Public Record of Meeting - Ottawa, June 9-10, 2002

Committees Report

Executive Committee

Council members decided that a letter will go to Minister McLellan asking her to approve the annual report of the Council.
Decision was made to hire a consultant to lead the development of a paper on vaccine development.

Communication Committee

Communication committee members developed a communications strategy for the report by Martin Spigelman Research Associates, HIV/AIDS and Health Determinants: Lessons for Coordinating Policy and Action. Health Canada representative indicated that the report will be distributed to other federal departments.

Championing Committee

a) HIV and Populations from HIV Endemic Countries

It was reported that at the Strategic Directions Follow-Up meeting in Montreal had recommended the formation of a national reference group (NRG) on HIV and populations from HIV endemic countries. The objective of the NRG would be to develop strategic actions for dealing with African and Caribbean populations in Canada. It was proposed that the NRG be an ongoing group and a letter be sent to Minister McLellan putting forward this recommendation.

There was discussion about whether the NRG should encompass all endemic populations or just African and Caribbean populations. It was concluded that there is a need for an NRG specifically on HIV in African and Caribbean populations because these populations face unique issues. In order to properly reflect this, a name change was proposed, such as "NRG on Populations Coming from Africa and Caribbean Nations", also that there should be representation from Francophone populations.

b) Inter-Ministerial Collaboration

The Championing Committee is re-visiting the report on Inter-Ministerial Collaboration (Towards a Broader View of Health) since this issue will be very relevant in the work of the Council over the next year.

c) Canadian Perinatal Exposure to ARV Registry

A letter to Minister McLellan has been drafted asking her to support the establishment of this registry. The expectation is that this registry will function under the F/P/T AIDS umbrella.

d) Spigelman Report

In response to Council's questions on the process followed for the literature review, Mr. Spigelman indicated that there are many gaps in this area of research.

e) G8 Letter

The three areas highlighted in the Council's letter to Minister McLellan on the G8 meeting were: a) the need to scale up financial resources for fighting communicable diseases; b) the need to ensure access to affordable medicines in developing countries; and c) the need to address health infrastructure needs in developing countries.

f) Gay Men

It was reported that Health Canada was reviewing the report from the National Reference Group on Gay Men and that there had been no update from the department on where this stands.

g) Immigration

Discussion took place regarding the timing of the meeting Council was seeking with the Hon. Denis Coderre, the Minister of Citizenship and Immigration. It was suggested that it would be preferable for Council to meet with Minister McLellan first, especially since the Minister of Health provides advice to the Minister of Citizenship and Immigration on health matters related to immigration.

It was reported that Council members have received the overheads from the presentation made at the last meeting by Dr. Brian Gushulak, Director General, Medical Services Branch, Citizenship and Immigration Canada.

h) Drug Review

The Championing Committee was concerned about continued delays in Health Canada's drug review process.

It was reported that the provinces are working on a harmonization process that would see all drugs put on a common formulary. The Championing Committee is concerned that this will result in fewer drugs being listed on the formularies in some provinces that are presently funding more than others.

Also reported was that the post-approval surveillance pilot project has moved into a second phase which will allow it to obtain reports of adverse reactions from doctors' offices. It was remarked that this pilot project is using a passive approach to gathering information.

It was reported that Alberta is refusing to provide liver transplants for people who are co-infected with HIV and HCV. Council members said that a lot of work needs to be done on the treatment needs of people who are co-infected.

I) Romanow Commission

Council was reminded that it decided earlier that it would review the interim report from the Romanow Commission and then decide whether to comment on it. The interim report was issued, and the Championing Committee recommends that Council provide comments to Minister McLellan.
It was decided that a letter be sent to the Minister McLellan with the following points:

• that Council supports a public health care system;
• that the public system should be protected and enhanced, and not eroded; and
• that the basic elements of the public health care system should include home care, adequate palliative care and the provision of drug access for all Canadians.

j) Safe Injection Sites

It was reported that a draft letter to Minister McLellan on safe injection sites would be ready soon.

k) Vaccines

It was reported that the Championing Committee is recommending that Council send a letter to Minister McLellan recommending that Health Canada develop a plan to scale up HIV vaccine research and development. Other organizations have sent similar letters. The plan is estimated to cost about $100,000. One issue which is not resolved is where these funds should come from. It was felt that they should not be taken from within the present CSHA funds but should rather be new money.

It was pointed out that when the CSHA was first announced and the Strategy resources were first allocated, the intent was that vaccine research would not be funded from within the Strategy. Vaccine research is very expensive, and if the $100,000 is taken out of the Strategy dollars, this would set a bad precedent. Several other Council members expressed concern about setting such a precedent.

