Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada - Meeting of June 19 - 21, 2008 - Vancouver, British Columbia
Public Record of Meeting

Present:

Ministerial Advisory Council: Brian Conway and John Charles Plater (Co-Chairs); Jonathan B. Angel, Monique Doolittle-Romas, Jacqueline Gahagan, Michelle George (June 20 & 21), Faye Katzman, Kenneth Monteith, Gerry Mugford, David M. Nelson, Anita Rachlis, Sheena Sargeant, Jacobet Edith Wambayi. Ex officio: Frank McGee

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

Secretariat: Fardosa Loyan, Susan Maves.

Facilitation and Recording Services: Wylie Thomas and Hajo Versteeg

Guests: Nina Arron, HIV/AIDS Division, PHAC; Patricia Hurd, HIV/AIDS Division, PHAC; Anne Marie Hume, Correctional Service Canada (CSC); Thomas Kerr, BC Centre for Excellence in HIV/AIDS; Henry Koo, PHAC Ontario Region; Mary Beth Pongrac, CSC; Beth Sherwood, PHAC Atlantic Region; Michael R. Smith, HIV/AIDS Division, PHAC, Geneviève Tremblay, HIV/AIDS Division, PHAC.

Welcome

The Co-Chairs, 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.

Update on Co-Chairs’ Meeting with the Minister of Health

The Co-Chairs of the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada provided an update on their meeting with the Minister of Health, which took place by teleconference on April 17. The teleconference was organized by the Minister of Health’s office in response to the letter he received from the Ministerial Advisory Council in which it raised its concerns over reductions in funding to the AIDS Community Action Program. The Co-Chairs suggested that the Ministerial Advisory Council write to the Minister of Health in follow up to their meeting with him.

Update on UNGASS and Global Leaders Forum on TB and HIV

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada received an update from Patricia Hurd a senior policy advisor with the HIV/AIDS Policy, Coordination and Programs Division of PHAC. Specifically, she provided updates on:

• Canada’s 4th annual report to the Secretariat General of the United Nations on the 2001 UNGASS Declaration of Commitments on HIV/AIDS, covering calendar years 2006 and 2007;
• The High-Level Meeting on UNGASS held in New York on June 10 and 11;
• The June 9th Global Leaders Forum on TB and HIV, which issued a call to action;
• The composition of the Canadian delegation to the New York meetings, which included representatives from civil society.

She also reviewed the Canadian delegation’s interventions at these events and offered to share summary reports with the Ministerial Advisory Council once these became available.

Ms. Hurd stayed on following her presentation to answer questions from the Ministerial Advisory Council. The Ministerial Advisory Council thanked the government for including the assessment of Canada’s response to HIV/AIDS prepared by civil society in Canada’s UNGASS report. Following her departure, the Ministerial Advisory Council agreed to write to Ms. Hurd to thank her for her presentation and to ask that it be kept informed of any steps to analyse the gaps between the UNGASS main report and the annex prepared by civil society, including a possible multi-stakeholder meeting to discuss next steps. It also asked the Secretariat to obtain a bulleted summary of her presentation and other materials she mentioned for distribution to members.

HIV-Related Activities Within Correctional Service of Canada

Anne Marie Hume, Director General for Public Health, Correctional Service of Canada (CSC), joined the meeting to provide an overview of HIV/AIDS-related programming at CSC undertaken with funds from the Federal Initiative to Address HIV/AIDS in Canada. Ms. Hume was joined by teleconference by her colleague Mary Beth Pongrac, Project Office for HIV/AIDS. Ms. Hume’s presentation included a backgrounder on the demographics and characteristics of the prison population, HIV and HCV prevalence, and CSC’s mandate and strategic priorities. She noted that CSC had recently undergone a structural reorganization and introduced a new Deputy Commissioner for Health Services, which has elevated the health portfolio within CSC. This has been accompanied by a new governance model for CSC Health Services.

Ms. Hume stayed on following her presentation to answer questions from the Ministerial Advisory Council. Following her departure, the Ministerial Advisory Council held a debriefing to identify actions in follow up. In the discussion that ensued, the Ministerial Advisory Council noted that it had received more information on CSC’s HIV/AIDS programming than it had in the past. It agreed to write to Ms. Hume to thank her for her presentation and advise her that its Partnerships Committee would be taking her presentation under advisement in preparation for further dialogue with her office. It also agreed to ask for more information on the specifics of the new governance model and its implications for harm reduction in prisons, partnering with outside groups and program evaluation.

Research Committee Report

The Research Committee provided its report to the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada, noting that it last met on April 24. The Research Committee reviewed its high priority issues and provided brief updates on the following:

• Pan-Canadian HIV/AIDS Research Plan;
• Canadian HIV Vaccine Initiative;
• Code of conduct for research in low resource settings;
• Research in federal prisons;
• Second generation surveillance;
• CIHR HIV/AIDS Community-Based Research Steering Committee;
• Highlights from the recent meeting of CHARAC (CIHR HIV/AIDS Research Advisory Committee). 

