Public Record of Meeting - March 17 - 19, 2007
Ottawa, 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 March 17 - 19, 2007, 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#min

Present:

Ministerial Council: Louise Binder (Co-Chair); Richard Elliott, Deborah Foster, Jacqueline C. Gahagan, Marie Anésie Harérimana, Kenneth Monteith, David M. Nelson, Anita Rachlis. Ex-officio: Frank McGee.

Regrets: Brian Huskins, Frank Plummer, Sheena Sargeant

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

Secretariat: Carol Dennis, Andrew Howard.

Facilitation Services: Wylie Thomas, Hajo Versteeg.

Presenters: Neil Burke, HIV/AIDS Division, PHAC; Yogesh Choudhri, Surveillance and Risk Assessment Division, PHAC; Marc-André Gaudreau, HIV/AIDS Division, PHAC; Karine Goneau-Lessard, the Marketing, Risk Communications and Public Involvement Division, PHAC; Marsha Hay-Snyder, HIV/AIDS Division, PHAC; Thomas Kerr, BC Centre for Excellence in HIV/AIDS; Michael McCulloch, HIV/AIDS Division, PHAC; Sandiran Premakanthan; HIV/AIDS Division, PHAC; Maxxine Rattner, HIV/AIDS Division, PHAC; Geneviève Tremblay, HIV/AIDS Division, PHAC.

Welcome and Approval of Agenda

Hajo Versteeg, the meeting facilitator, opened the meeting with a few words of welcome. A roundtable of introductions was made. He introduced Carol Dennis, the new staff responsible for the Secretariat at the HIV/AIDS Policy, Coordination and Programming Division of Public Health Agency of Canada (PHAC). Mr. Versteeg reviewed the agenda, which was approved without modifications.

Approval of the December 2006 Record of Decision

The Ministerial Council on HIV/AIDS approved the Record of Decision from its meeting in Ottawa on December 17 – 19, 2006, subject to specified changes.

Approval of the December 2006 Public Record of Meeting

The Ministerial Council on HIV/AIDS approved the Public Record of Meeting from its December meeting in Ottawa.

Committee Reports of the Ministerial Council on HIV/AIDS

• International Affairs Committee

  The International Affairs Committee provided its report to the Ministerial Council on HIV/AIDS. It reported that it had submitted the Ministerial Council’s comments on the revised draft testing guidelines to the World Health Organization in January. The Ministerial Council asked the Secretariat to send a copy of the final submission to members. The committee advised that it would be following up with the International Affairs Directorate at Health Canada regarding the topic of the Fall 2007 International Policy Dialogue, which the Ministerial Council has recommended should be harm reduction (See December 2006 PROM). The committee also discussed its need for new members and reassigning some of the issues that it had been assigned to other Ministerial Council Committees.

• Championing Committee

  The Championing Committee provided its report to the Ministerial Council on HIV/AIDS. The Committee reported that it had met by teleconference to work on organizing the agenda for the current meeting. The committee expressed its concerns over the apparent weakening of the role of harm reduction in Canada’s drug strategy and HIV prevention. Among other things, it was noted that the prison tattooing pilot project had recently been cancelled and that a decision on extending Vancouver’s supervised injection site had been deferred until December 2007. The Committee also indicated that it had been contacted by representatives from the immigrant and refugee communities in Toronto requesting the Ministerial Council’s assistance in setting up a meeting with Citizenship and Immigration Canada (CIC). The Ministerial Council agreed that the Committee should draft a letter to CIC requesting such a meeting.

• Research Committee

  The Research Committee provided its report to the Ministerial Council on HIV/AIDS. The Ministerial Council’s representative to the CIHR HIV/AIDS Research Advisory Committee (CHARAC) gave a summary of CHARAC’s recent meeting, which included a report on the results of the Fall 2006 call for applications to the CIHR HIV/AIDS Initiative and its Community-Based Research (CBR) Program, an overview of the results of an external review of CIHR by an international panel of experts and a discussion of work to develop a system for measuring the impact of health research. She noted that concerns had been raised at the meeting with respect to the success rate of applicants in the competitions, particularly in the Aboriginal stream of the CBR Program. She also advised the Ministerial Council that she had raised the issue of ensuring that researchers not affiliated with an institution with its own ethics review board have access to ethics reviews. The Ministerial Council also received an update on the March 1 and 2 National HIV/AIDS Surveillance Meeting from members who were at that meeting.