Council decided that a letter should be sent to the Minister calling for the development of a plan to scale up HIV vaccine research and development

It was suggested that a collaboration with other players interested in vaccine development will be required in order to bring about a national HIV vaccine strategy.

l) Medical Marijuana

It was reported that Council was waiting for a response from Minister McLellan to its letter about medical marijuana.

Monitoring and Evaluation Committee Report

A summary was presented of the report from the Monitoring and Evaluation Committee. Health Canada is starting work now on the Year 5 Evaluation. The Peer Review Committee for the Year 3 Evaluation recommended that an evaluation advisory committee (EAC) be established to provide advice and direction on the Year 5 Evaluation. The Monitoring and Evaluation Committee discussed several possible ways it could be involved in this process. The committee concluded that it does not have the expertise to participate directly in the evaluation process. It would prefer to play a role in monitoring the process used to conduct the evaluation.

The Monitoring and Evaluation Committee recommended to Council that Health Canada be asked to appoint a member of Council to the EAC for the Year 5 Evaluation and that this person be a member of the Executive Committee. The Monitoring and Evaluation Committee also recommends that Council ask Health Canada to appoint people to the EAC who come from different parts of Canada and who have expertise in conducting large-scale evaluations.

It was decided that a letter be drafted to Nina Arron, Director the HIV/AIDS Policy, Coordination and Programs Division, recommending that:

• the Year 5 Evaluation be started early so as to avoid the problems encountered by the Year 3 Evaluation;
• a Council member, who is also a member of the Executive Committee, be appointed to the evaluation advisory committee (EAC), if such a committee is established;
• Health Canada appoint people to the EAC who come from across Canada and who have expertise in large-scale evaluations; and
• the EAC needs a good mix of HIV expertise and evaluations expertise.

Report of the Special Working Group on Aboriginal Issues (SWGAI)

It was reported that the National Advisory Council on HIV/AIDS (NACHA) met in Edmonton on May 4-6, 2002, and established a committee to make appropriate linkages with the Council.

Health Canada Report

Interdepartmental Collaboration

One of the Minister's priorities for the coming months will be the Romanow Commission; other priorities are still to be identified. The events of September 11th had been taking up a lot of her time, but this situation has eased to some degree.

It was reported that Geneviève Tremblay, Minister McLellan's Special Advisor responsible for the HIV/AIDS file, has been briefed on the issues. She will be attending the XIV International AIDS Conference in Barcelona.

It was decided that Louise Binder would contact Geneviève Tremblay to request a meeting with the Minister.

Community-Based Research (CBR)

In April 2001, the HIV/AIDS Division established the CBR Transition Team to administer all of the CBR-related activities under the Strategy.

The draft report from Carl Bognar entitled Building on the Strengths of Communities: Options for Redesigning and Relocating the Community-Based Research Program had just been submitted to Health Canada and has been sent to members of the CBR Steering Committee for review.

It was decided that Council would present its comments to the CBR Steering Committee.

It was stated that Health Canada and the Canadian Aboriginal AIDS Network (CAAN) have been working together on the future of the Aboriginal Research Program in the CSHA. Progress has been made, but some components of the program were not up and running, and Aboriginal people still have a number of concerns.

It was suggested that when the Aboriginal Research Program is housed in a new location, the new hosts should be able to allocate the full $500,000 in the first year - in other words, they should not inherit the "debts" of the "old" program.

Continuously Emerging Anti-Retroviral Drug Resistant HIV

The report of the working group on multi-drug resistant HIV has been completed and will be discussed by F/P/T AIDS at its next meeting in June 2002. The working group recommended that although multi-drug resistant HIV is a new phenomenon, it should be considered an added complexity as opposed to an emergency. The report makes recommendations concerning inclusion of drug resistance into policies and programs in all sectors and jurisdictions.

Discussion took place about whether Council needs to develop a policy or take some further action on this issue. It was mentioned that there may be policy issues related to the costs of doing xenotyping and phenotyping as standard tests. Two other issues were identified:

• the effects of drug resistance on medications for people already living with HIV/AIDS; and
• the effects of drug resistance on prevention and future treatment for people who get infected with a drug-resistant strain of HIV.

It was also pointed out that there were no representatives from Québec on the working group.

Also reported was that many HIV positive women from HIV endemic countries are not covered by provincial medical plans, are able to access treatment for HIV only while they are pregnant, and will not receive treatment after their pregnancies are over. A question was raised as to whether this could have an effect on drug resistance.

It was pointed out that there are still many questions at the research and clinical level about the impact of drug resistance.