Tour of Vancouver’s Supervised Injection Site

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada spent the morning of June 20 on a tour of InSite, Vancouver’s supervised injection site, and of OnSite, an addictions and detoxification centre located upstairs from the supervised injection facility. The tour was preceded by a presentation from Thomas Kerr, BC Centre for Excellence in HIV/AIDS, who provided an overview of the research undertaken to evaluate InSite.

Update on the Project Evaluation and Reporting Tool

Henry Koo, Acting Director of the Public Health Agency of Canada’s Regional Office for Ontario, joined the meeting by teleconference to provide an update on the new Project Evaluation and Reporting Tool (PERT) being used by recipients of funds from the AIDS Community Action Program (ACAP). Data collected through the tool will allow for more rigorous program evaluation and contribute to research on effective health promotion and population health activities. An important use of the tool will be to allow government and community to tell the story of how ACAP contributes to the fight against HIV/AIDS. The tool has now been piloted in a number of regions and the lessons learned incorporated into the final version of the tool which will be rolled out starting in August.

Members of the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada familiar with the tool provided additional feedback and suggested that PHAC consult with users to improve the user-friendliness of the tool. They also suggested that community groups will need training on how to complete the questionnaire as well as how to retrieve and use the results.

Following the departure of Mr. Koo, the Ministerial Advisory Council asked the Secretariat to obtain copies of the different PERT forms used in the regions and a copy of the national report that is generated from the roll-up of the PERT data from across the country. It also asked the Secretariat to draft, on its behalf, a letter to Mr. Koo thanking him for his presentation and advising him to consult with stakeholders regarding the practical aspects of reporting through PERT, to provide clarity on whether or not PERT will be used to determine funding levels and to look at using PERT as model for other areas of the Federal Initiative.

Update on AIDS Community Action Program Funding

Nina Arron, Director, HIV/AIDS Policy, Coordination and Programs Division, Public Health Agency of Canada (PHAC), joined the meeting to provide an update on funding levels for the AIDS Community Action Program (ACAP) over the next two years. Accompanying Ms. Arron was Beth Sherwood, PHAC Regional Director for the Atlantic Provinces.

Ms. Arron noted that the Minister of Health would soon be announcing an investment of $12.1 million in fiscal year 2008-2009, representing an increase of $2 million over last year’s investment. A similar investment will be made in fiscal year 2009-2010, bringing the total investment to $24 million over two years. Ms. Arron provided a breakdown of funding across the regions, noting that requests for proposals would be issued in July for any funds not already committed. She noted that existing projects that are meeting their objectives will be eligible to have their funding extended until 2010, a process that will begin in the Fall of 2008. A similar process will be followed for the national grants and contributions programs which will invest $21 million over two years (2008-2010).

Ms. Arron stayed following her presentation to answer questions from the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada.  Members pointed out that the $12.1 million proposed in her presentation fell short of the $13.7 million recommended by the Ministerial Advisory Council as the minimum level of funding needed to address the concerns outlined in its letter to the Minister of Health. Several members advised Ms. Arron that there remained several unfunded organizations in their jurisdictions in need of funding as a result of a changing epidemic and expressed their hope that ACAP would eventually respond to fill the gap.

Following Ms. Arron’s departure, the Ministerial Advisory Council identified a small working group to write to the Minister of Health to advise him that the proposed funding announcement would not address the concerns it outlined in its letter to him in the Spring. It identified a number of additional points to include in the letter. It also asked the Secretariat to prepare a letter to Ms. Arron thanking her for her presentation and advising her that some sort of assessment should be undertaken post-2009 to ensure that the Federal Initiative remains current and resources flow to the right groups fighting the HIV/AIDS epidemic.

Public Health Issues Related to HIV and the Criminal Law

Michael R. Smith, Senior Policy Advisor, and Geneviève Tremblay, Manager, Populations Section, HIV/AIDS Policy, Coordination and Programs Division, Public Health Agency of Canada (PHAC) joined the meeting by teleconference 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. They reviewed a number of cases that have laid the foundation for the treatment of non-disclosure of sero-status under the Criminal Code of Canada. Unlike other countries where convictions are based on HIV transmission, in Canada proving exposure to HIV is sufficient grounds for conviction. They reviewed some of the possible public health consequences of this approach to non-disclosure.

Mr. Smith and Ms. Tremblay stayed following the presentation to answer questions from the Ministerial Advisory Council. Members pointed out that criminal law was at odds with public health principles in that it placed responsibility for safer sex entirely on the shoulders of the HIV-positive individual. At the same time, it forces individuals who obey the law to expose themselves to stigma and discrimination by disclosing their sero-status.  They also asked what PHAC was doing in terms of monitoring the effect that this application of the criminal law is having on people’s decision to get tested and to know their sero-status.

