HIV/AIDS. In 2004-2005, visits were made by Dr. J.W. Lee, Director General of the WHO; Dr. Richard Feachem, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria; and representatives of UNAIDS, the International Partnership for Microbicides and Foster Parents Plan in West Africa, among others. The visits provided opportunities to inform Canadian officials of the work of these organizations and to identify opportunities for increased collaboration on global health issues.

Canadian organizations also supported the building of global capacity to address the HIV/AIDS epidemic in 2004-2005. For example:

• PHAC has become globally recognized as a location of choice for international training on HIV testing methodologies. In 2004-2005, training was provided to scientists from Pakistan, Kosovo, Haiti, Russia, China, the Republic of the Ivory Coast, Ethiopia, South Africa, Sudan, Mozambique, Morocco, Zimbabwe, the Caribbean, and Mexico. PHAC provides this training through partnerships with organizations such as WHO, UNAIDS and Doctors Without Borders.
• PHAC's International Quality Assurance Program continued to assist resource-poor countries in monitoring the effectiveness of antiretroviral treatments. Two to three times a year, panels of stabilized whole blood are sent to approximately 300 laboratories in 60 to 70 countries, where CD4 lymphocytes are enumerated and the results sent back to Canada via the Internet. PHAC assesses the accuracy of the results submitted by each laboratory and provides feedback as required. This program helps to ensure that individuals on antiretroviral therapy in developing countries are receiving care and treatment comparable to the levels provided in developed countries.
• Funding from CIDA's Youth Employment Initiative enabled ICAD to sponsor five interns in 2004-2005 who linked organizations in Canada and overseas by serving work terms with both organizations. An HIV/AIDS epidemiologist worked with an organization in Kenya and with ICAD; an HIV/AIDS research assistant worked with an organization in India and with The Teresa Group in Canada; a human rights worker was co-hosted by an organization in Zambia and AIDS Calgary; an intern worked with the AIDS Orphans Project in Tanzania and with the Canada Africa Community Health Alliance and the University of Ottawa in Canada; and a project coordinator in Gabon was co-hosted by the Canada Africa Community Health Alliance and the University of Ottawa.

Future Directions

The Government of Canada has taken the initial steps towards strengthening its involvement in the HIV/AIDS response by focussing more strategically on areas of federal responsibility, becoming more efficient and better connected internally, and promoting greater collaboration with provincial/territorial governments and civil society. In the months and years ahead, the federal government will continue to reach out to others, in Canada and globally, to engage organizations not traditionally involved in HIV/AIDS, maximize its investments, and move towards a comprehensive and integrated Government of Canada response. It will also ensure that the domestic response continues to be evidence-based and grounded in the principles of human rights and will work to see that this approach is also reflected in the global response.

Previous | Table of Contents | Next

---

7 Canadian Communicable Disease Report, Volume 31-05, March 1, 2005.