Meeting of June 17-18, 2001 - Montreal - 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 Executive Committee had two conference calls since the last meeting in April.

It was noted that some of the issues the Executive had discussed, namely the Ministerial Council's budget and expenditures, as well as the publication of Council documents, would be discussed under Item # 9 - Council In-Camera Session on Day 2.

It was reported that while the Minister of Health's office did select its new Council members in time for this meeting, the orientation for new members would be deferred until September's meeting, in part because of the significant cost implications on Council's limited budget.

 STANDING COMMITTEE ON CHAMPIONING OF CURRENT AND EMERGING ISSUES

i) Vaccines

It was reported that the Committee had two presentations on this issue - one from Craig McClure and the other from David Thompson, both of whom are involved in the IAVI trial. They indicated that preliminary results will be presented in the fall and depending on the results, the investigators may apply for approval to sell the vaccine.

It was noted that a number of issues were raised with respect to vaccines in general and their delivery.

• Recruitment for trials - a diverse population is not being recruited (e.g. women, even though they represent 50% of cases worldwide).
• Education about the nature of vaccines (what they are or are not) has not been well defined for trial participants or for the general public and will be an increasingly important aspect should a vaccine be approved for use.
• Informed consent is a definite problem due to the length and complexity of the document that needs to be signed. There are ethical issues surrounding how much information must be contained within the consent and how to ensure it is comprehensible.
• Delivery - How to ensure that vulnerable populations get the vaccine given that they are hard to reach? How to determine who gets a vaccine during start up manufacturing period when it is in short supply? Will the most marginalized groups experience systemic discrimination when being considered?

It was reported that the recommendation coming from the two presenters is that Canada needs a national strategy to address all of the issues regarding vaccine trials and delivery. The committee is planning on inviting Kelly MacDonald on a conference call to discuss this issue from a researcher's perspective, after which the Committee will develop a set of recommendations for Council or at least issues for discussion/decision by Council.

ii) Inter-ministerial collaboration

It was reported that the report, Towards a Broader View of Health: Strengthening Inter-Ministerial Collaboration on HIV/AIDS in Canada, and a letter including recommendations has been sent to the Minister.

iii) Funding adequacy

It was reported that the report, Taking Stock: Assessing the Adequacy of the Government of Canada's Investment in the CSHA, and a letter containing recommendations has been sent to the Minister. The report is being translated and will be posted on the Council website.

iv) Correctional Services Canada (CSC)

It was reported a letter has been sent to the Minister recommending that he meet with the Solicitor-General.

v) Endemic Populations

It was reported that a letter has been sent to the Minister on this issue. It was reported that the Ontario HIV Endemic Task Force will hold a forum together on September 29, 2001 to deal with the issue of endemic populations and HIV/AIDS. A strategic plan will be circulated to various stakeholders for their feedback.

vi) Bill C-217: Blood Samples Act

It was reported that a letter has be sent to the Minister on this issue.

vii) Canadian Drug Strategy

It was reported that the letter on the Drug Strategy is in the final drafting stage and will be sent to the Minister in the near future.

viii) Determinants of Health

It was reported that FPT AIDS has approved its share of funds for this project. It was noted that, race, as a determinant of health, needs to be integrated into this project.

ix) CIHR Invitation

Council agreed to invite the CIHR president, Dr. Allan Bernstein to its September meeting.

x) UNGASS

It was noted that the Council had written to Prime Minister Jean Chrétien to encourage him to show leadership on this issue and to lead the Canadian delegation to the UN, but the reply Council received from him did not respond to Council's requests.

xi) IDU Response

It was reported that the Canadian HIV/AIDS Legal Network has met with the Minister resulting in some changes to the Minister's response. No date for its release has been established.

xii) Women's Reference Group

It was reported that that the Women's Reference Group (WRG) has disbanded. It was reported that it was unclear whether the group's recommendations will go forward since none appear in the HIV/AIDS Division's new work plans.

It was reported that members of the WRG would be writing a letter of complaint to HC criticizing the way in which they found out about the disbanding of the group. Concern was expressed that the members of the WRG were not made aware that theirs was a time limited group.

It was noted that HC is in the process of reviewing the terms of reference for national reference groups.

It was suggested that the WRG meet one more time by way of conference call to review and comment on responses to their recommendation, in addition to "closing" the group in a manner satisfactory to its participants.

The Council directed Health Canada staff to investigate these suggestions and report back to Council. It was further agreed that the WRG's recommendations be circulated to Council members.

xiii) Prevention Strategy for Gay Men

It was reported that a new prevention strategy report entitled Valuing Gay Men's Lives has been released. Copies of the report will be mailed out to members. It was suggested that Council invite Health Canada to do a presentation on this document at the September meeting.

It was pointed out that there was no Aboriginal representation on the Gay Men's Reference Group. It was noted that the Two Spirited survey distributed at the last Council meeting would be useful in documenting collaboration and in building partnerships. It was suggested that gay men's strategy document be linked with the Two Spirited survey.

xiv) Drug Review Process

Members were advised that it appears that the Advisory Panel on Product Licensing Process will be disbanded by the Therapeutic Products Division (TPD). The Championing Committee recommends that it not be disbanded since oversight and advice in implementing post approval recommendations are still required.

