Canada's Report on HIV/AIDS 2005

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Strengthening The Foundation

Canada's HIV/AIDS response has many aspects. Through research into the physical, psychological and societal impacts of this devastating disease, Canada is making important contributions to the world's understanding of HIV/AIDS. As well, basic biomedical research being conducted in Canada is improving our understanding of the evolving virus. Canadian organizations are also contributing to the development and dissemination of reliable, up-to-date information on HIV/AIDS and to addressing the stigma and discrimination that are root causes of the epidemic.

Advancing the Science of HIV/AIDS

In 2004-2005, CIHR administered $13.025 million in research grants and personnel awards on behalf of the Federal Initiative to Address HIV/AIDS in Canada (compared to $12.025 million under the CSHA). As shown in Table 3, this funding was disbursed across four major research themes: biomedical and clinical research; health services and population health research; clinical trials; and community-based research. In addition to these funds, CIHR committed almost $8.5 million from its own budget in 2004-2005 for direct HIV/AIDS research, as well as more than $6.75 million for indirect HIV/AIDS research (projects whose focus on HIV is less than 50 per cent). Federal Initiative funding for HIV/AIDS research will increase to $22.575 million annually in 2008-2009 and beyond.

Table 3: Federal HIV/AIDS Extramural Research Funding 2004-2005

Research Funding Stream	Funding
Biomedical/Clinical	$ 4,630,000
Health Services/Population Health	$ 2,440,000
Canadian HIV Trials Network	$ 4,097,500
Community-Based Research	$ 1,857,500
Federal Initiative Total	$ 13,025,000
CIHR Commitment	$ 8,449,000
Total Federal Investment in HIV/AIDS Research*	$ 21,474,000
* For the purposes of reporting, the $6.75 million in indirect HIV/AIDS research funded by CIHR is not included in the total.

CIHR provides funding for both investigator-initiated and more strategically directed research in HIV/AIDS.

In 2004-2005, 14 new HIV/AIDS projects were funded through regular competitions, bringing the total number of funded projects to 88. These competitions are open to health researchers in all domains, and the success of HIV/AIDS researchers within this large pool of applicants is a testament to Canada's strong and growing HIV/AIDS research capacity. CIHR also continued to support the training of junior scientists by offering training awards to 10 individuals (master's students, doctoral students and research fellows) studying in the field of HIV/AIDS. Three new salary awards were approved to allow scientists already working in this area to dedicate more of their time to research projects. This brings the total numbers of training or salary awards offered to HIV/AIDS researchers to 50.

In addition to these investigator-initiated efforts, CIHR approved funding under the Federal Initiative for strategically defined projects. Three projects were approved for funding under the Institute of Infection and Immunity Social and Behavioural Research Issues in HIV/AIDS and Hepatitis C strategic initiative. These grants are supporting new or existing groups to conduct multidisciplinary research in this area and to build capacity or add expertise to their core capabilities. Other strategic areas targeted for support include research in preventative interventions such as microbicides and vaccines and in Aboriginal health. CIHR also provided core funding of $4.097 million from the Federal Initiative in 2004-2005 for the CTN (see page 20).

With funding from the Federal Initiative and other sources, Canadian scientists continue to contribute substantial new knowledge to the fight against HIV/AIDS. Some of the latest findings were showcased at the 14th Annual Canadian Conference on HIV/AIDS. Organized by CAHR, the May 2005 threeday conference in Vancouver attracted more than 650 researchers and other stakeholders from across Canada. Abstracts of the 280 oral and poster presentations made at the conference were published in the Canadian Journal of Infectious Diseases (Volume 16, Supplement A, May/June 2005).

CAHR continued to attract and mentor new investigators to build Canada's HIV research capacity. In 2005, CAHR gave four New Investigator Awards to promising researchers. CAHR also awarded its Red Ribbon Award for outstanding service to the cause of research in Canada that will lead to increased understanding of the treatment and prevention of HIV/AIDS while enhancing the quality of life of those living with HIV.

