Public Record of Meeting - January 21-22, 2005
Toronto, Ontario

The Ministerial Council on HIV/AIDS was created to advise the Minister of Health on aspects of HIV/AIDS that have a national scope. The Minister of Health meets with the Ministerial Council at least once a year to receive its advice and recommendations, and reports annually to Canadians on the progress of the Federal Initiative to Address AIDS in Canada. Additionally, the Ministerial Council provides ongoing advice and communications to the Minister throughout the year.

The Public Record of Meeting (PROM) that follows provides an overview of the issues, information and recommendations discussed at the January 21-22, 2005, meeting of the Ministerial Council on HIV/AIDS. Where appropriate, discussion points and action items are reported to the public within the PROM. For a detailed summary of activities, please refer to the annual report which the Ministerial Council publishes every June for the preceding year ending March 31. Annual reports are available for download from the Ministerial Council's website:

http://www.phac-aspc.gc.ca/aids-sida/fi-if/minister-eng.php

Present:

Ministerial Council : Louise Binder, Lindy Samson (Co-Chairs); Mary Armstrong, Richard Elliott, Dionne A. Falconer, Deborah Foster, Michael Grant, Brian Huskins, Enrico Mandarino, Kenneth Monteith, David Nelson, Anita Rachlis, Sheena Sargeant. Ex-officio: Frank McGee, Provincial Co-Chair, Federal/Provincial/Territorial Advisory Committee on AIDS (FPT AIDS); Frank Plummer (January 22), Federal Co-Chair, FPT AIDS

Regrets: Jacqueline Gahagan, Marie Anésie Harérimana

Public Health Agency of Canada (PHAC) : Nina Arron, Director, HIV/AIDS Policy, Coordination and Programs Division, Grafton Spooner, Manager, Strategy Management and Partnership Unit, HIV/AIDS Policy, Coordination and Programs Division

Secretariat: Lilja Jónsdóttir, Karla Tate

Recording and Facilitation Services : Wylie Thomas, Hajo Versteeg. 

Presenters: Joan Anderson, AIDS2006 Local Host; Alan Bernstein, Canadian Institutes for Health Research (CIHR); Neil Burke, HIV/AIDS Policy, Coordination and Programs Division, Public Health Agency of Canada (PHAC); Fernand Comeau, HIV/AIDS Policy, Coordination and Programs Division, PHAC; Gail Flintoft, AIDS2006 Local Host; David Hoe, HIV/AIDS Policy, Coordination and Programs Division, PHAC; Paula Kirton, CIHR; Alan Li, Committee for Accessible AIDS Treatment (CAAT); Sylvie Martin, Citizenship and Immigration Canada; Bruce Moor, CIHR; Chris Power, CIHR HIV/AIDS Research Advisory Committee (CHARAC); Bhagirath Singh, CIHR; Steven Sternthal, HIV/AIDS Policy, Coordination and Programs Division , PHAC; Esther Tharao, African and Caribbean Council on HIV/AIDS in Ontario (ACCHO).

Orientation for New Members of the Ministerial Council on HIV/AIDS

The Ministerial Council on HIV/AIDS held a two-hour orientation session for new members in the evening of January 20, 2005.

Welcome and Approval of Agenda

Nina Arron, Director of the HIV/AIDS Policy, Coordination and Programs Division (HIV/AIDS Division) of the Public Health Agency of Canada (PHAC), welcomed new members of the Ministerial Council on HIV/AIDS on behalf of the Minister of Health and Dr. Frank Plummer, Director General, Centre for Infectious Disease Prevention and Control. She noted that Canada was at a pivotal moment in its response to the HIV/AIDS epidemic and that the new Federal Initiative (FI) to Address HIV/AIDS in Canada had now been launched.

The Co-Chairs said a few words of welcome and thanked members who recently left the Ministerial Council for their dedication and hard work. The meeting agenda was reviewed and accepted with minor changes.