National Aboriginal Council on HIV/AIDS (NACHA)

It was reported that NACHA held a meeting in Edmonton on May 4-6, 2002, at which the 2002-2003 workplan was reviewed and approved. The next meeting is scheduled for September 2002 in Montreal.

UNGASS Follow-Up

It was reported that the Declaration of Commitment that came out of the United Nations General Assembly Special Session (UNGASS) on HIV/AIDS requires governments to report annually on their implementation of the Declaration. The United Nations Joint Programme on AIDS (UNAIDS) sent out a call requesting that country reports be filed by the end of April 2002. The International Affairs Directorate (IAD) of Health Canada coordinated the preparation of Canada's report. In order to allow for some consultation with stakeholders, IAD negotiated an informal extension of the deadline to the end of May 2002. IAD requested input from all federal government departments involved in the CSHA and from the Canadian International Development Agency (CIDA).

The Canadian draft report was reviewed by Federal/Provincial/Territorial AIDS (F/P/T/AIDS) and non-governmental organizations (NGO) representatives on Health Canada's Working Group on International Issues (the Canadian AIDS Society, the Interagency Coalition on AIDS and Development, the International Council of AIDS Service Organizations and the Canadian HIV/AIDS Legal Network). These NGO representatives were invited to forward the draft report to their members for input. Comments received were incorporated into the final version, which was then forwarded to UNAIDS via the Department of Foreign Affairs and International Trade at the end of May 2002.

Several Council members made comments concerning the content of the report and they noted that the report paints an over-optimistic picture of what is happening with respect to the epidemic in Canada.

It was decided that further discussion of the report is required and that the Championing Committee should take up the issue. It was also noted that the report should be on the agenda of the next Council meeting.

XIV International AIDS Conference, Barcelona, July 7-12, 2002

It was reported that the International Affairs Directorate (IAD) was coordinating the Canadian Government's role and involvement at the XIV International AIDS Conference. A "Canada Booth" will be set-up in Barcelona representing the Canadian Strategy on HIV/AIDS (CSHA), its partners (including community organizations) and the Canadian International Development Agency (CIDA).

Resource Allocation

In the fall of 2001, the HIV/AIDS Policy, Coordination and Programs Division developed an action plan to guide the implementation of a resource allocation process. The action plan called for a consultation, the development of an options report, and the formation of a task group. A request for proposal was issued in February 2002 for the consultation and options report, and Martin Spigelman Research Associates was selected. A recruitment process is concluding to finalize task group members.

Social Justice Framework

At the Direction Setting Follow-Up meeting in Montréal in April 2002, there was strong, continuing support for the establishment of a social justice framework to guide the CSHA. Work continues on this file. The suggested next steps involve:

• continuing to work with the Council, and later with F/P/T AIDS, on the development of plan for the clarification of values and principles; and
• developing tools for program, policy and evaluation.

Health Canada will facilitate discussion with the Council and F/P/T AIDS on how the Spigelman report will feed in the development of the social justice framework.

CSHA Financial Status

The financial report for the final quarter of 2001-2002 indicates overspending of $327, 779. This deficit was absorbed within the overall Health Canada budget. In January 2002, when it was discovered that there would likely be a surplus in the 2001- 2002 budget for the CSHA, the HIV/AIDS Division initiated its Quick Response Reallocation Mechanism, which is designed to manage potential surpluses and pressures in the CSHA.

F/P/T AIDS Update

It was reported that the Guiding Principles for the HIV Testing of Women During Pregnancy were released by the Conference of Deputy Ministers in March 2002 and will be published in the Canada Communicable Diseases Report in June 2002. They will also be available on the F/P/T AIDS website. The Guiding Principles are based on existing policies covering HIV testing in general.

The next meeting of F/P/T AIDS is June 20-21, 2002 in Ottawa. Agenda items include a discussion on Fast-Check HIV testing issues; a review of fact sheets on the Canadian Perinatal Exposure to Antiretroviral Surveillance (CPEARS) Program; and a discussion on a document about the links between TB and HIV/AIDS. CPEARS is a very important surveillance program that F/P/T AIDS is helping to launch.

With respect to Fast-Check HIV testing, it was stated that the rapid point-of-care test kits were still off the market. Considering that the test is still useful to people in public health, particularly in remote areas, and that the deficiencies that have been identified stem from improper use of the test, concern was expressed that the manufacturer may pull the test from the market if it is required to meet impossible goals.

An update was provided on the Culver Report, which deals with how to handle situations where people living with HIV/AIDS are unable or unwilling to practice safer behaviours. A panel of experts will be organized by F/P/T AIDS for September 2002 to examine these issues.