Vaccines and Microbicides

CIHR has identified vaccines and microbicides as priority areas of research and has actively sought applications for both projects and personnel awards in this area. Examples of CIHR-supported research in 2004-2005 include:

• A researcher at the University of Toronto is using state-of-the-art techniques in immunology and virology to design a new, improved version of an HIV vaccine made from the canarypox virus. Although the current vaccine has been shown to be safe in humans, it does not create strong immune responses in vaccinated persons. If testing of the new vaccine in mice and monkeys shows promising results, it will move on to clinical testing in humans.
• A second research team at the University of Toronto is studying ways to prevent Black women from being left out of HIV vaccine strategies that may be available to the public within the next decade. Black women are commonly left out of research that could help decrease their vulnerability to infection and disease, and tend to be one of the last groups to gain from health care innovations.
• A researcher at the University of Manitoba is studying the immune systems of individuals who have been infected with HIV for years yet remain healthy. Specifically, the project is examining the antibody IgG1 b12 to determine whether it is capable of inhibiting HIV infection in mammals.
• In the field of microbicide development, a researcher at Université Laval is studying the safety, tolerance and acceptability of a vaginal gel containing sodium lauryl sulfate (invisible condom) among healthy women in Cameroon, Kenya, Benin and South Africa.

Work progressed during 2004-2005 on a national strategy to intensify the development of HIV vaccines and to plan for their effective and equitable distribution in Canada. The Canadian HIV Vaccines Plan is being developed by a steering committee comprising a person living with HIV/AIDS and representatives of CAS, the research community, IAVI and the Public Health Agency of Canada. A draft document is currently being updated in consultation with experts in the field.

In June 2004, Canada and other G8 nations endorsed the creation of the Global HIV/AIDS Vaccine Enterprise. Proposed by an international group of scientists to accelerate global efforts to develop a safe and effective HIV vaccine, the Vaccine Enterprise is an international alliance of independent agencies and organizations conducting or supporting HIV vaccine research. The Global HIV/AIDS Vaccine Enterprise Scientific Strategic Plan, developed and published in 2005, identifies major scientific roadblocks facing HIV/AIDS vaccine development, outlines a strategic approach to addressing them, and proposes a collaborative model to ensure that researchers around the world are harnessing their efforts towards a common goal. The Government of Canada is exploring how it will support the Vaccine Enterprise beyond its current activities of funding HIV vaccine research and supporting the development of the Canadian HIV Vaccines Plan.

Work is also under way to develop an action plan outlining Canada's role in microbicide development and access, both domestically and internationally. The proposal for such a plan arose at the 2nd Canadian Microbicides Symposium: Advancing HIV Prevention, held in Ottawa in March 2005. Organized by ICAD, CAS and other stakeholders, the symposium attracted participants from the research community, private sector firms, government and community organizations. Its goals were to build commitment for multi-sectoral Canadian contributions to microbicides and to provide opportunities for networking and collaboration. A committee led by a representative from CAS and including representatives from government, NGOs and the research community, has been formed to develop the action plan.

On World AIDS Day 2004, the Government of Canada announced a contribution of $15 million over three years to the International Partnership for Microbicides to develop a female-controlled method of protection against HIV/AIDS. The announcement was part of a $105 million package of initiatives targeting women and girls infected with or affected by HIV/AIDS in developing countries.

Surveillance of HIV Strains and Drug Resistance

PHAC has also been conducting surveillance of HIV strains and drug resistance in Canada (this information is important for assessing the usefulness of potential HIV vaccines, which will likely be strain-specific). While HIV-1 subtype B continues to be the predominant HIV strain in Canada, data published by PHAC in May 2005 indicate that 10.1 per cent of the sampled population of 2 152 individuals were infected with non-B subtypes. Significantly higher proportions of non-B subtype infections were detected among females (compared with males), among those who were older at initial diagnosis, among African/Caribbean or mixed ethnicities (compared with Caucasians) and among those reporting heterosexual sex as their primary risk factor (compared with MSM). The data also reveal that primary drug resistance to at least one antiretroviral drug was identified in 8.6 per cent of the sample population of 1 738 newly diagnosed individuals who had never received treatment (this is similar to the rates of primary drug resistance observed in other countries where highly active antiretroviral treatment is widely used). Multi-drug resistance was identified in 1.3 per cent of the sample population.

Addressing Stigma and Discrimination

In January 2005, the Canadian HIV/AIDS Legal Network launched A Plan of Action for Canada to reduce HIV/AIDS-related stigma and discrimination. The plan highlights the responsibility of governments at all levels to lead both by example and by rigorously applying anti-discrimination laws and measures to reduce stigma. Endorsed by the Canadian Labour Congress, the United Church of Canada, CAS and other national organizations, the plan was accompanied by a letter-writing campaign to help put the issue before policy makers. The plan calls for the meaningful participation of people living with and vulnerable to HIV/AIDS in developing public policy that concerns them; greater support by government leaders at all levels for the rights of people living with and vulnerable to HIV/AIDS; more active and creative work with the media to improve its coverage of HIV/AIDS-related issues; support for peer-based programs; and the strengthening of human rights mechanisms in Canada.

