Public Record of Meeting - June 1 - 3, 2006
Montreal, Quebec

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 June 1 - 3, 2006, 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 : Lindy Samson (Co-Chair); Mary Armstrong, Richard Elliott, Deborah Foster, Jacqueline C. Gahagan, Michael Grant ,Marie Anésie Harérimana, Kenneth Monteith, David M. Nelson, Anita Rachlis, Sheena Sargeant. Ex-officio: Frank McGee, Provincial Co-Chair, Federal / Provincial / Territorial Advisory Committee on HIV/AIDS (FPT AIDS).

Regrets: Louise Binder (Co-Chair), Dionne A. Falconer, Brian Huskins, Frank Plummer (ex-officio).

Public Health Agency of Canada (PHAC) : Grafton Spooner, Manager, Government and External Relations, HIV/AIDS Policy, Coordination and Programs Division.

Secretariat: Monica Thibault, Nina Elkin.

Recording and Facilitation Services : Wylie Thomas, Hajo Versteeg.

Presenters: Chris Archibald, Surveillance and Risk Assessment Division, Public Health Agency of Canada; Liviana Calzavara, Canadian Association for HIV Research; Jennifer Gunning, Institute of Infection and Immunity, Canadian Institutes of Health Research; Ted Myers, Canadian Association for HIV Research; Alita Perry, Global Health Research Initiative; Chris Power, CIHR HIV/AIDS Research Advisory Committee; Bhagirath Singh, Institute of Infection and Immunity, Canadian Institutes of Health Research; Ingrid Wellmeier, HIV/AIDS Policy, Coordination and Programs Division, Public Health Agency of Canada.

Welcome and Approval of Agenda

The Co-Chair of the Ministerial Council on HIV/AIDS opened the meeting with a few words of welcome and asked that a discussion on a recent letter from the National Partners raising concerns about allocations under the Federal Initiative to address HIV/AIDS in Canada (FI) be added to the agenda. The agenda was approved with modifications.

Approval of the February 2006 Record of Decision

The Ministerial Council on HIV/AIDS approved the Record of Decision from its meeting in Toronto on February 23 and 24, 2006, subject to specified changes.

Approval of the February 2006 Public Record of Meeting

The Ministerial Council on HIV/AIDS approved the Public Record of Meeting from its meeting in Toronto on February 23 and 24, 2006, subject to specified changes. It asked the Secretariat to ensure that French translations are included in meeting binders when the draft Record of Decision and the draft Public Record of Meeting are being considered for approval.

Business Arising from the February 2006 Meeting of Council

The Ministerial Council on HIV/AIDS reviewed the status of action items arising from its meeting in Toronto on February 23 and 24, 2006, as well as correspondence to and from the Ministerial Council. It established a new procedure to assign priority to action items identified at meetings.

Report from the Public Health Agency and Health Canada

Grafton Spooner, Manager, External and Government Relations of the HIV/AIDS Policy, Coordination and Programs Division (HIV/AIDS Division) of the Public Health Agency of Canada (PHAC) provided the Ministerial Council on HIV/AIDS with an update on the activities of the PHAC related to the FI. He referred the Ministerial Council to a copy of the financial status report and a written update in the meeting binders, and highlighted a number of issues for further discussion: the new Specific Populations HIV/AIDS Initiative Fund; the Government of Canada Position Statement on HIV/AIDS; Leading Together: Canada Takes Action on HIV/AIDS(2005-2010); staffing at the HIV/AIDS Division; and, preparations for the XVI International AIDS Conference (AIDS2006), including the Ministerial Council’s participation in the conference. The Ministerial Council asked the Secretariat to ensure that the French translation of the written update is included in the meeting binders and to provide it with details on application deadlines and decision timelines for the Specific Populations HIV/AIDS Initiative Fund.

The Ministerial Council discussed at some length the financial report provided by the Secretariat. It raised concerns about the significant proportion of FI funds that is spent on operations and management (O&M) and other administrative items. It received assurances from the Secretariat that this was to a significant extent an artefact of accounting rules and that the operations and management category of spending went beyond internal administrative items to include external personnel contracts for undertaking substantive work, such as support for social marketing. The Ministerial Council asked the Secretariat to separate out spending on personnel / consulting contracts from spending related to administration such as travel and accommodation in future presentations of the data. It also identified a number of additional questions related to the financial data for which it asked the Secretariat to provide answers.

