Meeting of December 10-11 2000, Ottawa - 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

No report tabled.

 STANDING COMMITTEE ON CHAMPIONING OF CURRENT AND EMERGING ISSUES

Canadian Working Group on HIV and Rehabilitation (CWGHR)

It was reported that representatives from CWGHR took part in a recent conference call with the committee. CWGHR reviewed its recent policy paper and outlined its next steps. For the foreseeable future, the group has decided to focus on professional practice and education. Other broad areas outlined in the paper include research, vocational and income support.

The committee requested that Council provide general support for continued work in this area and to keep rehabilitation issues in mind as part of the Strategy, particularly care, treatment and support, as well as legal and ethical concerns.

Rapid Point of Care Testing

Louise Binder advised Council that the committee had reviewed the Canadian HIV/AIDS Legal Network document, Rapid HIV Screening at the Point of Care: Legal and Ethical Questions. (Ralf Jürgens did not participate in these discussions as he is a co-author of the document.) The Committee recommended that the Council write to the Minister regarding federal action on recommendations 3, 4, 5 and 20 of the document.

AD HOC COMMITTEE ON COMMUNICATIONS

It was reported that the Public Record of Meeting (PRoM) for the June and September Council meetings are posted on the MC web site and are now up to date. It was also reported that the web site would be monitored to determine the number of hits (people visiting the site) it is getting on a monthly basis.

STANDING COMMITTEE ON MONITORING AND EVALUATION

The committee provided Council with a brief historical overview of the development of a process for ongoing review of the Canadian Strategy on HIV/AIDS (CSHA) allocations. The work done by the committee ranges from the development of a general process that enables reviews of the CSHA to the refinement of a five stage matrix for allocation reviews under the CSHA. The committee is still developing a Resource Allocation Framework to guide the process..

The Council provided its feedback and suggested further refinements to the Resource Allocation Framework.

SPECIAL WORKING GROUP ON ABORIGINAL ISSUES (SWGAI)

It was reported that the committee discussed the progress of the four recommendations that SWGAI made to Council and the subsequent letter that was sent to the Minister addressing some of these recommendations. It was reported that these recommendations do not appear to have been fully addressed by Health Canada.

It was acknowledged that Health Canada had been slow in initially responding to the recommendations. It was stated that the Situation Report was in translation and should be ready in January, 2001.

It was reported that a letter was sent to First Nations and Inuit Health Branch (FNIHB)of Health Canada inquiring about its HIV/AIDS monitoring and evaluation activities.

AD HOC COMMITTEE ON COMMUNITY-BASED RESEARCH

Health Canada provided Council members with an update on the work of the CBR Advisory Reference Group (CBR-ARG). It was reported that that Health Canada, the CBR-ARG and the Peer Review Panel met in Ottawa to discuss areas of concern regarding the CBR program with the aim to guide the development of a policy framework for the CBR program.

Council named Rick Marchand to sit as ex-officio member on the CBR-ARG.

BUSINESS ARISING

Next Meeting: The next meeting will be held in Toronto, April 1-2, 2001.

ADDITIONAL ITEMS

Minister of Health attends meeting

The Minister re-stated the importance of Council providing advice to him on the CSHA and HIV/AIDS. The Minister and members of Council discussed immigration, inter-ministerial collaboration and injection drug use.

The Minister spoke briefly on the immigration issue and acknowledged that the Council had not been fully involved. The Minister thanked Council for its advice on this issue. He stated that final advice has not been given to Citizenship and Immigration Canada (CIC), and that Health Canada was consulting various sources prior to submitting its final advice to CIC.

The Minister stated that he would be proposing more explicit collaboration among different ministries on HIV/AIDS.

The Minister stated that he hoped to release his response to the Canadian HIV/AIDS Legal Network's report, Injection Drug Use and HIV/AIDS, by February 1, 2001.

Immigration

It was reported that a letter had been sent to the Minister of Health with Council's advice on the issue of whether prospective immigrants to Canada should be screened and automatically excluded if testing positive for HIV. The letter opposed mandatory testing on the grounds of human rights and public health.

HIV Endemic Populations in Ontario

Dr. Robert Remis, of the University of Toronto, presented epidemiological data and statistical modeling techniques to describe the HIV epidemic among persons living in Ontario who were born in Caribbean or sub-Saharan African countries (HIV-endemic regions). His presentation was based on The HIV/AIDS Epidemic among persons from HIV-endemic countries in Ontario, 1981-1998: Situation Report.

It was noted that analyses of reported AIDS cases in Ontario indicated that persons from HIV-endemic regions accounted for an increasing proportion of provincial cases, particularly since 1996; representing 17% of AIDS cases in 1998. The annual rate of increase of HIV infections approximated 12%, representing 250 new infections in the past few years.

The results of the report highlight the need for epidemiologic research to validate results obtained through statistical modeling, specifically with regard to the substantial rate of HIV transmission in Canada. Social and behavioural studies are also needed to better understand the determinants of transmission among immigrants from HIV-endemic regions. Political will at the community, provincial and national level is required to support further investigations of this public health problem and develop effective preventive interventions.

