Government of Canada Report to the Secretary General of the United Nations on the United Nations General Assembly Special Session on HIV/AIDS Declaration of Commitment on HIV/AIDS January 2003 - December 2005

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Annex 2: Part A
National Composite Policy Index

I. Strategic Plan

I.1 Country has developed a national multi-sectoral strategy/action framework to combat HIV/AIDS.

The pan-Canadian response
Leading Together, Canada takes Action on HIV/AIDS (2005-2010), a blueprint for Canada-wide action on HIV/AIDS, was released in 2005. Leading Together calls for consolidated action on all fronts, including governments, community, researchers, health care providers, people living with and at-risk for HIV, individuals and others involved in Canada's response to HIV/AIDS. It lays out specific actions and targets necessary in order to achieve its bold vision that "the end of the epidemic is in sight." Leading Together includes the sectors of health, education, women, and youth. It is grounded in a human rights framework, strongly supports the engagement and leadership of people living with HIV/AIDS, and outlines concrete actions to increase awareness, address the social factors driving the epidemic, increase prevention, strengthen diagnosis, care, treatment and support, provide leadership in the global response, and enhance front-line efforts.

Canada 's federal response
In May 2004, the Government of Canada announced an increase in federal HIV/AIDS funding, with an increase in ongoing federal HIV/AIDS funding of the domestic response from $42.2 million per annum to $84.4 million by 2008-09. In January 2005, the Federal Initiative to Address HIV/AIDS in Canada was launched, outlining how the federal government will support this funding increase. The Public Health Agency of Canada, Health Canada, Canadian Institutes of Health Research and Correctional Service Canada all receive funding from this initiative.

The Federal Initiative has the following goals:

• Prevent the acquisition and transmission of new infections;
• Slow the progress of the disease and improve quality of life;
• Reduce the social and economic impact of HIV/AIDS;
• Contribute to the global effort to reduce the spread of HIV and mitigate the impact of the diseases.

The Federal Initiative builds on the Canadian Strategy on HIV/AIDS (1998-2004), reinforcing the importance of partnership and engagement with players across governments, civil society, and researchers. Governments, national and regional non-governmental organizations working in HIV/AIDS, professional associations representing persons working in care, treatment and support, people living with or at risk for HIV/AIDS, researchers, epidemiologists and policy makers are actively engaged in the development and delivery of policy and programmes supported with federal funding. It is an approach grounded in human rights and the determinants of health.

Through the Federal Initiative, population-specific approaches are being developed for the following groups: people living with HIV/AIDS, gay men, people who use injection drugs, Aboriginal people, federal inmates, youth and women at risk for HIV and people coming from countries where HIV is endemic.

In April 2005, Canada's International Policy Statement was launched. This whole-of-government approach will help strengthen coherence among Canada's aid and non-aid policies and actions. The Statement sets out a new framework for development cooperation that will increase the effectiveness of Canadian development assistance, focusing Canadian efforts and resources in key sectors and countries. The Canadian International Development Agency's (CIDA) programming will be focused on five sectors - health (including HIV/AIDS), good governance, basic education, private-sector development and environmental sustainability. CIDA is currently developing a Strategic Directions Paper for Health including HIV/AIDS. A concept paper on HIV/AIDS was elaborated in consultation with other Government departments and non-governmental organizations.

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.

Provincial and territorial responses
In Canada's federal system, provincial and territorial governments are responsible for the delivery of health care. Most provinces and territories have adopted or are developing strategies to address HIV/AIDS. In some provinces and territories, an integrated blood-borne pathogen and sexually transmitted infections approach has been adopted, recognizing that HIV/AIDS, hepatitis C and sexually transmitted infections affect similar population groups ( Quebec, Alberta, Saskatchewan, Northwest Territories). Other provinces and territories have focussed on HIV/AIDS - British Columbia, Manitoba, Ontario, Nova Scotia, Newfoundland, Nunavut and the Yukon.

The efforts of different levels of government are linked through the Federal/Provincial/Territorial Advisory Committee on AIDS, which has as its goals the promotion of public policy development; the promotion of increased inter-governmental, inter-jurisdictional and multilevel collaboration on issues related to HIV/AIDS and the promotion of the use of epidemiological data and community information in the development of policy, programs and services in Canada.