The Ministerial Council discussed its expectations with respect to reporting from the four partners of the FI, namely PHAC, Health Canada, Correctional Service Canada (CSC) and the Canadian Institutes of Health Research (CIHR). The Secretariat noted that a new committee of the four partners had just been formed which would be responsible for accountability of the partners under the FI. The Ministerial Council struck an ad hoc subcommittee to look into further defining expectations with respect to reporting, in consultation with other advisory bodies such as the National Aboriginal Council on HIV/AIDS (NACHA) and to report back to the Ministerial Council with recommendations.

World AIDS Day Report Editorial Process

The Ministerial Council on HIV/AIDS discussed the experience of its participation in the process to prepare last year’s World AIDS Day Report and identified a number of suggestions for improving the process which it asked its Communications and Liaison Committee to address in its work plan.

Work Planning

The committees of the Ministerial Council on HIV/AIDS (Championing Committee, International Affairs Committee, Research Committee, Ad Hoc Committee for AIDS2006, and Communications and Liaison Committee) held their annual work planning sessions from 13:00 to 17:30. The Executive Committee met on June 2 at 16:30.

Promoting the Vision of a National Research Plan

The Ministerial Council on HIV/AIDS held a half-day session on research to facilitate a discussion with key research organizations on a path forward in developing a pan-Canadian HIV/AIDS research plan. The need for such a session was identified at an earlier meeting when it became apparent that not all stakeholders were being consulted in the development of the research plan. The Ministerial Council heard presentations from the Canadian Association for HIV Research (CAHR), the Global Health Research Initiative (GHRI), CIHR, CHARAC, the Surveillance and Risk Assessment Division of PHAC and the Knowledge and Awareness Section of PHAC. The objectives of the session were to facilitate dialogue between these groups and to advance the process for developing the research plan. Presenters were asked to address three questions relating to the theme of promoting the vision of a national research plan: 1) What is your organization’s vision for a national HIV research plan? 2) What is your organization’s role within it? 3) How can we more effectively work together to develop and deliver a national HIV research plan? Following each of the presentations, a discussion was held with the presenters. For further information on the research plan, see the October 2005, December 2005 and February 2006 PROMs.

HIV/AIDS Division, Public Health Agency of Canada

Ingrid Wellmeier of the Knowledge and Awareness (K&A) Section of the HIV/AIDS Division, PHAC, presented an overview of PHAC’s knowledge exchange and research planning activities under the FI. The K&A Section of PHAC has lead responsibility for coordinating the development of the research plan, and, along with CIHR, commissioned three small baseline studies which will be used to inform the development of the national research plan. PHAC was responsible for two of the studies, namely: 1) A review of models of research planning and research priority setting; and, 2) a scan of research priorities identified in key documents. As part of its work to develop a knowledge exchange and research planning framework, PHAC will host a consultation with researchers, community stakeholders and federal, provincial and territorial governments in the Fall of 2006.

Canadian Institutes for Health Research

Bhagirath Singh , Scientific Director, Institute of Infection and Immunity, CIHR, and Chris Power, Chair, CIHR HIV/AIDS Research Advisory Committee (CHARAC), provided a joint presentation on CIHR’s role in setting the agenda for HIV/AIDS research in Canada. Dr. Singh began the presentation with an overview of CIHR’s role in funding health research in Canada and more specifically how it directs spending of the money it receives from the FI. He indicated that CIHR welcomed the opportunity to engage in dialogue with others to develop a national HIV/AIDS research plan some of the benefits of which he described.

Dr. Power presented an overview of research priority setting at CIHR. He described briefly an environmental scan of HIV/AIDS research in Canada commissioned by CIHR to provide background information in the development a national HIV/AIDS research plan. The study focused on investments in HIV/AIDS research by the country’s largest providers of funding, namely CIHR, the Ontario HIV Treatment Network and the Canadian Foundation for AIDS Research (CANFAR). He also described CHARAC’s work to develop a set of priorities to guide spending on HIV/AIDS research at CIHR. In developing the priorities, CHARAC consulted with stakeholders from a broad cross-section of sectors. Dr. Power expressed CIHR’s desire to work in partnership with others in the development of a national research plan for HIV/AIDS and support for establishing a working group made up of key partners to lead the development of the plan.

