Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada - Meeting of February 19 - 20, 2009 - Ottawa, Ontario

Public Record of Meeting

 

Present

Ministerial Advisory Council: Brian Conway (Co-Chair) and John Charles Plater (Co-Chair); Jonathan Angel, Monique Doolittle-Romas, Jacqueline Gahagan, Faye Katzman, Ken Monteith, Gerry Mugford, David M. Nelson, Anita Rachlis, Sheena Sargeant, Jacobet Edith Wambayi.

Regrets: Michelle George, Frank McGee.

Public Health Agency of Canada (PHAC): Grafton Spooner, Manager, External and Government Relations.

Secretariat: Marc-André Bélair, Susan Maves.

Facilitation and Recording Services: Hajo Versteeg and Wylie Thomas

Guests:Jacqueline Arthur, HIV/AIDS Division, PHAC; David Butler-Jones, Chief Public Health Officer of Canada; John Foster, North-South Institute; Marsha Hay-Snyder, HIV/AIDS Division, PHAC; Joanna Henry, North-South Institute; Patricia Hurd, HIV/AIDS Division, PHAC; Brian Huskins, Huskins and Associates; Tanya Lary, HIV/AIDS Division, PHAC; Stephanie Mehta, HIV/AIDS Division, PHAC; Michael R. Smith, HIV/AIDS Division, PHAC; Karen Walton, Resource Management and Analysis Division, PHAC; Donald Wong, Resource Management and Analysis Division, PHAC.

Welcome

The Co-Chairs of the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada opened the meeting with a few words of welcome. The meeting facilitator reviewed the agenda, which was accepted with modifications.

October 2008 Meeting Reports

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada approved the Record of Decisions and the Public Record of Meeting from its meeting in Ottawa on October 23 and 24, 2008.

Review of Business Arising Since the October Meeting

The Secretariat reviewed the status of action items identified at the October meeting and identified a number for further follow up. In response to a request received by the Co-Chairs, the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada agreed to participate in the Leading Together Championing Committee.

Roundtable “Check-In”

Time was allocated in the agenda to allow members of the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada to update each other on current activities and key issues.

Preparation for Meeting with the Chief Public Health Officer of Canada

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada spent time preparing for its meeting with the Chief Public Health Officer of Canada. A format for the meeting was agreed to and individual members were identified to raise each of the four issues to with the Chief Public Health Officer.

Meeting with the Chief Public Health Officer

The Chief Public Health Officer of Canada, Dr. David Butler-Jones, joined the meeting by teleconference to meet with the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada. Joining him in the room was Dr. Frank Plummer, Scientific Director General of the National Microbiology Laboratory. The following four issues were raised and discussed:

1. The Public Health Agency of Canada’s future directions and priorities regarding HIV/AIDS;
2. The Public Health Agency’s progress and orientation on the determinants of health;
3. The Public Health Agency’s funding realities and constraints regarding the Federal Initiative to Address HIV/AIDS in Canada; and,
4. The Public Health Agency’s position on harm reduction, particularly in relation to addressing the needs of key populations.

Following the departure of the guests, the Ministerial Advisory Council debriefed to determine follow-up actions.

Committee Reports to Council

Report from the Executive Committee

The Executive Committee provided its report to the Ministerial Advisory Committee on the Federal Initiative to Address HIV/AIDS in Canada.

Report from the Prevention, Care, Treatment and Support Committee

The Prevention, Care, Treatment and Support (PCTS) Committee provided its report to the Ministerial Advisory Council, highlighting a number of issues it is monitoring: stigma and discrimination; National Pharmaceutical Strategy; HIV Testing and Counselling; Treatment As Prevention; Status Reports for Specific Populations; and criminalization of non-disclosure of HIV status. In the discussion that followed, the Ministerial Advisory Council identified a number of possible agenda items for its next meeting.

Report from the Partnership Committee

The Partnership Committee provided its report to the Ministerial Advisory Council, noting that it was working on a letter to the Minister of Health encouraging her to participate in events related to World Hepatitis Day (May 19). On the advice of the Ministerial Advisory Council, the committee agreed to consult with the Hepatitis C Secretariat before proceeding.

Report from the Strategies Committee

The Strategies Committee provided its report to the Ministerial Advisory Council, highlighting a number of issues it is working on: a paper on evidence-based decision making and funding for HIV/AIDS.

Report from the Research Committee

The Research Committee provided its report to the Ministerial Advisory Committee, noting that a priority issue it is monitoring is the development of a pan-Canadian HIV/AIDS research plan. It also provided an update on the recent meeting of the CIHR HIV/AIDS Research Advisory Committee (CHARAC) and activities of the Canadian Institutes for Health Research and its HIV/AIDS Research Program.