CPHA has entered the third year of its highly successful social marketing campaign, aimed at breaking down the stigma and discrimination faced by all Canadians currently living with or affected by HIV/AIDS. For the 2005 campaign, CPHA has produced resources that are meant to support communities in their efforts to «Change the World!» by encouraging people to join the fight against human rights violations and to use safer sex practices. As in previous years, CPHA expects to receive more than 1 000 orders for campaign materials and will distribute more than 600 000 campaign items to community organizations and schools across the country.

CAAN is collaborating with a researcher at the University of Alberta to examine the influence of stigma on access to health services by people living with HIV/AIDS. The project, which is funded by CIHR, involves research in Edmonton and Ottawa to explore the experiences of both Aboriginal and non-Aboriginal people living with HIV/AIDS, with the goal of identifying areas of similarities and differences between the two groups. It also aims to identify organizational policies that contribute to or reinforce stigmatizing practices. In addition to interviews with people living with HIV/AIDS, the project involves focus groups and in-depth interviews with physicians, nurses, social workers, psychologists and community workers.

Skills Building Symposium

The 5^th Canadian HIV/AIDS Skills Building Symposium was held in Montréal in October 2005. Participants from across Canada - representing AIDS service organizations, members of the public and governments - attended the interactive event. Skills 2005 featured more than 80 workshops, 20 poster sessions, two days of satellite sessions and six panels, which featured best-practice models and wide-ranging discussion on critical issues in HIV/AIDS work in Canada today. Skills training and networking opportunities were provided in eight learning tracks: prevention; care/counselling/ support; treatment; human rights, law, policy and advocacy; organizational and community development; community-based research; international action; and rehabilitation. Skills 2005 also included the Youth Institute, which brought together youth (29 years old and under) and youth workers to build skills and share experiences related to HIV/AIDS.

WALK FOR LIFE

On September 8, 2005, comedian Rick Mercer launched the 2005 WALK FOR LIFE at Ottawa's City Hall. WALK FOR LIFE is Canada's largest single event for raising awareness and funds for HIV/AIDS. Approximately 40 000 Canadians in 130 communities participated in this year's event, which raised $2 million to assist local AIDS service organizations in every province and territory.

Held each fall, WALK FOR LIFE is coordinated nationally by CAS and funded entirely by the private sector.

Information Development and Dissemination

The development and dissemination of reliable information that improves the lives of individuals and strengthens Canada's response to HIV/AIDS continues to be a core activity of all organizations that receive funding under the Federal Initiative.

The Canadian HIV/AIDS Information Centre, a program of the CPHA, is Canada's largest distributor of free HIV/AIDS materials, with a client base that includes community-based organizations, the education sector, health intermediaries, federal/provincial/territorial governments, other NGOs, and the general public. As a distribution point for HIV/AIDS pamphlets, brochures, manuals, posters and videos developed by more than 60 partner organizations across Canada, the Centre responded to over 11 000 requests for information and shipped almost 800 000 items in 2004-2005. The Centre's library boasts a collection of more than 20 000 titles and responds to several hundred reference requests each year. Visits to the Centre's Web site more than doubled during the year, reaching over 600 000 «hits,» including repeat visits by more than 40 000 individuals and organizations.

In response to needs identified through its annual client survey, the Information Centre developed three new resources: a booklet entitled Talking to Kids about HIV/AIDS; a pamphlet for women entitled Sex toy stories: A user's guide to HIV and STI prevention; and a very popular novelette entitled In my quiet space: A based-on-reality fiction about HIV transmission and discrimination. All three resources are available in both English and French.

Responding to the trend towards increased use of the Internet as a source of information, CATIE expanded the services available through its site and launched several new Web-based information programs. Catie.ca/nurses was developed in partnership with the Canadian Association of Nurses in AIDS Care is a site for connecting potential volunteers across Canada with AIDS service organizations; and Languages.catie.ca is a multilingual treatment information site. CATIE also continues to host a vibrant Web site for youth (www.livepositive.ca).

