Meeting of April 1-2, 2001, Toronto - Public Record of Meeting

Executive Committee
Standing Committee on Championing of Current and Emerging Issues
Ad hoc Committee on Communications
Standing Committee on Monitoring and Evaluation
Special Working Group on Aboriginal Issues (SWGAI)
Ad hoc Committee on Community-Based Research
Business Arising
Additional Items
Health Canada Report
Federal/Provincial/Territorial (FPT) Advisory Committee on AIDS Report
Workplans

EXECUTIVE COMMITTEE

It was reported that the Co-Chairs, Don Kilby and Roger Le Clerc, met with the Minister's Office to discuss the Minister of Health's response on the Canadian HIV/AIDS Legal Network IDU report.

 STANDING COMMITTEE ON CHAMPIONING OF CURRENT AND EMERGING ISSUES

Interministerial Collaboration on HIV/AIDS

It was reported that the background paper on interministerial collaboration on HIV/AIDS had been completed. The paper identified potential barriers to collaboration, a summary of recommendations and a list of potential partners.

The Council agreed to send the report to the Minister along with a letter outlining specific recommendations related to enhanced interministerial collaboration.

Investment in the CSHA

It was reported that the paper examining the adequacy of economic investment in the CSHA had been completed. It identified a number of measures by which to consider adequacy of investment. They are: changes in funding priorities within a static pot of money; inflation; government's fiscal situation over time vs. the amount dedicated to HIV/AIDS; health care spending patterns and; changing incidence and prevalence and mortality rates.

The Council decided to send the report to the Minister along with a letter requesting increased funding for the CSHA based on the findings of the paper.

Correctional Service of Canada

It was reported that members of the Championing Committee had a meeting with the new CSC Commissioner, Lucie McClung, and some of her staff. Issues related to access to treatment, needle exchange programs, universal access to methadone and Aboriginal issues were reviewed and the results of the meeting were very encouraging. The new Commissioner was very receptive and supported the concept of an overall health strategy for inmates. A follow-up meeting is being scheduled.

The Council agreed that a letter be written to the Minister of Health requesting that he meet with the Solicitor General and offering him a delegation from MC to prepare him for the meeting.

Determinants of Health Project

A draft proposal entitled ,HIV/AIDS, Health Determinants and the Role of Government Departments was distributed to the Council. Its goal is to increase the capacity of federal and provincial/territorial government departments outside of health departments to address the range of HIV/AIDS related health determinants.

This is a joint project between the Ministerial Council and FPT AIDS. The Council agreed to release its share of the funds for the literature review.

AD HOC COMMITTEE ON COMMUNICATIONS

A draft communications strategy was tabled. It is divided into three areas, as follows: public profile of the Ministerial Council; incoming information and; outgoing information.

A revised version based on the input of Council members will be tabled at the June meeting.

STANDING COMMITTEE ON MONITORING AND EVALUATION

Based on the Ekos evaluation of the Council, the committee proposed to Council that it consider refining its objectives, as recommended by the Ekos report. The Council agreed that a half day be set aside at the June meeting for this purpose.

The Monitoring and Evaluation Committee will prepare background material and lead this exercise.

SPECIAL WORKING GROUP ON ABORIGINAL ISSUES (SWGAI)

It was reported that a previous request to the Minister of Health regarding a possible inter-departmental cabinet meeting on Aboriginal HIV/AIDS issues will not take place. Instead, the Minister has indicated that he would be exploring more explicit inter-departmental collaboration on HIV/AIDS issues.

It was reported that the Situational Analysis: A Background Paper on Aboriginal People and HIV/AIDS was complete and ready for release. Albert McLeod and Art Zoccole will release the paper at the upcoming Aboriginal Summit to be held May 4-5, 2001 in Calgary.

AD HOC COMMITTEE ON COMMUNITY-BASED RESEARCH

An update on the work of the Community-Based Research Advisory Reference Group (CBR-ARG), operated by Health Canada, was provided. The Council has an ex-officio seat on this committee.

A request for proposals to develop options for the future of the CBR program has been issued. The membership of the CBR-ARG has been expanded and the group has a new terms of reference is now known as the Community-Based Research Steering Committee

BUSINESS ARISING

Next Meeting: June 17-18, 2001, Montreal

ADDITIONAL ITEMS

HIV endemic country populations in Canada

Council had previously discussed this issue and received a range of presentations on the situation of HIV endemic country populations. The Council is in agreement that this a serious issue in Canada and requires action. The Council agreed to write a letter to the Minister outlining the importance of this issue and recommending that a meeting of relevant stakeholders be convened in order to move forward on a response.

Canada's Drug Strategy (CDS)

Cathy Airth of Health Canada provided the Council with background and an update on the CDS.