I. 2 Country has integrated HIV/AIDS into its general development plan.

HIV/AIDS is clearly positioned as an important domestic and international issue for the federal government. The Federal Initiative coordinates the domestic response and also seeks to bridge the domestic and international responses. It is a horizontal initiative, involving four federal departments and agencies - the Public Health Agency of Canada, Health Canada, the Canadian Institutes of Health Research, and Correctional Services Canada. The Canadian International Development Agency and Foreign Affairs Canada work together on the international response. The domestic and global responses are linked through various mechanisms to ensure policy coherence and shared learning.

I. 3 Country has evaluated the impact of HIV/AIDS on its economic development for planning purposes.

The total annual cost (direct and indirect) of HIV/AIDS was estimated to be approximately $1 billion in 1998 ¹. While there are few definitive figures available, provinces and territories pay the costs of medical services for those living with HIV/AIDS, and pay for the cost of medications, including anti-retrovirals ². In 2003, British Columbia's Provincial Health Officer estimated that the province spent approximately $100 million on HIV-related services. In 2001-02, the Ontario government spent approximately $50 million to support HIV-related services (not including physician costs, drug programmes, in-patient hospital services, and home care and palliative care services).

I. 4Country has a strategy/action framework for addressing HIV/AIDS issues among its national uniformed services, military, peacekeepers and police.

The Treasury Board of Canada policy on HIV/AIDS applies to both the armed forces and the Royal Canadian Mounted Police. This policy outlines a number of requirements and guidelines with respect to the rights and benefits of employees living with HIV, the availability of voluntary testing and pre and post-test counselling, education and information, and precautions for employees with a potential risk of exposure.

The Department of National Defence has an occupational health policy to enable people living with HIV/AIDS to work according to their health and ability. It is also intended to safeguard the confidentiality of the military member's personal health information. In addition, all Canadian Forces personnel scheduled for operational duty must complete pre-deployment training that includes a preventive medicine component. Sexually transmitted infections, including HIV/AIDS, are included in this training.

II. Political Support

II. 1 The head of government and/or other high officials speak publicly and favourably about AIDS efforts at least twice a year.

The Minister of Health, the Minister of State for Public Health and the Minister of International Cooperation make regular speeches or comments about the epidemic and responses to it. In 2004, significant funding increases to both the domestic and international responses were announced.

II. 2 Country has a functional national multi-sectoral HIV/AIDS management /coordination body recognized in law.

Several multi-sectoral coordination and advisory bodies are in place to coordinate the response to HIV/AIDS and to provide advice to the government from the community, medical, and research sectors.

The pan-Canadian context
HIV/AIDS is managed by multiple jurisdictions of governments at three levels; federal, provincial and territorial, and municipal. Each jurisdiction has authority for HIV/AIDS management within its mandate and all collaborate with civil society. The Federal/Provincial/Territorial Advisory Committee on AIDS established in 1988, provides policy advice on issues and priority initiatives, and promotes timely, effective and efficient inter-governmental and inter-jurisdictional collaboration on issues related to HIV/AIDS in Canada. The Federal/Provincial/Territorial Heads of Corrections Working Group on Health, made up of members from correctional services from federal, provincial, and territorial governments, works collaboratively: to promote program and policy development that is informed and sensitive to the complex issues surrounding inmate health; and to provide proactive leadership and advice to the Federal/Provincial/Territorial Heads of Corrections on trends and best practices as they relate to health in a correctional setting.

Government of Canada Assistant Deputy Minister Committee
In 2005, The Government of Canada Assistant Deputy Minister Committee on HIV/AIDS was established to promote greater linkages and alignment of federal government policies and programmes relating to HIV/AIDS. It is currently made up of the Assistant Deputy Ministers of fourteen departments and agencies with mandates that influence or are related to Canada's response to HIV/AIDS. The committee provides a common platform to promote horizontal coordination and programme coherence across federal departments and agencies.

Federal advisory bodies
The Ministerial Council on HIV/AIDS, established in 1988, provides advice to the Minister of Health on pan-Canadian aspects of HIV/AIDS. Council members are appointed by the Minister of Health and are chosen for their experience and collective expertise, which span the disciplines that form the Canadian response to the epidemic, from the research community to front-line professional and non-professional workers involved with emerging at-risk groups. Five of its fifteen members are people living with HIV/AIDS.

The National Aboriginal Council on HIV/AIDS is an advisory body made up of Aboriginal peoples (First Nations, Inuit and Métis) who provide policy advice to Health Canada and the Public Health Agency of Canada and other relevant stakeholders about HIV/AIDS and related issues among all Aboriginal (Inuit, Métis and First Nations) peoples in Canada.