XVI International AIDS Conference

The Ministerial Council on HIV/AIDS received an update on preparations for the XVI International AIDS Conference being hosted by Canada in Toronto in August 2006 from Joan Anderson, AIDS2006 Local Host [???], and Gail Flintoft, Chair of the Canadian AIDS Society. Ms. Anderson and Ms. Flintoft advised the Ministerial Council that a question on the visa application form, which most delegates to the conference must complete, requires people with HIV to declare their status. They noted that this could become a potentially embarrassing issue for Canada and possibly result in the conference being pulled, as it is the policy of the International AIDS Society not to hold its events in countries that discriminate against people living with HIV/AIDS. As well, there are considerable pressures to hold the conference in the developing world, where the epidemic is taking its greatest toll. Another issue is that visa applicants must pay a processing fee, which discriminates against people from developing countries, the majority of whom are from countries that require a visa to visit Canada. More generally, they reported that there were inconsistencies in how the immigration rules are applied to HIV-positive individuals.

The Ministerial Council advised Ms. Anderson and Ms. Flintoft that this was an issue that it had been following closely and understood the critical timelines involved. It informed them that it would be raising the issue in a meeting with representatives from Citizen and Immigration Canada (CIC) later in the day and provided suggestions for action. The presenters agreed to provide briefing notes which the Ministerial Council could use when it raises the issue with the Minister of Health and others and offered to keep the Ministerial Council updated.

Following the departure of the presenters, the Ministerial Council discussed possible next steps and agreed to write a letter to the Minister of Health to advise him of the urgency of the issue.

Update on Leading Together: Canada's HIV/AIDS Action Plan

The Ministerial Council on HIV/AIDS received an update on Leading Together: Canada's HIV/AIDS Action Plan (2005-2010) from Steven Sternthal and Fernand Comeau of the HIV/AIDS Division, PHAC. Messrs. Sternthal and Comeau noted that the development of the plan began in the middle of 2002 and involved large-scale consultations which were conducted through a variety of means including face-to-face meetings, interviews, presentations and online feedback. They emphasized that, although PHAC had played a significant role in its development, Leading Together was a multi-stakeholder--not a federal--document; the FI should be considered the federal government's contribution to the implementation of Leading Together. They reviewed the key elements and structure of the document, noting that for each of its six key strategies, Leading Together identifies desired outcomes, a list of actions and measurable targets to be reached by 2010. They reported that Leading Together was in final draft form and that they would be consulting with federal departments, advisory bodies (such as NACHA, Ministerial Council, FPT AIDS) and national NGOs to discuss its implementation in the months ahead.

Following the presentation, the Ministerial Council discussed next steps and opportunities for supporting the implementation of Leading Together. Members of the Ministerial Council expressed reservations about championing the document in its current form and provided specific advice for addressing its concerns. The Ministerial Council thanked the presenters and advised them that it would be in touch once it had had a chance to review the document further.

Following the departure of the presenters, the Ministerial Council discussed next steps and agreed that its members would need time to read Leading Together carefully before providing comments. It scheduled a teleconference to discuss formulating its advice on Leading Together.

Preparation for Meeting with the Canadian Institutes of Health Research

The Ministerial Council on HIV/AIDS spent time preparing for its meeting with representatives of the Canadian Institutes of Health Research (CIHR). It was noted that a partial list of issues the Ministerial Council wished to raise with CIHR had been included in the letters of invitation, copies of which were distributed in the meeting binders.

Presentation by the Canadian Institutes of Health Research

The Ministerial Council on HIV/AIDS heard presentations from Alan Bernstein, President of CIHR and Chris Power, Chair of the CIHR HIV/AIDS Research Advisory Committee. Accompanying Drs. Bernstein and Power were: Dr. Bhagirath Singh, Scientific Director, Institute of Infection and Immunity (III); Dr. Bruce Moor, Assistant Director, III; and Ms. Paula Kirton, Team Lead, HIV/AIDS & HCV Initiatives, III.

Dr. Bernstein presented an overview of HIV/AIDS research at CIHR. He noted that CIHR was one of four partners in the Federal Initiative to Address HIV/AIDSin Canada (formerly the Canadian Strategy on HIV/AIDS) through which it received $13 million to fund HIV/AIDS research in 2004/2005. As part of the agreement for receiving FI funding, CIHR committed to a minimum $3.5 million / year in additional direct spending on HIV/AIDS research. CIHR estimates that it spends closer to $9 million directly on HIV/AIDS, and a further $7.5 million indirectly. Dr. Bernstein reviewed examples of the HIV/AIDS research projects funded by CIHR. He noted that CIHR had recently assumed responsibility for administering the Community-Based Research (CBR) Program of the FI and that it had modified its eligibility criteria to maintain the spirit of CBR.