Strategic Planning Day

A summarized output of the work done during the Strategic Planning Day on June 8th was distributed. The handout includes a list of criteria for setting priorities, a list of current priorities and a list of new issues that could be added to the list of current priorities.
Items that came out of the Strategic Planning Day that needed to be discussed by the full Council at this meeting:

who will work with the Janet Dunbrack and Glen Brown, the two consultants hired to work with

• Council on strategic planning;
• the frequency of Council meetings;
• the role of the Communications Committee;
• the committee structure; and
• priority setting for Council for the coming year.

One of the recommendations coming out of the Strategic Planning Day was to reduce the number of Council meetings from four a year to three, and to hold one face-to-face meeting of the Executive Committee each year. Council discussed this recommendation and also discussed the length of its meetings. Council decided that there would be three meeting each year, as follows:

• one three-day meeting in the Fall, with the first day set aside for orientation of new members;
• one three-day meeting in June, with the first day set aside for strategic planning; and
• one two-day meeting in January or February.

It was reported that one recommendation from the Strategic Planning Day was to retain the Communications Committee with the same responsibilities as before, plus the following ongoing activities:

• World AIDS Day
• the Annual Report of Council
• promoting the Council
• establishing links and cultivating partnerships
• orienting new Council members

Council agreed with this recommendation and clarified that the Communications Committee is responsible for reviewing documents to be posted on the Council website. Council assigned the following ongoing activities to the Executive Committee:

• the annual meeting with the Minister
• identifying issues for Council

Council agreed that the three existing standing committees would be retained (Executive Committee, Championing Committee and Communications Committee). The Executive Committee will continue to be composed of the co-chairs and the chairs of the other committees.

The Communications Committee will be renamed the Communications and Liaison Committee. The Championing Committee will establish working groups on specific issues as needed. Council decided that two ad-hoc committees would be retained (Research Committee and the Special Working Group on Aboriginal Issues). The Monitoring and Evaluation Committee will be discontinued and its work will be taken up by the Executive Committee. The Visioning Committee will also be discontinued.

Additional Items - Presentations

National Aboriginal Council on HIV/AIDS (NACHA)

Art Zoccole introduced the guests representing the National Aboriginal Council on HIV/AIDS (NACHA):

• Todd Armstrong, Pauktuutit Inuit Women's Association and the Canadian Inuit HIV/AIDS Network
• Denise Lambert, Kimamow Atoskanow Foundation
• Duane Morrisseau, Métis National Council
• David Lee, Needle Exchange Program in the Downtown Eastside of Vancouver

The mandate of NACHA is to provide advice to Health Canada to ensure that the HIV/AIDS-related needs of all Aboriginal peoples in Canada are met. It was explained that NACHA was formed to replace the seven or eight Aboriginal working groups that were providing HIV/AIDS advice to different players.
Having just one Council will make this process more efficient, reduce costs and ensure greater accountability. NACHA is made up of representatives of four caucuses: Inuit, First Nations, Métis and Community. Each caucus is autonomous. NACHA is based on parity, not representation by population, and that this constitutes a major shift in thinking.

The following information was also provided:

NACHA is concentrating on building the capacity of its people

• A lot of time is being spent on cross-cultural awareness and understanding, and on building trust between the people in different caucuses
• NACHA is accountable to a broad base of Aboriginal people
• Representation on NACHA is skills-based, not organization-based.

Following the presentation, most of the discussion revolved around what relationship NACHA should have with the Ministerial Council.

It was suggested that a formal mechanism could be established that would involve an ongoing written exchange between NACHA and the Ministerial Council.

Directions Setting Follow-Up Meeting Update

Health Canada officials provided Council with an update on the Directions Setting Follow-Up meeting that was held in Montreal in April 2002 and on the work that has transpired since then. It was pointed out that direction-setting is a key consultative mechanism to ensure the ongoing responsiveness of the CSHA and that the Montreal meeting was an important step in the further development of the direction-setting process. The next steps in this process will be influenced by the outcomes of the work on Direction #10: Develop a Five Year Operational/Strategic Plan.

At the Montreal meeting, small groups were established for each of the ten directions. Each small group came up with between one and three suggested actions for moving the directions forward. Coming out of the Montreal meeting, three next steps were identified:

1. The development of a comprehensive meeting follow-up strategy.
2. The development of a communications plan.
3. Taking stock of the overall direction-setting process (including an examination of the role of Task Group).

A number of challenges were identified with respect to Direction #10, including defining what is included in the strategic plan and deciding who owns the plan.

A communiqué would be issued at the end of June to bring stakeholders up to date on what has transpired since the Montreal meeting. The records and summaries of the teleconference proceedings will also be disseminated widely. The taking stock activities will be done over the coming Fall and Winter.