Meeting of November 28-29, 1999, Ottawa - Public Record of Meeting

Executive Committee
Special Working Group on Aboriginal Issues
Ad hoc Committee on Communications
Ad hoc Commitee on Canadian Institute for Health Research
Standing Committee on Monitoring and Evaluation
Championing Current and Emerging Issues Business Arising
Additional Items
Presentations
Workplans

EXECUTIVE COMMITTEE

Council agreed that its role is to focus on the larger issues and the overall management of the CSHA. In this context, the "Dialogue on HIV/AIDS: Policy Dilemmas Facing Government" provided an excellent opportunity to see what other countries are doing in the field of HIV/AIDS.

 SPECIAL WORKING GROUP ON ABORIGINAL ISSUES

Council agreed that a face-to-face meeting of the Working Group should be held in early 2000 to review the material presented at the September meeting and to develop recommendations for Council at the March meeting.

The absence of an Aboriginal person on the planning committee for the International Conference on HIV/AIDS in Toronto in 2004 was discussed. Council agreed to write to the International AIDS Society to express concern and ask that this be addressed.

AD HOC COMMITTEE ON COMMUNICATIONS

No New Items

AD HOC COMMITTEE ON CANADIAN INSTITUTE FOR HEALTH RESEARCH (CIHR)

Presentation by representatives of the Transition Secretariat of the CIHR and the CIHR Interim Governing Council

Representatives of the CIHR presented on its structure and the time frame for its establishment. Council expressed its support for a separate research institute for HIV/AIDS. It also discussed the importance of having community representation on the peer review committee.

Discussion and recommendations on the CIHR and the meeting with the Minister of Health

Council members agreed on the following action items:

• sending a letter to the Minister reaffirming Council's support for a separate health research institute for HIV and nominating two researchers to the Governing Council of the CIHR;
• establishing an Ad Hoc Committee on CIHR to look at strategies for ensuring that HIV/AIDS is a strong part of the CIHR agenda. The Committee is to study options and report back to Council at its March 19-20 meeting;
• having representatives of Council meet with the Minister and Deputy Minister to review the recommendations of the TPP Working Group on HIV/AIDS.

STANDING COMMITTEE ON MONITORING AND EVALUATION

The Committee presented the draft terms of reference for a project to evaluate the activities of the Ministerial Council. Council accepted the terms of reference and instructed the Committee to proceed with the project

Special issue: Allocation under the CSHA

The Standing Committee on Monitoring and Evaluation presented their model for allocating funds within the CSHA, stressing that it was not a model for addressing end-of-year surpluses or deficits. In designing the model, the Committee looked at models from other jurisdictions and countries, for example, Australia and UNAIDS. The model presented assumes that total allocations are not static.

Council endorsed the Committee's work and made the following suggestions:

• Allocations should be reviewed in three years time, taking into consideration the political calendar. Minor adjustments should be made on an annual basis.
• Impact analyses should be done with objective measurement tools.

STANDING COMMITTEE ON CHAMPIONING OF CURRENT AND EMERGING ISSUES

The Committee reported on the following areas:

(i) Prisons: A meeting with Correctional Service Canada (CSC) has been set for November 30 with the Director General of Health Services and the CSC HIV/AIDS Program Coordinator.

(ii) Women: A reference group to advise on the work plan for prevention, care, treatment and support will be set up by March 2000. Council had input to the reference group and to the criteria for membership. Council supports the inclusion of additional representation from other strategic areas once the women's reference group is established and running.

(iii) Canadian Institutes of Health Research (CIHR): Council reaffirmed its decision to support a separate institute for HIV research under the CIHR.

(iv) Corporate Involvement: Council agreed that the Committee should continue the work of the previous committee in this area, develop terms of reference, and obtain quotes from consultants about the cost of a paper that would analyze issues and propose solutions.

(v) Activities in the area of the drug review process: Recommendations from the August 12 stakeholder meeting were strongly endorsed at the October 1 Cross-disability Stakeholder Group meeting. These recommendations were presented to senior management of the Therapeutic Products Programme (TPP) at their annual planning meeting, where they received general support. (The recommendations were also endorsed by Ministerial Council at its September 1999 meeting and were sent to Health Canada.) Council accepted the Committee's recommendation that the Council continue as an observer on the TPP review process; this now will be undertaken by the Oversight Group. The secretariat will draft a letter to the TPP for the co-chairs' signature.

(vi) Rapid Testing: The Canadian HIV/AIDS Legal Network is preparing a brief to present to Council at the next meeting.

(vii) Drug Pricing: There are no new developments in this area. The Committee is waiting for the Patented Medicine Prices Review Board's decision on complaints about excessive pricing.

(viii) Immigration: A process is under way, led by the Health Protection Branch (HPB), to develop policy on immigration screening for HIV/AIDS, tuberculosis and syphilis. Members of the HIV/AIDS community were not invited to take part in focus groups held recently on this issue. The Committee will be investigating the matter and reporting at the next meeting.

(ix) The Committee reported that the Laboratory Centre for Disease Control (LCDC), as part of its program impact assessment project, had hosted a meeting of cross-disability groups. HIV/AIDS groups were not invited. Council agreed to send a letter to LCDC to (i) clarify what meeting took place and ask why representatives from the HIV/AIDS community were not invited; (ii) address the issue of alleged comments about HIV/AIDS funding; (iii) raise the issue of lack of community consultation at LCDC. Canada has one of the best programs in the world for quality control of CD4 testing, but recent budget cuts have threatened its quality. The Committee will inform LCDC's Immunology Advisory Group that the Ministerial Council is interested in a formal submission from them about their concerns over the future of the program.

BUSINESS ARISING

NHRDP provided an update on its activities.