II. 3 Country has a functional national HIV/AIDS body that promotes interaction among government, the private sector and civil society for implementing HIV and AIDS strategies/programmes.

The Federal Initiative identifies partnership and engagement as a policy direction, bringing a wide range of sectors together to strengthen coordination and coherence of action. The experience of civil society is conveyed to the federal government through the advisory bodies mentioned above and through national multi-sectoral, multi-stakeholder meetings that have played a key role in setting directions for the Canadian response to the epidemic.

The federal government supports the Canadian Association of HIV/AIDS Researchers and the Clinical Trials Network, which brings together researchers, health care providers and the private sector.

The Consultative Group on Global HIV/AIDS Issues is made up of national NGOs, researchers, Health Canada, Public Health Agency of Canada, Canadian Institutes of Health Research, Canadian International Development Agency and Foreign Affairs Canada. It acts as a forum for government and civil society to engage in a dialogue on Canada's response to the global epidemic, including the provision of advice to participating government departments on the global HIV/AIDS epidemic; and of guidance and suggestions regarding collaboration and policy coherence to ensure a more effective response.

The Canadian Institutes of Health Research (CIHR) HIV/AIDS Research Advisory Committee is chaired by a member of the CIHR Institute of Infection and Immunity Advisory Board, and has members representing multiple CIHR Institutes, HIV/AIDS researchers, Health Canada, the Ministerial Council on HIV/AIDS and broader community organizations. This membership enables the Committee to be a voice for HIV/AIDS researchers within CIHR, and encourages good communication between stakeholders interested in HIV/AIDS research. The Committee has a mandate to make recommendations to CIHR regarding research priorities for HIV/AIDS.

II. 4 Country has a functional HIV/AIDS body that is supporting coordination of HIV-related service delivery by civil society organizations.

Service delivery is a provincial responsibility that is managed differently from province to province. Some provinces fund service delivery by community based organizations. In some provinces, the provincial government, the regional office of the federal government and NGOs work together to engage in planning, priority identification, and enhanced coordination of community based activities by the civil society. In addition, many projects are funded through the AIDS Community Action Programme, a Public Health Agency of Canada regional fund that supports frontline responses to HIV/AIDS in communities.

Civil society coordination is achieved through different mechanisms, including participation in government-led planning and consultation processes, and through national and regional umbrella organizations.

Political support for the HIV/AIDS programme

The federal government has consistently supported the response to HIV/AIDS in Canada. The Prime Minister has been active on the international scene, calling for an enhanced global response to HIV/AIDS. Significant budget increases to both the domestic and international responses were announced in 2004. The Standing Committee on Health monitors and reviews federal HIV/AIDS efforts to ensure that funding is used where it is most needed.

III. Prevention

III. 1 Country has a policy or strategy that promote information, education and communication (IEC) on HIV and AIDS to the general population.

There is currently no unifying strategy, but information, education and communication are provided through a variety of mechanisms which are described below. Under the Federal Initiative, The Public Health Agency of Canada administers an HIV/AIDS Information Services Initiative (HISI) Fund to support a national service whereby high quality HIV/AIDS information is identified, made meaningful, and available. The initiative currently supports the Canadian HIV/AIDS Information Centre, administered by the Canadian Public Health Association, and the Canadian AIDS Treatment Information Exchange: two services that have an international reputation for the provision of comprehensive HIV/AIDS prevention, care, treatment and support information. Following a national consultation, the HISI fund will undergo a redesign in 2006 to incorporate the principals of knowledge transfer and exchange.

The Public Health Agency of Canada supports national and front-line communications and social marketing activities to improve Canadians' knowledge of HIV, to address community and societal attitudes, and to reduce the stigma and discrimination that fuel the epidemic. National public awareness programmes are being developed to provide accurate information on HIV and to highlight the ways in which stigma and discrimination contribute to the epidemic.

III. 2 Country has a policy or strategy promoting HIV and AIDS-related reproductive and sexual health education for young people.

Sexual and reproductive health education is delivered within the school setting, under curricula set by provincial and territorial ministries of education within Canada. The type of HIV/AIDS information provided and the age at which it is provided varies across Canada.

The role of the federal government is in establishing guidelines, carrying out research and surveillance and funding social marketing campaigns.

In 2003 Health Canada, together with governmental and nongovernmental organisations at the provincial, territorial and community levels, produced a revised edition of the Canadian Guidelines for Sexual Health Education. The Guidelines provide the framework for the development of comprehensive sexual health education programmes and services that meet the diverse needs of Canadians.