Dr. Power provided an overview of CHARAC and its role advising the Internal Advisory Board (IAB) of the Institute of Infection and Immunity (III) on research priorities for HIV/AIDS. He noted that CHARAC also advised other institutes of CIHR indirectly via the participation of III on CIHR Research Priorities and Planning Committee (RPPC). Membership in CHARAC is broad and includes representation from multiple CIHR Institutes, HIV/AIDS researchers, the Ministerial Council, PHAC and broader community organizations.

Following the presentations, the Ministerial Council held a discussion with the representatives from CIHR and CHARAC and expressed its desire to continue dialogue and to present to CIHR should the opportunity arise. It noted its concerns about maintaining the spirit of CBR and ensuring that it is driven by the needs of community. Among other things, it advised CIHR that an ethical review process for CBR was still lacking. It raised concerns about ensuring that funding levels for HIV/AIDS research are sustained and that research in other disease groups is not integrated with HIV/AIDS research without additional funding.

Following the departure of the presenters, the Ministerial Council discussed follow-up actions. It asked the Research Committee to draft a letter thanking the presenters and reiterating its concerns about the functioning of CBR, the availability of ethics review to community researchers and integration of other disease groups with HIV/AIDS and expressing its desire for continued dialogue.

Approval of November 2004 Record of Decision and Public Record of Meeting

The Ministerial Council on HIV/AIDS approved the Record of Decision from its meeting on November 27 - 29, 2004, in Ottawa, subject to a number of changes. It agreed to postpone approving the Public Record of Meeting to a future meeting in order to allow the Communications and Liaison Committee time to develop a template and guidelines. It was noted that there were concerns about balancing timeliness and transparency with ensuring that persons connected to Ministerial Council decisions are given enough time to respond to Council advice.

Preparation for Meeting with Citizenship and Immigration Canada

The Ministerial Council spent time preparing for its meeting with representatives of Citizenship and Immigration Canada (CIC). It was noted that, in addition to the issue of the visa application forms raised earlier, there were questions about CIC's policies and programs for HIV testing of migrants, pre- and post-test counselling and accessibility of health and support services.

Report from Health Canada and the Public Health Agency of Canada

Frank Plummer, Director General, Centre for Infectious Disease Prevention and Control, PHAC, welcomed new and returning members to the Ministerial Council on HIV/AIDS. He explained that this session was normally set aside for the Health Canada / PHAC report, but that today it would be replaced by a presentation on the new Federal Initiative (FI) to Address HIV/AIDS, which he described as the federal government's contribution to Leading Together. He noted that the FI was the first major program of the new agency and represented a significant portion of its budget.

The Federal Initiative to Address HIV/AIDS in Canada

The Ministerial Council on HIV/AIDS heard a presentation on the new FI from David Hoe and Neil Burke of the HIV/AIDS Division of PHAC. Mr. Hoe described the main elements of the FI, its relationship to Leading Together, how it differs from previous Canadian Strategies on HIV/AIDS and how the Ministerial Council can support its implementation. He noted that the federal government would be creating a new accountability framework for the FI, which will include establishing new bodies to coordinate and align federal agencies and departments in the FI. Mr. Burke reviewed funding figures to show how the FI funds will be divided between program areas as well as between departments and agencies and to highlight differences with the CSHA. Funding for the FI is being increased over a five-year period and will reach $84.4 million/year in 2008/09. At the end of their presentations, Messrs. Burke and Hoe described next steps in implementing the FI and suggested areas for advice from the Ministerial Council. Following the presentations, a discussion was held with the presenters in which the Ministerial Council provided specific comments and suggestions.

Citizenship and Immigration Canada Presentation on HIV/AIDS and Immigration

Sylvie Martin, Acting Director, Immigration Health Program at Citizenship and Immigration Canada (CIC), provided the Ministerial Council on HIV/AIDS with a presentation on HIV/AIDS and immigration to Canada. She extended regrets from Mr. Anthony Hannaford who was unable to make the meeting due to flight scheduling problems. Dr. Martin described the requirement for HIV testing, which has been part of the routine immigration medical examination administered to immigrants and certain classes of temporary residents since January 2002. She reviewed the grounds for medical inadmissibility and the pre- and post-test counselling programs that are in place. She also provided statistics on the number and demographics of immigration applicants who tested positive for HIV from January 2002 to the end of 2004.