She noted that Canada's Drug Strategy (CDS) is a coordinated effort to reduce harm associated with the abuse of drugs, alcohol and other substances to individuals, families and communities. She noted that the Strategy adopted the Swiss model approach and is based on four pillars: prevention; treatment and rehabilitation; enforcement and control; harm reduction.

It was reported that at the direction of the Conference of Deputy Ministers of Health, the FPT Committee on IDU is establishing a task force to conduct a feasibility study of establishing a scientific, medical research project regarding a supervised injection site in Canada. The work of the task force will enable decision-making regarding supervised injection sites based on evidence.

Further information on the CDS

The Council emphasized that a substantive portion of the money must be spent on prevention, treatment and harm reduction. It was suggested that this is politically sellable and that the enforcement and control component should not be given any more emphasis than other components. It was also noted that there should be meaningful involvement between user, community and advocacy groups and that collaboration between the CSHA and the CDS is crucial. Finally, it was noted that the CDS is focused on safe communities and crime prevention, whereas drug addicts and those supporting harm reduction appear to be marginalized.

Focus on International Issues

The Council received a series of presentations on HIV/AIDS and international issues.

Reeta Bhatia of the International Affairs Directorate, Health Canada outlined the urgency of the international situation and made the case for Canadian involvement in international HIV/AIDS work as follows:

• Canada has committed itself to help.
• Canadians are internationally recognized leaders.
• Ensure the sustainability of our development investments.
• It is in our economic interest.
• It can enhance our domestic response.
• It can enhance the capabilities & reputation of our NGOs & ASOs.
• Acting globally can reduce the spread of HIV and other infectious diseases.
• We already know what works.
• It is simply the right thing to do.

Further information on the CSHA and international issues

Michael O'Connor, Executive Direcor of the Interagency Coalition on AIDS and Development (ICAD) gave an overview his agency's work and how Canadian AIDS Service Organizations (ASO) can both contribute to and benefit from international work.

In particular, ICAD facilitates twinning projects between Canadian and international ASOs to provide technical assistance and to learn from international approaches to HIV/AIDS work. Further information on ICAD is available at: http://www.icad-cisd.com

Christopher Armstrong of the Canadian International Development Agency (CIDA) provided the Council with an overview of CIDA's HIV/AIDS action plan.

CIDA's social development priorities are: health and nutrition; basic education; child protection and; HIV/AIDS. Within the next 5 years, 38% of CIDA's resources will go to these priorities. Since 1987, CIDA has committed over $150 million to HIV/AIDS initiatives around the world and will commit another $270 million over the next 5 years. CIDA's HIV/AIDS Action Plan was discussed with Canadian partners, underwent further consultation at the International Conference on HIV/AIDS in Toronto in June 2000 and then was officially released in July 2000.

CIDA supports the national strategic plans of governments in developing countries to combat HIV/AIDS and establishing priorities in programming to ensure optimal impact, cost effectiveness, and consistency with international guidelines. CIDA's goal(s) are to increase the outreach of CIDA programming to Canadian NGOs, academic institutions and the private sector in order to increase their involvement in international HIV/AIDS work.

Further information on CIDA's HIV/AIDS Action plan is available at:http://www.acdi-cida.gc.ca/CIDAWEB/acdicida.nsf/En/JER-330162057-T2S

Stefanie Beck, Department of Foreign Affairs and International Trade provided the Council with an overview of the United Nations Special Session on HIV/AIDS (UNGASS) and the Canadian government's preparations for this meeting.

Ms. Beck detailed the UN Resolution A/RES/55/13 (passed November 2000) and stated that the Secretary General has been requested to bring it to the attention of governments, specialized agencies and programs of the United Nations, international financial and trade institutions, intergovernmental and non-governmental organizations (NGOs), as well as to other partners including the business sector. The Resolution has stressed the full and active participation of least developed countries in the preparatory consultations and voluntary contributions to a trust fund to enable less developed country (LDC) participation.

The purpose of the UNGASS is to review and address HIV/AIDS in all its aspect and to ensure a global commitment to enhancing coordination and intensifying efforts to combat HIV/AIDS in a comprehensive manner. The participation of the highest level of representation from Member States and observers, non-governmental and civil society organizations, and UN Systems Organizations would be vital for the success of UNGASS.

Further information on the UNGASS is available at: http://www.un.org/ga/aids/

Richard Burzynski of the International Council of AIDS Service Organizations (ICASO) provided Council members with an overview of the non-governmental organization (NGO) sector and UNGASS.

For many NGOs, the United Nations process remains a place where declarations are regularly signed with little action resulting. ICASO believes that by working in a coordinated way, through a strategy of coherent activities, their inputs could be maximized to have the greatest impact. ICASO began developing an evolving strategy that they shared with their NGOs partners and colleagues.