Global Health Research Initiative

Alita Perry, Manager, Global Health Research Initiative (GHRI), provided an overview of her organization, its past achievements and projects under development. The GHRI was established in 2001 by CIHR, the Canadian International Development Agency (CIDA), Health Canada and the International Development Research Centre (IDRC) through a cooperative agreement aimed at coordinating and strengthening Canada’s response to addressing the global gap in health research. Ms. Perry described in detail the recently established Teasdale-Corti Global Health Research Grants Program which will offer grants to teams of researchers from Canada and lower to middle income countries (LMIC) valued at up to $1.6 million/team over 4 years. The first stage of the application process, completed in January of 2006, received 259 letters of intent (LOI) of which 32 received funding to further develop research proposals. A number of these were related to HIV/AIDS.

Canadian Association for HIV Research

Ted Myers, President, Canadian Association for HIV Research (CAHR), provided an overview of CAHR and its work to develop an inventory of Canadian HIV research, including ideas for a national HIV/AIDS research plan. Dr. Myers noted that there are over 650 members, covering the full spectrum of researchers, including basic scientists, clinical scientists, epidemiologists, social and behavioural scientists, clinicians, public health and community workers and persons living with HIV/AIDS. CAHR is currently undertaking a number of projects to raise its visibility as a national stakeholder and leader in the development of a national research plan. Dr. Myers highlighted work to create a web-based inventory of HIV/AIDS research conducted in Canada or by Canadians over the last five years. In addition to providing important input into the development of a national research strategy, the Canadian HIV Research Inventory will: provide a national directory of research, researchers, trainees and funding organizations; foster pan-Canadian and cross-disciplinary collaborations by allowing researchers to find other individuals/organizations with similar interests; promote mentorships and opportunities for graduate training in HIV research; allow an analysis of patterns of HIV research in Canada (in order to identify strengths and gaps in HIV research); and, help evaluate policies and programs for HIV research in Canada. He suggested a set of principles to guide the development of the national research plan and a set of needs that the plan must address.

Surveillance and Risk Assessment Division, Public Health Agency of Canada

Chris Archibald, Director, Surveillance and Risk Assessment Division (SRAD), PHAC, provided an overview of HIV surveillance in Canada and its relationship to epidemiological research. He reviewed in some detail work underway by the Surveillance Working Group of the Federal / Provincial / Territorial Advisory Committee on HIV/AIDS (FPT AIDS) to enhance the provision of timely, relevant data to focus the policy and programmatic response to the epidemic. A central part of the plan is the Targeted Epidemiological Studies Initiative on HIV/AIDS (TESIH) which provides a framework for identifying data gaps and the specific studies / actions needed to address them. The framework consists of a matrix that maps the data needed with 4 possible sources of data—1) routine case reporting; 2) enhanced/expanded surveillance (e.g., adding CD4 counts to testing); 3) repeated cross-sectional studies; and 4) special one-time research studies. The matrix will provide a tool to help its proponents work with their partners to identify gaps, set priorities and advocate for studies to address the gaps in the data.

HIV/AIDS Research Ethics

Ted Myers provided the Ministerial Council on HIV/AIDS with an overview of the University of Toronto’s HIV Research Ethics Board, which he chairs. He noted that the HIV/AIDS research ethics board (REB) at the University of Toronto has been in place since 1997, but that the university had recently made a decision to disband it. Dr. Myers described the history of the REB at the University of Toronto and the reasons behind the decision to disband it. He also reviewed the unique characteristics of HIV/AIDS research to make a case for HIV/AIDS-specific REBs. He noted that the Declaration of the United Nations General Assembly Special Session on HIV/AIDS (UNGASS), of which Canada is a signatory, calls on countries to establish such boards. Following Dr. Myers presentation, the Ministerial Council engaged in a broad discussion on REBs, noting that there are many researchers operating outside of institutional settings who require ethics reviews of their research protocols.

Debriefing on Half-Day Research Session on Promoting the Vision of a Pan-Canadian Research Plan

The Ministerial Council on HIV/AIDS debriefed on the discussion earlier in the day regarding the development of a pan-Canadian HIV/AIDS research plan. It agreed to write to Ms. Wellmeier thanking her for her presentation and outlining the following recommendations for a path forward in developing the plan:

• PHAC should convene a steering committee of a core set of stakeholders to guide preparations for a Fall consultation on a pan-Canadian research plan. PHAC is both the facilitator of the process to develop the research plan and an important player. PHAC should consider involving the following groups in the steering group: PHAC; CIHR; GHRI; CAHR; the provinces; and community-based research groups, among others. The Ministerial Council would be pleased to participate in the steering group, if needed.
• The process to develop a pan-Canadian research plan should be developed from the outset as an iterative process so that it remains responsive to changing needs.
• Preparatory work needs to be done prior to the Fall consultation to collate and synthesize the results of the various baseline studies that were undertaken. These include the work recently undertaken by CAHR, CIHR and PHAC described in the presentations. A consultant should be engaged to prepare the synthesis. The Fall consultation should include all streams of research (not just the clinical and basic sciences). The Ministerial Council would happy to participate in the Fall consultation.