The 2002 Canadian Youth Sexual Health and HIV/AIDS Study, coordinated by the Council of Ministers of Education Canada, found that youth's feelings of susceptibility to HIV/AIDS have decreased since 1989; and that one - half of grade nine students did know that there is no cure for AIDS. The survey also found an increase in respect for the basic human rights of those living with HIV.AIDS, compared to 1989 results. This information is being used along with other sources to help shape an upcoming social marketing campaign.

III. 3 Country has a policy or strategy to promote information, education and communication and other preventive health interventions for most-at-risk populations.

The Federal Initiative will support specific community-based social marketing campaigns developed by and for specific populations, namely gay men, Aboriginal people, people who use injection drugs, federal inmates, women and youth at-risk, people from countries where HIV is endemic, and people living with HIV/AIDS. Some current projects include:

Gay men
Working with a National Advisory Team composed of partner organizations from across Canada, the Public Health Agency of Canada has funded AIDS Vancouver to develop and roll out two phases of a national social marketing campaign to reinvigorate HIV/AIDS prevention among gay men across Canada.

Aboriginal peoples
At the national level, the First Nations and Inuit Health Branch of Health Canada continued to support Aboriginal organizations in delivering HIV/AIDS awareness programmes. This included the expansion of Aboriginal AIDS Awareness Day to a week-long event beginning on World AIDS Day, with the Canadian Aboriginal AIDS Network as the main coordinator and implementer of activities; and supporting the work of Pauktuutit Inuit Women's Association with Inuit people.

The Aboriginal Strategy on HIV/AIDS in Canada supports regional and local levels to organize their efforts to respond to HIV/AIDS. It includes specific strategies on national coordination and technical support; community development and capacity building; prevention and awareness; sustainability, partnerships and collaboration; legal, ethical and human rights issues; engaging aboriginal groups with specific needs; supporting harm reduction approaches; holistic care, treatment and support; and research and evaluation.

Federal inmates
Correctional Service Canada (CSC) recognizes that the management of infectious diseases such as HIV can only successively be achieved through the implementation of a range of prevention, treatment and harm reduction activities. CSC delivers several education programmes for inmates, such as the National HIV/AIDS Peer Education and Counselling Programme, Circles of Knowledge Keepers (an Aboriginal HIV/AIDS peer education and counselling programme), and the Choosing Health in Prisons Programme. CSC offers inmates voluntary testing for HIV/AIDS, sexually transmitted infections (STIs), hepatitis A, B and C and tuberculosis. All inmates are offered vaccinations for hepatitis A and B, and an annual influenza vaccination. CSC has an HIV Post Exposure Protocol for staff and inmates.

In partnership with the Public Health Agency of Canada, CSC health services staff received training on the prevention, diagnosis, treatment and management of STIs. This training was accompanied by an STI manual developed to summarize this information specifically for working with an incarcerated population. CSC also tracks infectious disease prevalence, and uptake for testing, treatment and participation in prevention education, through its Infectious Disease Surveillance System. The purpose of this work is to monitor trends and to inform the development of policies and prevention programs.

Inmates in CSC penitentiaries have access to the following harm reduction measures:

• Bleach for cleaning injecting, tattooing and piercing equipment;
• Condoms, dental dams and water-based lubricant;
• A methadone maintenance treatment programme;
• A safer tattooing practices pilot project that is now operating in six federal penitentiaries

Needle exchange programmes are not currently available in federal penitentiaries; however, CSC has sought the scientific and technical advice of the Public Health Agency of Canada on the risks and benefits of prison needle exchange programmes.

III. 4 Country has a policy or strategy to expand access, including among most-at-risk populations, to essential preventative commodities

Currently access to preventative commodities in Canada includes the following items:

Condoms, HIV testing (anonymous, nominal and non-nominal), syringes, sterile water, bleach, cookers, filters and sharps containers. Other preventative commodities include the hepatitis B, hepatitis A and flu vaccines, tuberculosis testing and treatment, hepatitis B and C testing, methadone programmes, physician assisted narcotics programmes, drug rehabilitation programmes, post-exposure prophylaxis, health promotion and prevention information programmes, universal access to a primary health care physician and universal access to primary and secondary education. Programmes on social marketing for condoms, blood-safety, safe injections in health care settings, and antenatal syphilis screening are in place.