AD HOC COMMITTEE ON COMMUNICATIONS

The proposed draft communication strategy for the Ministerial Council was tabled.

Three proposed mechanisms were presented as the key components of the draft communication strategy for Council:

a) promoting the Council's public profile;
b) managing incoming information;
c) managing outgoing information.

It was suggested that reports commissioned by the Council be for public information and use. It was suggested that the committee be empowered to review the report for World AIDS Day (WAD) and to provide advice to the Minister. It was further suggested that Council discuss and identify key messages for the MoH to bring forward on WAD as a standard agenda item for September meetings.

It was requested that Council decide the continuing status of the Ad hoc Communications Committee. The Council agreed that the committee be made a permanent committee of the Ministerial Council.

STANDING COMMITTEE ON MONITORING AND EVALUATION

No New Items

SPECIAL WORKING GROUP ON ABORIGINAL ISSUES (SWGAI)

A brief update on the Aboriginal Summit in Calgary was provided. The purpose of the summit was to ratify a proposed collaborative framework to facilitate the input of Aboriginal people into HIV/AIDS-related policy and programming decisions at the federal level and to nominate members to sit on the proposed Aboriginal Council.

During the Summit, separate caucuses were set up for each of the three Aboriginal groups and each was asked to consider the framework. The Summit was considered successful in that the framework was endorsed in principle by all the Aboriginal caucuses.

The Aboriginal Council will be comprised of 24 Aboriginal seats, with six seats for each of the Aboriginal groups and six seats for the Canadian Aboriginal AIDS Network.

AD HOC COMMITTEE ON COMMUNITY-BASED RESEARCH

No New Items

BUSINESS ARISING

Next Meeting: September 8-10, 2001, Ottawa

ADDITIONAL ITEMS

First Nations and Inuit Health Branch (FNIHB)- Presentation by Keith Conn, Director-General, FNIHB.

HEALTH CANADA REPORT

Migrant Screening and HIV/AIDS

The Minister has sent a letter to the Minister of Citizenship and Immigration with the following recommendations:

• that the testing of immigrants for HIV is fully justified and is an important first step towards diagnosis, treatment and counselling;
• that HIV positive individuals not be automatically excluded on the grounds of public health because HIV is not transmitted through casual contact and transmission is completely preventable;
• that there be a requirement for appropriate counselling and education to reduce the risk of transmission, with the option to exclude in cases where counselling and education efforts are deemed ineffective.

One of the objectives of Health Canada's HIV/AIDS Strategy is to eliminate the stigma that too often attaches to those living with HIV. Our policy toward HIV testing for migrants should be designed to complement our HIV/AIDS strategy, and to reduce the stigma, not reinforce it.

CSHA Direction-Setting and Work-Planning Process

An update on the direction-setting process, including the 2001/02 CSHA workplans, was recently distributed to Council members. The CSHA Direction-Setting and Work-Planning Task Group has identified three recommendations to Health Canada to move forward.

i) That a communication strategy be created to transmit the messages coming out of Gray Rocks and to encourage broader participation in the direction-setting process.
ii) That Health Canada begin to move forward on an implementation process for the ten directions.
iii) That a broad collaborative work-planning process be designed for 2002-03.

Aboriginal Summit and Follow- up

In March, 2000, Health Canada hosted the Aboriginal Information Sharing Meeting on HIV/AIDS in Winnipeg, Manitoba. The gathering was a joint meeting between provincial and federal government representatives and members of national Aboriginal organizations, Aboriginal Health providers, Aboriginal community based AIDS organizations, and Aboriginal people living with HIV/AIDS. One of the issues that arose at the meeting was the need to better coordinate consultative mechanisms between the government and the Aboriginal community.

To achieve the goal of a more coordinated and efficient approach to consultation, an interim working group was established following a national call for interested individuals to join the working group. The interim group was structured to provide equal representation from First Nations, Inuit, Metis and the members of the Canadian Aboriginal AIDS Network (CAAN). Each population was represented by political representatives, front-line workers, and people living with HIV/AIDS. The Aboriginal Interim Working Group (AIWG) met for the first time in October, 2000, with the goal of reviewing existing collaborative mechanisms and determining what changes should be enacted to improve the collaborative process. By the conclusion of the AIWG's term, they had agreed to a single collaborative mechanism that would provide advice to every element of the CSHA, as required. This mechanism was called the National Aboriginal Council on HIV/AIDS. Health Canada had committed in Winnipeg to having the interim working group report back to the community once their work was complete and a meeting was called for May, 2001, in Calgary, Alberta.