The Ministerial Council also agreed to send thank you letters to the other presenters in which it would broadly outline its recommendations to Ms. Wellmeier.

The Ministerial Council asked its Research Committee to look into the question of ethics review for community-based research, ethics review of research conducted outside of institutions., and ethics review of HIV-related research conducted outside of Canada, taking into consideration the suggestions at the meeting, including possibly commissioning a review of how different sectors have dealt with ethics review of research conducted outside of institutions. It asked the Research Committee to take the day’s presentations and discussion under advisement and report back to the Ministerial Council with further recommendations. It also asked all its committees to take the day’s presentation and discussion into consideration as they develop their work plans and activities over the coming year. Finally, the Ministerial Council identified the need to discuss research in prisons, including possibly organizing presentations at a later meeting.

Update from the Federal / Provincial / Territorial Advisory Committee on AIDS (FPT AIDS)

Frank McGee, Provincial Co-Chair of FPT AIDS, gave the Ministerial Council on HIV/AIDS an update on the committee’s activities since the last meeting. He reported that the committee had worked on a consensus statement on HIV/AIDS, which will be signed off by the FPT deputy ministers of health in time for the XVI International AIDS Conference. The consensus statement will be quite similar to the Government of Canada Position Statement on HIV/AIDS in both content and language. He also informed the Ministerial Council that the committee would soon be releasing its report A National Portrait which describes best practice in the response to HIV/AIDS from across the country. The Ministerial Council asked the Secretariat to forward copies of the report to its members as soon as the report is published.

Committee Reports of the Ministerial Council on HIV/AIDS

International Affairs Committee

The International Affairs Committee provided its report and work plan to the Ministerial Council on HIV/AIDS. The committee identified three areas of focus in the coming year:

• Foreign Affairs Canada’s HIV/AIDS Strategy —The committee will offer its support and advice to Foreign Affairs Canada as it implements its HIV/AIDS strategy. It was noted that the Ministerial Council had participated in the development of the strategy through the provision of detailed comments on drafts of the strategy in 2004-2005.
• Canadian International Development Agency’s HIV/AIDS Strategy —The committee will offer its support and advice to the Canadian International Development Agency’s HIV/AIDS strategy.
• Bill C-9 —This piece of legislation, which was passed in 2004, would allow the manufacture of generic drugs for export to countries experiencing a health emergency, such as the HIV epidemic in Sub-Saharan Africa. For a number of reasons, the legislation has not been fully implemented.

Ad Hoc Committee for AIDS2006

The Ad Hoc Committee for AIDS2006 gave its report to the Ministerial Council on HIV/AIDS, noting that this would be its last report. The Ministerial Council discussed its participation in the conference and agreed to a number of immediate action items:

• Prepare a draft of the Ministerial Council’s poster presentation Ministerial Council on HIV/AIDS: Facilitating Inter-Departmental and Inter-Governmental Policy Development . The Ministerial Council asked the Secretariat to set up a number of teleconferences to work on the poster and related printed materials and to expedite the translation of materials into French.
• Staff the poster presentation. Ministerial Council members were identified to staff the poster presentation, which will take place on August 15.
• Participate in the Canada Exhibition Booth at AIDS2006. The Ministerial Council asked the Secretariat to contact the people organizing the booth to determine staffing needs at the booth and to circulate this information to Council with information on whom to contact regarding staffing the Canada Booth
• Identify Ministerial Council documents to include in the Canada CD-ROM which will be distributed at the Canada Exhibition Booth. The Ministerial Council identified a number of documents to include on the CD-ROM.
• Organize an informal networking / experts panel on HIV/AIDS advisory bodies. The Ministerial Council asked the Secretariat to organize a teleconference to work out the details of the session, which will be held at the AIDS Bureau of Ontario’s boardroom in the evening during the week of AIDS2006

Executive Committee

The Executive Committee provided its report to the Ministerial Council on HIV/AIDS. It confirmed the establishment of a new Ad Hoc Committee on Treatment Issues to focus on the following areas: 1) the National Pharmaceutical Strategy; 2) the Common Drug Review; 3) drug formularies; 4) post-approval surveillance; 5) medical marijuana; 6) internet pharmacies; 7) issues related to immigrants’ and refugees’ access to treatment. The Ministerial Council agreed with the committee’s recommendation to create a manual of policies and procedures and asked the Secretariat to begin developing the manual over the summer.