The availability of these preventative commodities and programmes varies across Canada and is dependant upon a number of factors including federal health transfers to provinces and territories, provincial, territorial and municipal allocations of resources to health, and approaches used by provincial and municipal health related agencies. Canada endorses the principle of universal access to HIV/AIDS education, prevention, diagnosis, care, treatment, support and rehabilitation services.

III. 5 Key prevention activities

Prevention activities vary across the country, depending on the nature of the epidemic in the jurisdiction, and the mode of delivery. For the most part, prevention activities are delivered by local AIDS service organizations, community based organizations, and public health units. These specific activities identified by UNAIDS are available in Canada - namely, social-marketing programmes for condoms; school-based AIDS education for youth; behaviour-change communications; voluntary counselling and testing; programmes for sex workers; programmes for men who have sex with men; programmes for injecting drug users; programmes for other most-at-risk populations; blood safety; programmes to prevent mother-to-child transmission of HIV; programmes to ensure universal precautions in health care settings. There is currently no formal programme to promote accurate HIV and AIDS reporting by the media. Availability to some prevention activities does vary across the country, and there are challenges in reaching marginalized people. Certain key activities are highlighted below.

HIV Testing
Nominal and non-nominal HIV testing is available in all provinces and territories, and many offer anonymous testing as well.

Prevention of Mother to Child Transmission
Voluntary HIV testing programmes are available in all provinces and territories for pregnant women. In 2002 The Federal/Provincial/Territorial Advisory Committee on AIDS released Guiding Principles for HIV Testing of Women during Pregnancy, which reinforce the application of the widely supported principles of voluntarism, confidentiality and informed consent in the refinement and development of relevant policy.

Treatments are available in all provinces and territories to prevent mother-to-child transmission of HIV, although this is not sufficient to prevent all HIV infections in newborn babies. In 2004, 163 cases of perinatal exposure to HIV were reported, of the 139 whose mothers received any perinatal ART prophylaxis, 108 of the perinatally exposed infants were confirmed not infected, 3 were confirmed to be infected, and the status of 28 was not confirmed³.

In federal penitentiaries, prenatal care is provided for all pregnant offenders. This includes voluntary testing for HIV. All women are encouraged to participate in testing and/or appropriate treatment to prevent transmission from mother to child. Opioid-dependent offenders who are pregnant are encouraged to undergo methadone treatment to decrease the risks associated with injection drug use and pregnancy.

Programmes for People who use Injection Drugs - Supervised Injection Site
In September 2003, Canada's first legal supervised injection site was opened, as part of a partnership between Vancouver Coastal Health Authority, the Portland Hotel Society and the British Columbia Ministry of Health. Health Canada granted the Vancouver Coastal Health Authority an exemption under current Canadian legislation to launch a supervised injection site pilot research project, and is providing up to $1.5 million in funding to support the evaluation component of the project to determine whether supervised injection sites will improve the health of drug users and reduce the harm associated with illicit drug use . Funding for the establishment and administration of the pilot project, and the actual supervised injection site, is the responsibility of the Vancouver Coastal Health Authority.

While the one-year evaluation results were promising, the evaluation represents only an initial step in terms of assessing whether the supervised injection site in the Downtown Eastside of Vancouver is reducing the harm associated with injection drug use. Efforts to document the health outcomes of people who use injection drugs associated with the site will continue throughout a three-year evaluation period and beyond.

North American Opiate Medication Initiative (NAOMI)
NAOMI is a medical research study designed to determine whether medically prescribed heroin is more effective than methadone in treating people who have failed standard therapies for chronic opiate addictions. The study is funded by the Canadian Institutes of Health Research, and will be undertaken by the University of British Columbia, the University of Montreal and the University of Toronto. The Canadian Institutes of Health Research is providing $8.1 million for the clinical trial to be conducted. In 2005, Health Canada granted approval to the clinical trial proposal and issued an exemption - for scientific purposes - under current Canadian legislation, authorizing the use of heroin in the clinical trial. NAOMI commenced recruitment in February 2005.

IV. Care and support

IV. 1 Country has a policy or strategy to promote comprehensive HIV and AIDS care and support, with sufficient attention to barriers for women, children and most-at-risk populations.

The responsibility for the direct delivery of care is under provincial and territorial jurisdiction. Different jurisdictions take different approaches to HIV and AIDS care and support, but most have a policy or strategy to address this issue. Leading Together has as one of six action areas: 'Strengthen diagnosis, care, treatment and support services'.