The Calgary meeting, known as the Second Aboriginal Summit on HIV/AIDS, had two goals; the first was for the AIWG to receive the endorsement of Summit participants for the new collaborative framework, and second, for Summit participants to endorse the Aboriginal Council and select members for the new collaborative mechanism. There were four caucuses established for each of the three Aboriginal populations and one for members of CAAN. Each caucus was to meet, discuss the framework, the Council, and select six members for the Council. At the conclusion of the meeting there was agreement with the framework principles and structure, and agreement with the Council as the mechanism to make the collaborative framework function. There have been members appointed to the Council from the First Nations, Inuit and CAAN caucuses. The Metis caucus ended up splitting during the process of membership selection because the Metis National Council felt that only their nominees could represent Metis interests. Metis participants at the Summit, many with much stronger backgrounds in HIV/AIDS work, disagreed with this position and selected their own nominees. Health Canada is currently working with the Council to seek advice on how to resolve this impasse.

National Reference Group on Women and HIV

The National Reference Group (NRG) on Women and HIV/AIDS was successful in meeting the goals and objectives as outlined in its terms of reference. The specific recommendations related to women and HIV/AIDS identified by the group will be used to inform the HIV/AIDS Division's work planning over the next several years. In addition, the Division will share the outcomes of the NRG with government partners, relevant national and provincial organizations and with the Ministerial Council on HIV/AIDS to inform their work.

FPT HIV Programs Coordinators Information Sharing meeting

On March 5-6th, 2001, the HIV Prevention, Care and Treatment Programs Unit (PCTPU) hosted the FPT Program Coordinator's meeting in Montreal. The meeting, which was co-chaired by Barbara Jones, Manager PCTPU and Richard Cloutier of the Centre Québécois de coordination sur le sida (CQCS), focused on the unknown epidemic. Presentations were made on the current epidemic with regards to what is know/unknown and the impact on prevention programming, HIV testing issues in specific populations including pregnant women, Aboriginal and ethnocultural communities, injection drug users, gay men and incarcerated populations. Speakers were also invited from both the National Association of People with AIDS (NAPWA) and the CDC to discuss program strategies used in the U.S. to increase awareness related to serostatus.

Based on the information provided, the FPT Prevention Coordinators engaged in preliminary discussions related to identifying a common FPT agenda related to addressing the unknown epidemic through national awareness initiatives.

United Nations General Assembly Special Session on HIV/AIDS

The United Nations General Assembly Special Session (UNGASS) on HIV/AIDS is scheduled to be held on June 25-27, 2001. At the Special Session, member states are expected to endorse a Declaration of Commitment which will help set the direction for the global response to HIV/AIDS over the next decade. The Declaration will call for member states to take action in the following areas: leadership; prevention; care and support; human rights; reducing vulnerability; children orphaned by HIV/AIDS; alleviating social and economic impact; research and development; HIV/AIDS in conflict-affected areas; and resources. Two preparatory consultation meetings were held in New York City, February 26 - March 2 and May 21-June 3, 2001 during which the draft Declaration of Commitment was discussed. While most of the document has been agreed upon, some elements remain unresolved. It is likely that discussions on these will continue until the eve of or during the Special Session itself.

In an effort to solicit input into the draft Declaration, the federal government undertook an online consultation with interested Canadians, and a one day consultation meeting with representatives of AIDS groups, development organizations, persons living with HIV/AIDS, various federal government departments, provincial government representatives and other key stakeholders. A report of the electronic- and the day long- consultations are available through the Interagency Coalition on HIV/AIDS and Development.

The official Canadian delegation to UNGASS is led by the Department of Foreign Affairs and International Trade and includes officials from Health Canada, the Canadian International Development Agency and two community representatives: Ralf Jurgens and Bob Mills. In addition, Health Canada has provided financial support to representatives of several Canadian AIDS service organizations accredited to participate at the Special Session and its second preparatory meeting. Following UNGASS, these organizations will develop a report for ASOs, on their experience at UNGASS from a civil society perspective.

New Council

The members of next year's Ministerial Council on HIV/AIDS are as follows:

Don Kilby, Louise Binder (Co-Chairs), Jennifer Hebert, Art Zoccole, Esther Tharao, Rick Marchand, Peter Zawadzki, Sholom Glouberman, Lindy Samson, Dionne Falconer, Michael O'Shaughnessey, René Lavoie, Richard Elliot, Richard Jenkins.

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

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 2001, 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 advised the Conference of Deputy Ministers of Health on the outcomes of the consultation and received approval to table the report with the Conference of Ministers of Health in September 2001.

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. Working group members are currently seeking a community representative to participate in their work.

The Working Group on Point-of-Care Testing held a meeting June 13, 2001 in Winnipeg. The purpose of the meeting is to provide greater clarity on two key questions: (1) which health care providers are appropriate providers of POC HIV testing, and (2) which settings/contexts are appropriate for the provision of POC HIV testing. The data will help to guide future policy-making.

FPT AIDS will held its last meeting on June 14-15, 2001 in Winnipeg. Options for an appropriate public health response to the issue of "person unwilling/unable to prevent HIV transmission" were examined.

An FPT working group on the unwilling/unable issue may convene a small multi-stakeholder meeting (addictions, mental health, public health, community et al.) on this issue in the fall. The purpose of the meeting will be to define standards of conduct for disclosure and safe sexual behaviour.

In collaboration with the members of the Ministerial Council's Championing Committee, FPT AIDS members will be reviewing proposals from two consultants for a literature review on HIV and health determinants to guide interdepartmental collaboration.

 WORKPLANS

No New Items