Other national organizations are also engaged in developing and disseminating HIV/AIDS knowledge and information. For example, using the latest data available from UNAIDS, ICAD issued new or updated regional overviews of the HIV/AIDS epidemic. ICAD also developed a fact sheet that examines the vulnerability of migratory populations to HIV/AIDS and the challenges inherent in delivering services and programs to migratory groups. As well, ICAD collaborated with the School of Health and Human Performance at Dalhousie University, the Southern African AIDS Trust and CHF-Partners in Rural Development to develop Guidelines for Incorporating HIV/AIDS and Gender Considerations into Agricultural Programming. ICAD staff and representatives of 20 NGOs subsequently received training on the guidelines.

CAS updated the document HIV/AIDS Transmission Guidelines to reflect changes in HIV/AIDS treatment, prevention and care, and to include new information about sexually transmitted infections and HIV/hepatitis C co-infections. A CD-ROM version of the guidelines and a pamphlet on HIV and hepatitis C prevention were also produced and distributed.

CTAC published and began to distribute the final report from its community-based research study on Post-Approval Surveillance, which identified methods for successfully collecting adverse event information directly from people living with HIV/AIDS and confirmed the need for a national, consumer-centred active post-approval surveillance system for HIV/AIDS drugs. Abstracts were presented at a number of conferences. CTAC's partners in this project were Voices of Positive Women, the British Columbia Persons With AIDS Society, the Comité des Personnes atteintes du VIH du Québec and CAAN.

In October 2004, the Canadian HIV/AIDS Legal Network published a report on the operation of prison-based needle exchanges in Spain, Germany, Switzerland, Moldova, Belarus and Kyrgyzstan. The report concluded that needle exchanges are an extremely effective HIV prevention measure among incarcerated populations and recommended that federal and provincial/territorial correctional services in Canada immediately implement multi-site pilot needle exchange programs.

With financial support from UNAIDS, the Legal Network has developed two tools that will ensure that information on experiences with HIV/AIDS-related legal and human rights issues is available to people who need it. The first is a searchable CD-ROM containing almost 1 000 documents in four languages (English, French, Spanish and Russian), including monographs, legal decisions and advocacy papers that can be searched by key word, topic, country or document type. The second tool is an analysis of 30 court cases related to HIV/AIDS from 16 countries. The collection focusses on three substantive areas: discrimination, access to treatment and prisoners' rights. With the help of UNAIDS' global network, both tools will be widely disseminated to legal and human rights groups, legal professionals, law schools and other interested parties.

The Canadian HIV/AIDS Legal Network has also developed a series of information sheets to guide communities that may find themselves part of vaccine trials or that want to ensure that they benefit from vaccines when they are available. The information sheets, which were developed with funding from WHO, UNAIDS and IAVI, will be translated and widely disseminated in the coming year. CATIE's Treatment Information Network - a group of approximately 30 treatment information providers from across Canada, many of whom are living with HIV/AIDS - has developed an action plan to encourage and facilitate increased collaboration, with the goal of strengthening Canada's HIV treatment network. During 2004-2005, action groups were created to move forward in four key areas identified in the action plan: partnerships and collaboration, social marketing, treatment publications and volunteer treatment information training. CATIE has also developed an online Treatment Information Network discussion group to facilitate communication and the sharing of resources among members of the Network. As a result, agencies have begun to share their training resources online. CATIE also held a two-day satellite session prior to the 5th Canadian Skills Building Symposium in October 2005 to plan a national training session for treatment information providers.

ICAD and CAS completed development of a toolkit to enhance the capacity of community-based AIDS service organizations to integrate international perspectives in their work. The toolkit is available in both official languages and can be downloaded from the CAS Web site. The two organizations also co-hosted a three-day «train the trainers» workshop on the toolkit in February 2005.

Future Directions

The Federal Initiative is building on the success of the CSHA and previous strategies to continue to strengthen the foundation of Canada's HIV/AIDS response. As part of this effort, federal investments in HIV/AIDS-related social, behavioural, biomedical and clinical research will continue to grow under the Federal Initiative. As well, support will be provided to federal departments and agencies and nongovernmental stakeholders to ensure that HIV/AIDS prevention, care, treatment, support and rehabilitation information is widely available to those who need it, across Canada and throughout the world. The federal government will also strengthen reporting under the Federal Initiative by building its capacity to measure performance, including the gathering of quantitative data from funded projects to complement narrative reports and epidemiological information.

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