HIV Endemic Populations in Canada

Dr. Donald Sutherland and Dr. Chris Archibald, of the Bureau of HIV, STD and TB, Health Canada, reported on epidemiological trends in HIV/AIDS in Canada among persons from HIV-endemic countries.

It was reported that there is an increased proportion of AIDS cases and HIV infections represented by the endemic-population category.

Dr. Sutherland reported that sources of data at the national level vary widely given that each provincial jurisdiction has their own criteria for surveillance data which is then submitted to the Bureau of HIV, STD and TB (BHST). Some provinces (e.g. Ontario) do not report ethnicity in HIV case reports.

Dr. Sutherland and Dr. Archibald recommended the following:

• There needs to be more complete exposure category and ethnicity data transmitted from provinces to national HIV/AIDS surveillance system to permit better monitoring of trends.
• To obtain more locally relevant information, the cooperation of community groups and support from all levels of government is required.
• Work with community groups and local public health officials to do local investigations through targeted studies.

Members of the Council stated that it is important to have the best data possible and that collaboration with the appropriate communities is critical.

Presentation - HIV Endemic Task Force

Ms. Charles-Fridal, of the HIV Endemic Task Force, advised Council that Toronto-area community groups and researchers in the University of Toronto's Faculty of Medicine have formed a task group to address the rising prevalence of HIV/AIDS in Ontario's African and Caribbean communities.

It was noted that the communities themselves must ultimately determine what issues need to be addressed and try to educate members of the endemic communities.

Ms. Charles-Fridal advised Council that the HIV Endemic Task Force was recommending that a specific HIV/AIDS Strategy for endemic country populations be set up.

Council discussions following the presentations expressed concern with the accuracy of the statistics representing endemic communities and the fact that the data presented was primarily was Ontario (Toronto) focused.

HEALTH CANADA REPORT

National Reference Group on HIV Post Exposure Prophylaxis

The first meeting of the National Reference Group on HIV Post-Exposure Prophylaxis (PEP-NRG) was held on Thursday October 26 and Friday October 27, in Toronto. The outcomes of the meeting included a review of recent research on PEP, a set of five objectives corresponding to the recommendations made at a 1998 National Conference on Non-Occupational PEP, and a list of proposed short-term activities that will work towards achieving the objectives. The PEP-NRG will identify research needs regarding PEP, provide mechanisms to facilitate communication and enhance data collection between PEP providers, and guide the development of model practices to facilitate protocol development and enhancement in the provinces/territories.

Aboriginal Capacity-Building Program for Community-Based Research

Health Canada has allocated up to $300,000.00 annually toward a four year Aboriginal Capacity- Building Program for Community- Based Research (CBR). Health Canada and the Canadian Aboriginal AIDS Network (CAAN) have convened a formal working group to re-design the Aboriginal Capacity Building Program for Community Based Research.

The working group met in November 2000 to discuss terms of reference for the working group and identify components of the program framework. In addition to designing the objectives, the working group is responsible for developing the application process, a communications and implementation plan, and an evaluation.

National Aboriginal Interim Working Group on HIV/AIDS

The National Aboriginal Interim Working Group (IWG) was established in September, 2000 in response to requests from the Aboriginal community for a review of existing focus groups and advisory bodies to the various branches of Health Canada. The IWG has held three teleconferences and two face-to-face meetings and will, at the end of its six-month term, provide advice to Health Canada on the establishment of new collaborative framework with the Canadian Strategy on HIV/AIDS (CSHA).

The IWG will develop a report on the existing collaborative mechanisms and provide its recommendations for any future activities it deems necessary to enhance collaboration between the Canadian Strategy on HIV/AIDS and Aboriginal communities. This report will be distributed nationally to all participants of the planning summit and to all organizations/individuals who were contacted to provide nominations to the IWG. The final recommendations will be made to Health Canada following the Summit meeting of May, 2001.

Canadian Institutes of Health Research

Health Canada is moving forward with the Canadian Institutes of Health Research (CIHR) on a number of partnership initiatives including two activities that will have a direct impact on HIV/AIDS research. These are the transfer of some CSHA research programs to the CIHR for administration, and the development of a system of accreditation, training and oversight for research ethics boards.

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

The FPT AIDS report is as follows:

• The FPT AIDS Working Group on Point-of-Care Testing held a teleconference in November 2000 where it was agreed that the working group will gather information about where test kits are being used across the country. This will facilitate information sharing should any policy/programming issues arise concerning the kits.
• The FPT AIDS Working Group on Injection Drug Use is continuing its work with other FPT committees (reflecting expertise in population health, drugs, corrections and justice) to develop a framework that will guide collaborative government action to reduce the harms associated with injection drug use in Canada.
• Working groups on mother-to-child HIV transmission, emerging issues, drug access and rehabilitation, Aboriginal issues, and priority-setting continue their work.
• The next meeting of FPT AIDS will be February 22-23 2001. The meeting will include a discussion of changes to the committee's terms of reference to allow non-governmental participation on FPT AIDS working groups.

 WORKPLANS

No new items