Report from the International Committee

The International Committee provided its report to the Ministerial Advisory Council, noting that its recent activities had focused on three issues: a comparative study of national HIV/AIDS strategies; a proposal for holding a panel session on national HIV/AIDS advisory bodies and mechanisms for the 2010 International AIDS Conference; and, membership on the Consultative Group on Global HIV/AIDS Issues. The Ministerial Advisory Council agreed to become a member of the Consultative Group and asked the International Committee to identify a representative.

Council Membership Renewal

The Secretariat provided the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada with an update on the membership renewal process, noting that a new Ministerial Advisory Council would be constituted for the Fall of 2009.

Council Work Planning

The Secretariat provided the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada with an update on the work-planning process. Council Committees agreed to allocate time on their next teleconference to identify work plan items and to each designate an individual to work with the Secretariat to prepare a work plan for the coming year.

Ministerial Advisory Council Meeting Dates

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada identified dates for its next two meetings: June 4 – 6, 2009 (Ottawa) and October 1 – 3 (Toronto). It also identified alternate dates for the Spring meeting to allow the Secretariat and Executive Committee the flexibility to schedule a meeting with the Minister of Health.

Federal Initiative Financial Report

Stephanie Mehta, Senior Policy Analyst, HIV/AIDS Division, PHAC, joined the meeting to provide the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada with the financial report for the Federal Initiative. Also present were Marsha Hay-Snyder, Manager, Accountability and Awareness Section of the HIV/AIDS Division, and Karen Walton and Donald Wong of the Resource Management and Analysis Division of PHAC. Ms. Mehta’s presentation included a summary of total reported expenditures and anticipated expenditures of the Federal Initiative for fiscal year 2008-2009 broken down by the four partners (Correctional Service Canada, Canadian Institutes of Health Research, Health Canada and PHAC) and by programmatic area of the Federal Initiative as requested by Council at earlier meetings. She confirmed that the annual funding envelope of the Federal Initiative is $72.6 million.

Following the presentation, the Ministerial Advisory Council had an opportunity to ask the guests to explain the variances reported and describe their plans for improving internal financial coding and reporting systems. It advised the presenters to begin using the “$72.6 million” figure in all communications related to the Federal Initiative and to sort out any variance due to coding errors before presenting the financial report to other audiences.
Following the departure of the guests, the Ministerial Advisory Council agreed to write a letter to the presenters thanking them for the financial report and repeating its advice that all government communications use the $72.6 million when referencing the funding envelope for the Federal Initiative. It also agreed to write a second letter to the Minister of Health thanking her for the increased transparency in the financial report and advising her that the government should start using the $72.6 million figure.

Update on Reviews Implicating the Federal Initiative

Current Realities and Future Directions

Marsha Hay-Snyder provided the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada with an historical overview of federal investments in the response to HIV/AIDS in Canada and a summary of the current and planned reviews related to the Federal Initiative. She reviewed a number of ongoing initiatives and environmental influences that will affect funding and the focus of the Federal Initiative in the future. These include the need to take stock of the first five years of the Federal Initiative and changes in the epidemic, and the results of a summative evaluation and an implementation evaluation currently underway. As a result of these, the Public Health Agency of Canada is planning to review its Federal Initiative programs to identify opportunities for greater efficiencies and effectiveness, balancing resources between government and non-government delivery of programs and stakeholder engagement.

Update on Review of Committees Under the Federal Initiative

Tanya Lary, Senior Policy Advisory, External and Government Relations, HIV/AIDS Division, PHAC, joined the meeting to provide an update on work underway to review the advisory and coordinating structure that supports implementation of the Federal Initiative. The objectives of the review are to ensure that existing committees are aligned with the objectives of PHAC and the priorities of the Government of Canada and that the results produced are of high value and consistent with expected outcomes of the Federal Initiative. Ms. Lary outlined next steps in the review process and opportunities for input from the Ministerial Advisory Council. An external consultant has been hired to conduct the review, with completion expected by July 2009.

Following the presentations, the Ministerial Advisory Council had an opportunity to provide feedback and ask questions of the presenters. Following the departure of the guests, the Ministerial Advisory Council asked the Secretariat to write letters to the presenters thanking them for their updates and reconfirming its desire to be involved in the reviews. It also asked the Strategies Committee to take the discussion under advisement as it prepares a letter to the Minister of Health with advice on the reviews and the Partnership Committee to report back at a later meeting with recommended follow up to Ms. Lary’s presentation.