Following the departure of the presenters, the Ministerial Advisory Council agreed to write to the presenters thanking them for their presentation and advising them that PHAC monitor the effects of HIV criminalization on public health objectives such as HIV testing. It also identified a role for PHAC in providing the courts with information on the relative risks of different behaviours and agreed to write to PHAC to advise it to issue a statement endorsing existing HIV transmission guidelines and possibly update them. The Ministerial Advisory Council asked its Prevention, Care, Treatment and Support Committee to take the presentation under advisement and report back with recommended next steps.

Prevention, Care, Treatment and Support Committee Report 

The Prevention, Care, Treatment and Support Committee provided its report to the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada, noting it had last met on April 21.

Update on the April 2008 Conference of the Canadian Association for HIV Research

Brian Conway provided an update on the recent Annual Conference of the Canadian Association for HIV Research held in Montreal on April 24-27, 2008.

Strategies Committee Report

The Strategies Committee provided its report to the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada, noting that it last met on April 15 via teleconference. The committee reviewed its planned activities and priorities related to:

• CSC’s HIV/AIDS programming;
• Review of the Federal Initiative;
• Use of evidence in policy making;
• Hepatitis C Program

Standard Procedure for Responding to External Correspondence

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada reviewed its procedures for responding to the correspondence it receives from external stakeholders. It asked the Secretariat to add the details of how correspondence is processed to the Standard Operating Procedures Manual and to the Ministerial Advisory Council’s website.

Partnerships Committee Report to Council

The Partnerships Committee provided its report to the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada, noting that it had met by teleconference on April 10th and May 21st. It noted that one of its members would be attending the next meeting of the National Aboriginal Council on HIV/AIDS (NACHA) at the request of the Council. It also noted that it had received a summary of NACHA’s last meeting which was circulated in the meeting binders. The Ministerial Advisory Council discussed its desire to develop a closer working relationship with NACHA and agreed to discuss the matter further at its next face-to-face meeting.

Debrief on Tour of Vancouver’s Supervised Injection Site

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada held a debriefing on its visit to InSite, Vancouver’s supervised injection facility, and discussed its advice to the Minister of Health. At the end of the discussion, it agreed to write to the Minister of Health advising him of the following:

• The Ministerial Advisory Council was impressed by the multi-faceted approach taken at InSite which integrates addictions counselling and a detoxification centre in the same location, and the passion, knowledge and commitment of the staff working there;
• It has become clear to Ministerial Advisory Council that the debate has become inappropriately polarized which does injustice to the complicated and urgent public health issue that is injection drug use;
• The Ministerial Advisory Council views InSite as a partial, but vital response in the continuum of prevention, care, treatment and support of injection drug use and its public health consequences;
• It will be important to objectively and rigorously evaluate all parts of the response to injection drug use across the board;
• InSite represents value for money invested in that each infection prevented saves society “X” dollars (referencing the average cost of treatment and support for HIV-positive individuals).
  It also asked the Secretariat to draft a letter to the staff of InSite to thank them for the tour.

Review of Business Arising from the March 2008 Meeting

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada approved the Record of Decision and Public Record of Meeting from its meeting in Toronto on March 16-17, 2008.

The Secretariat reviewed the status of action items identified at the March meeting as well as the correspondence sent to and from the Ministerial Advisory Council.

International Committee Report

The International Committee provided its report to the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada, highlighting its work in the following areas:

• Status of commitments made by Canada at the 2005 G8 Summit in Gleneagles, Scotland;
  Federal departments and agencies involved in the international response to HIV/AIDS;
• International opinion survey on Canada’s contribution to the global response to the epidemic;
• Consultative Group on Global HIV/AIDS Issues;
• Events for the Minister of Health to attend the XVII International AIDS Conference in Mexico City as well as messaging for the Minister.

Ministerial Advisory Council Meeting Dates

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada confirmed is meeting dates for October 23 and 24, 2008, and February 19 and 20, 2009. It also identified a number of possible agenda topics for the Executive Committee to consider when it meets to set the agenda for the meetings.

Executive Committee Report

The Executive Committee provided its report to the Ministerial Advisory Committee on the Federal Initiative to Address HIV/AIDS in Canada. It reviewed action items from previous meetings and assigned them to Council’s committees to consider for action.

Work Plan

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada reviewed a draft of its work plan for 2008-2009. It identified a number of changes and identified items that needed to be costed out for budgeting purposes.

Preparations for Possible Mini Cabinet Shuffle

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada asked the Secretariat to arrange a teleconference for full Council in the event that there is a change in Minister of Health as a result of a Cabinet shuffle. The purpose of the call would be to discuss briefing the new minister and advising him/her on preparations for a possible attendance at the 2008 International AIDS Conference.

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.