Mr. Burzynski noted that ICASO developed its first public strategy document entitled: A Guide for Meaningful Involvement of NGOs and Civil Society, a resource document which explains the process, the key documents, the meetings, and how to advocate for NGO participation.
ICASO advocates that the UNGASS Declaration of Commitment must have four critical components:

• Political acknowledgment of the scale of the pandemic;
• Public political commitment willing to adopt the necessary legislative changes and programs to save lives;
• Concrete agreements by governments to meet the massive funding needs; and,
• Acknowledgment of the central role played by NGOs, community-based organizations and people living with HIV/AIDS.

Further information on ICASO and its work on UNGASS is available at: http://www.icaso.org/

HEALTH CANADA REPORT

Immigration Screening

Health Canada gives public health policy advice to Citizenship and Immigration Canada (CIC) regarding medical screening of migrants (immigrants, refugees and temporary long-term visitors) for infectious diseases. Health Canada developed a science based process for determining which diseases represent a threat to public health---the Montebello Process. Using decision tree methodology, five diseases (Tuberculosis, syphilis, HIV, hepatitis B and Chagas' Disease) were analysed. HC has reported to CIC on the probability of transmission of these diseases as a result of immigration.

HC has reaffirmed the need for medical screening for active tuberculosis and syphilis. Advice on the other diseases was based on narrowly focussed scientific information on risk of transmission and, as a consequence, the lowest health risk course of action. At present HC is developing further advice taking into consideration the broader public health aspects of this matter.

For HIV screening, the Minister has sought the input of the Ministerial Advisory Council on HIV/AIDS regarding the Department's recommendation to screen migrants for HIV/AIDS, in addition to the views of immigrant support groups.

CSHA Direction-Setting and Work-Planning Process

In October 2000, ten directions were established at the first CSHA annual direction-setting meeting held at Gray Rocks to guide the development of CSHA work plans for fiscal year 2001-02 and beyond. A work plan information sharing meeting, later postponed, was identified as a key follow-up activity of Gray Rocks.

On February 26, 2001 the CSHA Direction-Setting and Work Planning Process Task Group met to advise Health Canada on the next steps related to Gray Rocks and the work planning meeting. The task group has recommended that (i) a more in-depth strategy be developed and implemented this Spring to communicate the success of Gray Rocks and the ten directions and (ii) a new CSHA-wide work planning process be designed for implementation this fall for fiscal year 2002-03. Both of these activities will be addressed by the HIV/AIDS Division in its work plan for 2001-02.

As in previous years, draft 2001-02 CSHA work plans for Health Canada, Correctional Service Canada and Canadian Institutes of Health Research are currently being compiled and will be distributed to CSHA partners for review and comment before the end of April.

Community-Based Research (CBR)

CBR Program
A request for proposals to develop policy options for the CBR program has been issued. A peer review committee will review proposals received by the May 11th deadline. It is anticipated that a final report will be completed by November 30, 2001.

Aboriginal Capacity-Building Program
The Working Group, which included representatives of the Aboriginal HIV/AIDS community, the professional research community, Canadian Aboriginal AIDS Network and Health Canada, has completed it work. The program will include the following components: scholarships, summer training awards, and a national Aboriginal coordinator for CBR.

Community-Based Research Transition Team
The HIV/AIDS Division has established a CBR Transition Team to manage the CBR Program, the Aboriginal Research Program, the CBR Capacity-Building Program and the Aboriginal Capacity-Building Program for Community-Based Research. The CBR Transition Team has a mandate for two years and reports to the Director, HIV/AIDS Division. The CBR Team was created in response to the discontinuation of the National Health Research and Development Program (NHRDP), which has administered the CBR and Aboriginal Research Programs since their inception, and to ensure better coordination of the Division's CBR related activities.

Developing a Collaborative Framework between the CSHA and the Aboriginal Community

Health Canada, in conjunction with the Aboriginal Interim Working Group, will be hosting the second Aboriginal HIV/AIDS Summit in Calgary, Alberta on May 4 and 5, 2001. This second Summit is a report back to the community from the Aboriginal HIV/AIDS Information Sharing meeting held in Winnipeg in March, 2000. At the Winnipeg meeting it was agreed that a small, interim working group would be established to help review the existing mechanisms for Health Canada to consult with Aboriginal communities, while trying to develop a more centralized, efficient process. The Interim Working Group has completed its task and will report on its new collaborative framework at the meeting in Calgary.

First Nations and Inuit Health Branch Report

This report provided an update on FNIHB activities including special surveillance projects, the role of epidemiological data in FNIHB planning, as well as work in the area of 2-spirited people and evaluation and monitoring.

FNIHB is presently involved in a seroprevalence survey of pregnant status Indian women in BC. Partners on this project include Vancouver Blood Centre, Canadian Blood Services; Chiefs' Health Committee, First Nations Summit Society; FNIHB acific Region; and the University of British Columbia.