Following her presentation, the Ministerial Council raised its concerns about the disclosure of HIV status on visitor visa application forms and offered its support in finding a permanent solution in time for the August 2006 International AIDS Conference. As well, the Ministerial Council raised a number of other issues related to pre- and post-test counselling and advised Dr. Martin of gaps between CIC policy and practice.

Following Dr. Martin's departure, the Ministerial Council identified follow-up actions. It asked the Secretariat to arrange a teleconference between members of the Ministerial Council, CIC, the AIDS2006 Local Host and others to discuss ways to address the issue of the visa form. It also provided comments on a draft letter to the Minister of Health advising him of the issue, which it asked the Secretariat to finalize.

Community Presentation on HIV/AIDS and Immigration

Esther Tharao, Co-Chair, African and Caribbean Council on HIV/AIDS in Ontario (ACCHO) and Alan Li, a physician with the Regent Park Community Health Centre in Toronto, met with the Ministerial Council on HIV/AIDS to present on immigration HIV testing and the barriers to accessing HIV/AIDS services experienced by immigrants to Canada. They identified a number of problems in how the current system deals with HIV/AIDS and immigrants and suggested a number of specific solutions for Council to champion.

Following the departure of the presenters, the Ministerial Council discussed follow-up action and agreed to facilitate a meeting between CIC, PHAC and immigrant community groups. It asked the Secretariat to draft a letter to the Minister of Health informing him that it would be participating as an observer at a meeting between CIC and community groups, which is consistent with population-specific approaches called for in the FI. The Ministerial Council asked the Secretariat to arrange a conference call for full Council to discuss pressing business not covered in the meeting, including a more detailed discussion of Dr. Li's and Ms. Tharao's suggestions. It asked the Secretariat to draft letters to Ms. Tharao and Dr. Li to thank them for their presentation and advise them of its follow-up activities.

Debrief on Federal Initiative Presentation

The Ministerial Council held a discussion to determine follow-up to the presentations it received earlier in the day from David Hoe and Neil Burke of the HIV/AIDS Division. It asked the Secretariat to draft letters thanking Messrs. Burke and Hoe and reiterating the main points it raised in the meeting. It also identified a number of additional points of advice and clarification, which it asked the Secretariat to include in the letters.

Debrief on Leading Together Presentation

The Ministerial Council held a discussion to determine follow-up to the presentations it received the day earlier from Fernand Comeau and Steven Sternthal of the HIV/AIDS Division. It asked the Secretariat to draft letters thanking Messrs. Comeau and Sternthal and reiterating the main points it raised in the meeting. It also identified a number of additional points of advice and clarification, which it asked the Secretariat to include in the letters.

Business Arising From the November 2004 Meeting

The Ministerial Council on HIV/AIDS reviewed the status of action items identified at its meeting on November 27 - 29, 2004, in Ottawa. It also reviewed incoming and outgoing correspondence since that meeting.

Next Face-to-Face Meeting of the Ministerial Council on HIV/AIDS

The Ministerial Council on HIV/AIDS confirmed the date of its next face-to-face meeting in Montreal on May 6-7, 2005, and identified a number of agenda items for consideration by the Executive Committee.

Committee Reports of the Ministerial Council on HIV/AIDS

The Ministerial Council on HIV/AIDS asked the chairs of committees to report out by exception, given the short time remaining in the meeting.

Update from the Federal/Provincial/Territorial Advisory Committee on AIDS

Frank McGee, Provincial Co-Chair, FPT AIDS, reported that the committee had not met since the last meeting of the Ministerial Council on HIV/AIDS. He noted that the next meeting of FPT AIDS would be held in Vancouver on February 14, 2005.

Close of Meeting

The Co-Chairs thanked members of the Ministerial Council on HIV/AIDS for their hard work and commitment. They encouraged new members to read the Ministerial Council's annual report and to settle on committee membership in time for the May meeting.