Research Committee

The Research Committee provided the Ministerial Council on HIV/AIDS with its report and work plan. The committee identified a number of areas of focus over the next year:

• Research in Prisons —The Ministerial Council agreed with the committee’s recommendation to invite CSC to present to the Ministerial Council at a future meeting on research in prisons and how ethics reviews are conducted.
• Research Ethics —The Ministerial Council agreed with the committee’s recommendation to organize a session on research ethics at a future meeting to which it would invite presentations from the CIHR research ethics office, the person responsible for community-based research and the Ontario HIV Treatment Network (OHTN).
• Global Engagement —The Ministerial Council agreed with the committee’s recommendation to hold a session on Canada’s contribution to the global response to HIV/AIDS in the Fall/Winter.
• Research Ethics Boards —The committee reported that it would continue to look into the issue of research ethics reviews for researchers operating outside of institutions who do not have access to this service, particularly with respect to community-based researchers and Canadian researchers conducting research outside the country.
• Pan-Canadian Research Plan —The committee reported that it would continue to monitor and engage in facilitating the process to develop a pan-Canadian research plan.

Communications and Liaison Committee

The Communications and Liaison Committee provided its report to the Ministerial Council on HIV/AIDS. It noted that it was working on a number of immediate items:

• World AIDS Day Report Editorial Process —The committee reported that it is working on formally submitting feedback on the WAD Report editorial process.
• Ministerial Council Annual Report —The committee reported that the annual report will be completed over the summer.
• Ministerial Council Strategic Plan —The committee asked Council’s committees to look at their individual work plans against Leading Together and Council’s 2003-2006 strategic plan in preparation for a strategic planning exercise in the Fall/Winter.

Championing Committee

The Championing Committee provided its report to the Ministerial Council. The committee described the areas of focus for its work over the coming year, which includes: harm reduction; the allocation of Federal Initiative funds; interdepartmental and intergovernmental cooperation, including work with the Interdepartmental Assistant Deputy Ministers Committee on HIV/AIDS; population-specific approaches; and, health care reform.

Allocation of Funding Under the Federal Initiative

The Ministerial Council on HIV/AIDS held a one-hour in camera session to discuss its response to a letter from the National Partners in which they raised concerns about changes to the allocation of funds within the FI. The Ministerial Council identified a number of actions for follow up, including a letter to thank the National Partners for bringing the issue to its attention and to outline follow-up actions. The Ministerial Council also agreed to write to PHAC requesting further clarification on allocations under the FI and to send a survey to front-line organizations regarding their experiences with changes in funding allocations.

Update on Code of Conduct

The Ministerial Council on HIV/AIDS received a status update on work to develop a code of conduct for HIV/AIDS research involving civil society. The project is being carried out by a partnership of the Atlantic Centre of Excellence for Women’s Health (ACEWH); Human Sciences Research Council of South Africa; Centre for the AIDS Program of Research in South Africa (CAPRISA); CAHR; and, Dalhousie University, with funding from the CIHR-III, CIDA, CAHR and Dalhousie University. A two-hour session involving the University of Toronto and the University of Kwazulu-Natal is being organized in connection with AIDS2006 on August 13. The Ministerial Council provided feedback and indicated its support for the development of the code. It asked its members to provide additional comments to the team developing the code, including suggestions for case studies that illustrate why such a code of conduct is needed.

Next Meeting Dates

The Ministerial Council on HIV/AIDS set tentative dates for its Fall/Winter meetings as follows. The first meeting will take place on October 12 and 13, 2006, in Ottawa, with an orientation session for new members in the evening of October 11. The second meeting will be held on December 17, 18 and 19, 2006, in Ottawa.

Close of Meeting

The Co-Chair thanked members of the Ministerial Council on HIV/AIDS for their work during the meeting and the Secretariat and PHAC for their support. The Ministerial Council and PHAC personnel thanked departing members for their hard work and contributions over the years.