Federal/Provincial/Territorial Advisory Committee on AIDS

2006 - 2009 Strategic Plan

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Environmental Scan: Challenges

Crafting strategic policy is an ongoing and dynamic enterprise. (For this reason, the F/P/T AIDS meets three times per year at face-to-face meetings and monthly by teleconference, to both execute and reflect upon its strategy). The capacity to be strategic rests in the ongoing ability of F/P/T AIDS to recognize emerging trends and the opportunities and challenges they present.

The challenges identified by F/P/T AIDS in June 2006 to successfully combat HIV/AIDS include:

• How to make clear and paramount the complex facts about HIV/AIDS and HIV/AIDS research among Canadians, the media, and policy-makers.
• How to sustain high interest in HIV/AIDS issues among community-based political champions and politicians.
• How to understand and act upon the direct correlation between growing poverty and an increased vulnerability to disease among poorer Canadians and in the populations of low- and middle-income countries.
• How to address the persistent stigma attached to and discrimination against vulnerable populations or populations most likely to be exposed to HIV/AIDS.
• How to ensure that as we learn more about the disease and how it spreads, we continue to challenge our indicators of success and failure and seek new, appropriate measures.
• How to increase the efficiency of our responses to the disease, given the increasing cost of the solution set.
• How to foster evidence-based decision making in political environments that are often driven by ideology.

The Narrowing Horizon for Possibility

The world has become a more fragmented, complex and dangerous place. At the same time, society's expectations for access to wealth and government services is high - particularly among higher income individuals. So while we expect to live with less risk, we are living in a world with more of it. Society must ask: Where do the risks really lie? What are all the possibilities for mitigating them? What can we afford to do? Without the input of many perspectives, the range of possible solutions narrows.

Below are some examples of how the narrowing range of possibilities is affecting the world of HIV/AIDS and other related diseases:

Governments are preoccupied with the security of person and place. As domestic and international demands vie for attention, care will need to be taken to ensure that populations that are vulnerable to health threats do not become more vulnerable and disposable.

Evidence suggests that prohibiting drug use and pouring resources into expensive enforcement does not reduce the social and physical harm associated with drug-taking practices. Fear of a flu pandemic risks a disproportionate shift of energy and resources away from more immediate health challenges.

Excluding instances of rape and other forms of sexual coercion, we agree that consenting sexual partners are equally responsible for their own sexual health. When it comes to preventing the spread of STIs, sex is a negotiation and a matter of risk mitigation for all partners. Yet some partners who have not disclosed their HIV serostatus have been prosecuted for non-disclosure. This is not true for those who have other STIs. Consequently, people with HIV/AIDS who engage in high-risk sexual activity have been "criminalized" .

The Deepening Gap

The gap between rich and poor is growing wider, the middle class is declining, and we are entering a global era of haves and have-nots that threatens stability within and between nations. How is this phenomenon reflected in the world of HIV/AIDS?

Vulnerable populations or populations most likely to be exposed to HIV are becoming even more at risk. While most Canadians are earning more, First Nations, Inuit and Metis people remain impoverished. These groups have the same economic, social and health profile as the populations of many Third World nations.

Gentrification of the downtown cores of many large Canadian cities has displaced and dispersed the poor. Finding affordable shelter is more difficult, and it has become more difficult to reach and help these groups. Their situation has worsened.

Populations in areas of economic boom are generally at increased health risk because the social infrastructure needed to manage the negative impacts of sudden growth lag behind economic growth. These impacts include increased problematic drug and alcohol use, family abuse and breakdown, unemployment among lesser skilled citizens, gambling, and an increase in high-risk sexual activity. At a global level, the disparity in access to care, treatment and support between richer countries and middle- and low-income countries is growing deeper.

Inter-iurisdictional Collaboration

The F/P/T AIDS document, A National Portrait: A Report on Governments' Responses to the HIV/AIDS Epidemic in Canada, paints an encouraging picture. Most jurisdictions have strategies, action plans, or initiatives that recognize that HIV is an important issue. Across this array of activity, values are common, while approaches are appropriate to local contexts. As well, the HIV surveillance systems present in each jurisdiction are better than the surveillance systems used for other diseases.

Emerging Science and the Cost of New Technologies

Scientific research and the development of new technologies are cornerstones of the HIV/AIDS strategy in Canada. As our knowledge of how to address HIV/AIDS improves, expectations among those living with HIV/AIDS are raised. But we are not always able to afford to do what we know how to do. Unfulfilled expectations among populations can lead governments to make unwise decisions about how to spend dollars allocated to care, treatment and support.

Stigma and Discrimination

Unfortunately, stigma attached to and discrimination directed against vulnerable populations and populations most likely to be exposed to HIV persists. These groups include gay men, First Nations Inuit and Metis people, injection drug users, inmates of correctional facilities and people from countries where HIV/AIDS is endemic.

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