Update on HIV Disclosure and Criminal Law

Michael R. Smith, Senior Policy Advisor, Populations Section, HIV/AIDS Policy, Coordination and Programs Division, Public Health Agency of Canada joined the meeting to provide an overview of the public health issues raised by the application of Canadian criminal law to individuals who fail to disclose their HIV sero-status to sexual partners. He reviewed a number of cases that have laid the foundation for the treatment of non-disclosure of sero-status under Canadian law. Unlike other countries where convictions are based on HIV transmission, in Canada proving exposure to HIV is sufficient grounds for conviction and vitiates consent which opens the way for serious criminal charges such as aggravated assault and even murder. Mr. Smith reviewed some of the public health consequences of this approach to non-disclosure and discussed the advantages of using a public health approach instead of the criminal law in these approaches
Following his presentation, Mr. Smith remained in the meeting to answer questions. The Ministerial Advisory Committee noted the urgency of addressing this issue given its possible consequences on people’s decisions to know their HIV sero-status and suggested a number of roles in addressing this issue. Following his departure, the Ministerial Advisory Council asked the Prevention, Treatment, Care and Support Committee to take Mr. Smith’s presentation under advisement and report back with recommended actions including possible advice to the Minister of Health. The Ministerial Advisory Council asked the Secretariat to draft on its behalf a letter thanking Mr. Smith for his presentation.

Update on Population-Specific Status Reports

Jacqueline Arthur, Manager, Populations Section, HIV/AIDS Policy, Coordination and Programs Division, Public Health Agency of Canada, provided the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada with an update on the development of eight Status Reports for specific populations and to seek its guidance on a draft dissemination and communications plan for the reports. The Status Reports will provide information on the epidemic and the response to those epidemics in each of the 8 at-risk populations namely: people living with HIV/AIDS; gay men; people who use injection drugs; Aboriginal Canadians; prisoners; youth at risk; women and girls; and, people from countries where HIV is endemic.
In the discussion that followed Ms. Arthur’s presentation, the Ministerial Advisory Council identified a number of events, venues and target audiences for disseminating the Status Reports. Following her departure, the Ministerial Advisory Council asked the Secretariat to draft a letter thanking Ms. Arthur for her update.

Paper on Evidence-Based Decision Making

Brian Huskins of Huskins and Associates joined the meeting to provide the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada with a status update on the paper he is preparing on the use of evidence in policy decision making and to receive guidance for completing the work. In the discussion that followed, the Ministerial Advisory Council identified and clarified questions it would like answered in the report. Following the departure of the guest, the Ministerial Advisory Council asked the Secretariat to prepare a letter thanking Mr. Huskins for his update and asked the Executive Committee to consider allocating time in the next meeting agenda to discuss and clarify the process for hiring consultants.

Update on the Determinants of Health Policy Forum

Patricia Hurd, Senior Policy Advisor, HIV/AIDS Policy, Coordination and Programs Division, Public Health Agency of Canada, joined the meeting by teleconference to provide the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada with an overview of the Policy Forum on the Determinants of Health that the HIV/AIDS Division is organizing on behalf of the Assistant Deputy Minister’s Committee on HIV/AIDS. The forum, which will be held on June 8 – 9, 2009, will help raise awareness among federal departments and agencies of the social and economic conditions that determine health status and to identify opportunities to collaborate on addressing these conditions to promote health and quality of life for Canadians.
Following Ms. Hurd’s presentation, the Ministerial Advisory Council had an opportunity to ask questions and indicated its desire to receive an update following the policy dialogue. Following Ms. Hurd’s departure, the Ministerial Advisory Council asked the Secretariat to prepare a letter on its behalf thanking Ms. Hurd for her presentation.

Comparative Analysis of National HIV/AIDS Strategies in High-Resource, Low-Prevalence Countries

John Foster and Joanna Henry of the North-South Institute joined the meeting to provide the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada with a status update on the comparative analysis they are preparing of national HIV/AIDS strategies in other high-resource, low-prevalence countries. The Ministerial Advisory Committee provided guidance for completing the report including suggestions of countries to include in the study and issues to address. Following the departure of the presenters, the Ministerial Advisory Council asked the Secretariat to prepare a thank-you letter to the presenters on its behalf and asked the Executive Committee to consider inviting the North-South Institute to its next meeting to present the results of its study.

Closing Remarks 

The Co-Chairs thanked members of the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada and the Secretariat for their hard work and dedication.