Aboriginal HIV/AIDS epidemological data provide vital statistical information useful for monitoring, evaluation, tracking, identifying emerging trends and disseminating information regarding the cause of the epidemic in the general Canadian population, and specifically among Aboriginal Canadians. Surveillance data also provide the necessary tools to gauge the degree to which intervention efforts are succeeding in combatting the spread of HIV/AIDS.

For example, in spite of data imperfection of our current Aboriginal data, best estimates appear to point to findings which suggest that Aboriginal people are infected at a younger age than non-Aboriginal people, that injection drug use is the most important mode of transmission, and that the HIV epidemic among Aboriginal people shows no signs of abating.

Awareness of this information allows planners to more strategically invest resources to address the needs of high risk Aboriginal populations. Access to and use of such information influence the selection of outreach intervention campaigns targeted to high risk Aboriginal exposure categories such as MSM, youth, women and IDU.

According to the HIV/AIDS Epi update "HIV/AIDS among Aboriginal people in Canada, April 2000", 2-Spirited people (MSM) represented the highest percentage (52.4%) of the 288 cumulative exposure categories of male AIDS case reports. Left unchecked this trend poses a challenge to preventative efforts and gives cause for serious concerns for individual and public Health safety. FNIHB is working in partnership with other federal departments and Health Canada Branches to reverse the increasing incidence of HIV infections among 2-Spirited people. As a result, in 1998, FNIHB Headquarters provided funding for the development of a palliative care manual for 2-Spirted people. Investment of resources directed to prevention, care, treatment and support for 2-Spirited people are reflected in FNIHB's regional work plans.

Injection Drug Use and HIV/AIDS: Legal and Ethical Issues

In 1999, during an address to mark World AIDS Day, the Minister of Health committed to providing a response to the recommendations found in the Canadian HIV/AIDS Legal Network's report Injection Drug Use and HIV/AIDS: Legal and Ethical Issues. The response, entitled Injection Drug Use and HIV/AIDS: Health Canada's Response to the Report of the Canadian HIV/AIDS Legal Network, is in the final stages of departmental approval.

During Health Canada's review of the report, it was identified that additional work was required in two specific areas where the Legal Network had made recommendations: 1) research related to drug users, HIV/AIDS and illegal drugs, and 2) the provision of illegal drugs to drug-dependent persons in the care setting. In fiscal year 2001/02, the HIV/AIDS Division will examine these areas in greater depth.

Injection Drug Use and HIV/AIDS: Health Canada's Response to the Report of the Canadian HIV/AIDS Legal Network, along with the recommendations in the Federal/Provincial/ Territorial Committee on Injection Drug Use report Reducing the Harm Associated with Injection Drug Use in Canada (March 2001), outline the current and planned Departmental commitments to address the harm associated with injection drug use in Canada. Together these documents reflect this Government's view that Canada's response to injection drug use requires both improved interventions and the promotion of a supportive, non-discriminatory environment in which these interventions are offered.

FEDERAL/PROVINCIALl/TERRITORIAL (FPT) ADVISORY COMMITTEE ON AIDS REPORT

FPT AIDS members held their last meeting in February 2001. The meeting featured a half-day special session on Aboriginal issues. The Canadian Aboriginal AIDS Network (CAAN) presented and participated in the committee's deliberations throughout the special session. As next steps, FPT AIDS will participate in the upcoming 2nd National Aboriginal Summit on HIV/AIDS and in the collaborative advisory body which is expected to emerge from the Summit.

FPT AIDS is represented on an FPT Committee on Injection Drug Use. Other areas of government represented include FPT committees on population health, drugs, justice, and corrections, and officials from the RCMP, hepatitis C, and Aboriginal health. In March 2000, the FPT Committee on Injection Drug Use released a working draft of the report entitled Reducing the Harm Associated with Injection Drug Use in Canada to a broad range of stakeholders for consultation. In June 2001, the Committee will advise the Conference of Deputy Ministers of Health on the outcomes of the consultation. The report will then be finalized and submitted to Ministers of Health in September 2000.

The Working Group on Mother-to-Child HIV transmission is gathering data to quantify and characterize women in Canada who do not receive prenatal care. These data will be used to support improvements to prenatal HIV testing policies and programs.

The Working Group on Point-of-Care Testing is reviewing the varying definitions of "health care professionals" among jurisdictions. This will be coupled with an analysis of settings where use of test kits may be appropriate. These data will help to guide future policy decisions should the kits come into greater use.

FPT AIDS will hold its next meeting June 14-15 in Winnipeg. Options for an appropriate public health response to the issue of "persons unwilling/unable to prevent HIV transmission" will be examined.

 WORKPLANS

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