IV. 2 Key care, treatment and support activities

The specific activities identified by UNAIDS - screening of blood transfusions, universal precautions; treatment of opportunistic infections; antiretroviral therapy; nutritional care; STI care; family planning services; psychosocial support for those living with HIV and their families; home-based care; palliative care; treatment of common HIV-related infections; and post exposure prophylaxis - are available in Canada. Medical services are delivered by provincial and territorial health systems, while civil society organizations play a key role in delivering psychosocial support, home-based and palliative care. Availability to some services does vary across the country, and marginalized people are less likely to be aware of and to access care and support services. Key activities are outlined below.

Access to HIV/AIDS related medicines
The Canada Health Act sets the standard for all provinces and territories to provide all medically necessary physician and hospital services to eligible residents. The cost of HIV-related drugs is covered either through public or private insurance plans, or for those on income assistance, through drug access programmes at the provincial or territorial level. While the majority of people living with HIV/AIDS have access to necessary drugs, instances do occur where access is limited. Drug access and cost reimbursement programmes can result in drug interruptions. A 2002 study found that one in three people who died of AIDS in British Columbia had never been treated with antiretroviral drugs; Aboriginal peoples, low-income people and women were over-represented in this group. This study demonstrates the ongoing challenge of reaching marginalized populations. For people living in Canada without legal status, provision of drugs and receipt of health care is tenuous.

Prescription medication and medical transportation is provided to 'registered Indians' (First Nations people with status under the Indian Act) and to Inuit under a federal programme known as the Non-Insured Health Benefits Programme.

Access to medicines in federal penitentiaries
Upon receiving a positive diagnosis for HIV, a federal inmate is referred to the institutional physician and a community HIV/AIDS specialist. Treatment is directed by the community HIV/AIDS specialist, who also determines the treatment regime most appropriate for the individual. HIV medication is provided at no cost to the inmate. Prior to release from penitentiary, the inmate is connected with a community health provider, and is provided with an interim supply of medications.

IV. 3 Country has a policy or strategy to address the additional needs of orphans and other vulnerable children.

There is not a significant number of HIV/AIDS orphans in Canada, and children under 15 represent only 1.3% of total positive HIV test reports in Canada since 1985. (PHAC, 2004)

Youth, particularly those who are street involved, Aboriginal and/or gay, have been identified as one of the populations at risk for HIV/AIDS and the federal government is developing a population-specific approach for youth at risk. A Canada Fit for Children: Canada's National Plan of Action, released in 2004, is Canada's official response to its commitments made at the UNGASS on Children in 2002. Promoting healthy lives, including combating HIV/AIDS, is one of the priority areas of this plan.

The needs of vulnerable children are met through the delivery of provincial health and social services that include child protection services, adoption services, child and family counselling and social service agencies, welfare and disability income support programmes, publicly funded primary health services and subsidized housing. The delivery of these programmes varies across Canada and is dependent upon federal funding in the form of health transfers to provinces; provincial and municipal allocations of resources to health; and approaches used by provincial and municipal health and social service related agencies.

V. Monitoring and Evaluation

Different jurisdictions have different roles in Canada's health care system, and take different approaches to monitoring and evaluation of their own activities. At present, there is no single national plan, but Leading Together, lays out concrete actions outcomes and goals, and the shared responsibility of different actors in Canada's response to HIV/AIDS. A Championing Group for Leading Together will be examining ways to monitor progress.

The federal government has a detailed Results Based Management and Accountability Framework for the Federal Initiative that includes a data collection and analysis strategy, performance indicators and quantifiable goals, guidelines on tools for data collection, and data dissemination and reporting commitments.

Canada's Report on HIV/AIDS is published annually, providing an account of annual progress to the public. Civil society is involved in providing input into the report and commenting on draft reports. Semi-annual Surveillance Reports, and annual HIV/AIDS Epi Updates are published, providing a roll up of provincial and territorial HIV/AIDS surveillance data to the national level, and an overview of HIV epidemiology among various risk groups. These reports serve to monitor the state of epidemic, to help guide and evaluate HIV prevention, and to assist with ongoing risk assessment and management.

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1. Albert, Terry and Gregory Williams, The Economic Burden of HIV/AIDS in Canada. Canadian Policy Research Network, 1998.
2. In some provinces, the payment of anti-retrovirals is only for those on income support, other provinces pay the cost of anti-retrovirals for anyone who is HIV positive, regardless of income.
3. HIV and AIDS in Canada, Surveillance Report to December 31, 2004. Public Health Agency of Canada, 2005.

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