Council proposed that the NHRDP examine the issue of capacity building for groups wishing to receive funding but lacking some of the skills required in traditional "old school" research. The need for capacity building was acknowledged, and it was noted that the HIV/AIDS Policy, Coordination and Programs Division would be working with the NHRDP to address the issue.

Council members expressed the need for an appeal process for proposals that are turned down. It was suggested that NHRDP consider a conditional acceptance as well as acceptance and rejection and develop a process to enable applicants to strengthen capacity.

Next meeting

The next meeting is confirmed for March 19-20, 2000.

ADDITIONAL ITEMS

The Ministerial Council received a report from FPT AIDS, which provided an update on FPT AIDS activities related to:

• a national conference on post-exposure prophylaxis against HIV in non-occupational settings;
• a discussion paper on intergovernmental collaboration on HIV/AIDS;
• a preliminary report from the F/P/T AIDS Working Group on Injection Drug Use;
• provincial and territorial drug plans as they relate to the cost and accessibility of HIV therapeutic agents.

Health Canada report to Council (November 1999):

• The financial statements were reviewed and an anticipated surplus of $500K is estimated.
• It is expected that funds carried over from 1998/1999 for the Aboriginal-research and community-based research programs will be fully spent in 1999/2000.
• Council was informed of focus group activities held in November to look at HIV screening options for immigrants. Council expressed serious
  concerns about the documentation provided and asked for clarification. Council will work with the secretariat to draft a letter requesting clarification on documents used for the recent focus groups.
• Council directed the secretariat to request a detailed breakdown of the $1.825 million HPB expenditure in the 1998/1999 financial status report and the $2.05 million HPB forecast expenditure for 1999/2000.

Discussion with the Honourable Allan Rock, Minister of Health

The following issues were discussed with Council members:

• the impact of HIV/AIDS across all departments;
• funding needs for HIV/AIDS;
• the CIHR;
• the drug approval process;
• injection drug use/World AIDS Day.

The Minister agreed to take Council's advice on these areas into consideration.

PRESENTATIONS

Special Issue: HIV/AIDS and Injection Drug Use

Council received presentations from VANDU, the B.C. Centre for Excellence in HIV/AIDS and the International Harm Reduction Association. Council noted that although injection drug use is not a separate area under the CSHA, it is extremely important, as it transcends all sectors and represents many layers of stigmatization. Members of VANDU were invited to share with Council their knowledge, experiences and recommendations.

VANDU provided an overview of its structure and activities and presented the following recommendations:

• create and support a national network of user-run user groups. Where user groups do not exist, they can be encouraged;
• design and carry out research in the user community, with researchers coming in as requested;
• create a fund for legal cases to remedy discrimination against users in hospitals and to deal with violations of human rights by police and those involved with prisons, welfare and other services;
• ensure that users are central to policy work in order to have practical, workable, effective and life-saving public health policies;
• establish a national harm reduction coalition that includes user groups.

The representative of the B.C. Centre for Excellence in HIV/AIDS presented Council with the five most urgent recommendations and one long-term recommendation:

Short-term:

• methadone-plus services;
• trial of prescription heroin;
• user groups established across the country;
• community funding;
• The Minister of Health and the provinces need to talk to Aboriginal peoples about how they are going to develop a strategy to address injection drug use. Thirty percent of injection drug users in Vancouver are Aboriginal.

Long-term:

• The most important long-term problem the Government needs to address is childhood sexual and physical abuse. Those most at risk of drug use were abused during childhood.
• The representative of the International Harm Reduction Association presented the following short- and long-term recommendations for addressing the spread of HIV and other diseases among injection drug users.

Short-term:

• reestablish the National Drug Strategy and ensure coordination with the CSHA;
• establish comprehensive harm-reduction services, including:
• health rooms (safe injecting sites), tolerance areas, medical and support services and shelters for drug users; The following services should be available in prisons and other institutions:
• expansion of syringe availability and disposal services in all areas, urban and rural;
• there should be assurance that these services meet standards that should be established by the federal government.

Rapidly expand drug treatment services, including:

• accessible methadone programs that are truly based on harm-reduction principles;
• drug treatment and services for drug users, with special attention to the provision of services for users of cocaine and other stimulants.
• Request that police forces practise non-enforcement of drug laws for possession of syringes (clean and dirty) and drugs for personal use.
• Provide comprehensive, integrated services to HIV-positive drug users, including access to HIV therapies and supportive housing.

Long-term:

There should be a thorough review of drug law and policy in Canada, including:

• the decriminalization of drug possession for quantities of drug for personal use;
• modification of drug and paraphernalia laws to explicitly allow for possession of clean and used syringes and for syringe-exchange services;
• a critical examination of Canada's obligation under international treaties concerning both drugs and human rights.

Provision should be made for the prescribing of drugs, including heroin, amphetamines and cocaine, to dependent drug users.

Council considered the recommendations made by the presenters on HIV injection drug use, looking for overlap. The following recommendations were identified as common to all three:

• low-threshold methadone;
• funding for user groups and the need for information;
• safe sites for injecting drugs;
• housing and welfare;
• the Frankfurt approach as a model;
• legal action;
• prescribing of other drugs;
• marrying of the drug strategy and the CSHA.

Council agreed to send a letter to the Minister:

• thanking him for his commitment to respond by June 2000 to the recommendations in HIV/AIDS and Injection Drug Use: Legal and Ethical Issues;
• informing him that Council supports the Legal Network's recommendations;
• endorsing the consensus recommendations of the three presenters listed above;
• indicating that Council strongly supports a funded drug strategy that works with the CSHA; and
• informing him that this area will continue to be a priority for Council and that Council will be looking at ways to address the identified issues.

 WORKPLANS

No New Item