  The Ministerial Council asked the Research Committee and the Secretariat to inquire about the status of work to develop a pan-Canadian research agenda and report back (see June 2006 Public Record of Meeting). It also asked the Secretariat to circulate to its members the materials distributed at the February meeting of CHARAC.

• Executive Committee

  The Executive Committee provided its report to the Ministerial Council on HIV/AIDS, noting that it had worked on developing the agenda for this meeting and on setting up a meeting between the Ministerial Council and the Minister of Health, which had since been cancelled. It added however that the Secretariat was working to reschedule that meeting. The Executive Committee asked the Ministerial Council’s various committees to look at the issue they had been assigned and determine whether there were any gaps or overlaps with other committees.

• Treatment Issues Subcommittee

  The Treatment Issues Subcommittee provided its report to the Ministerial Council on HIV/AIDS. It reminded the Ministerial Council of the findings from the June 2006 National Pharmaceutical Strategy (NPS) Progress Report, which it presented at the December 2006 meeting. The report provides recommendations in five areas: 1) Catastrophic Drug Coverage; 2) Expensive Drugs for Rare Diseases; 3) Real World Drug Safety and Effectiveness; 4) Common National Formulary; and, 5) Drug Pricing and Purchasing Strategies. In the discussion that followed, the Ministerial Council agreed that the committee should write a letter to the NPS Secretariat with its advice in each of the five areas. The committee also identified concerns with the functioning of the Special Access Program, which provides practitioners with access to non-marketed drugs to treat patients with serious or life-threatening conditions when conventional therapies fail. The Ministerial Council agreed with the recommendation that the committee write to Health Canada to raise these concerns. The Ministerial Council also identified a representative to the Canadian Agency for Drugs and Technology in Health’s Invitational Symposium and asked the Secretariat to make the necessary arrangements.

Canadian HIV Vaccine Initiative

The Ministerial Council on HIV/AIDS received an update from members who had attended the February 20 conference call briefing on the recent announcement of federal funding for the Canadian HIV Vaccine Initiative. Some members of the Ministerial Council expressed concern that the announcement may affect funding levels in existing commitments such as the Federal Initiative. The Ministerial Council agreed that more details were needed and asked the Secretariat to invite the appropriate people from the HIV/AIDS Division to present at a future meeting.  The Ministerial Council also agreed to send a letter to the Minister of Health thanking him for the funding and asking him to confirm that the announcement represents new funding.

Business Arising from the December 2006 Meeting of Council

The Ministerial Council on HIV/AIDS reviewed the status of action items arising from its meeting in Ottawa on December 17 – 19, 2006, as well as correspondence and provided guidance to the Secretariat in completing any outstanding items.

Use of Evidence in Public Health Policy Making and Programming

The Ministerial Council on HIV/AIDS held a discussion on the importance of evidence in public health programming and policy making, noting that evidence appeared to have been ignored in a number of recent decisions to cancel existing programming. Following a lengthy discussion, the Ministerial Council agreed to commission a policy brief on the foundations of good public policy highlighting the importance of human rights, evidence-based decision making and referencing the Krever Commission and the Precautionary Principle. It established a small working group to develop a statement of work for hiring a consultant and oversee the selection process. The Ministerial Council agreed that the paper should be prepared with some urgency, and asked the Secretariat to expedite the process so that a first draft would ready for the Ministerial Council to consider by the end of April.

Report from the Public Health Agency of 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 PHAC related to the Federal Initiative. He referred the Ministerial Council to a copy of a written update in the meeting binders, and highlighted a number of issues for further discussion: the Review of the Federal Initiative; the April 2007 HIV Prevention Forum; the Leading Together Championing Committee; and, the new Canadian HIV Vaccine Initiative Announcement. He also advised the Ministerial Council that the enabling legislation for PHAC came into force on December 12, 2006, which, among other things, provides the Agency with the regulatory authority for the collection, analysis, interpretation, publication and distribution of information. The legislation will allow the Agency to formalize relationships with the provinces and territories. He noted that the federal partners were in the process of developing a common system for quarterly financial reporting, and drew the Ministerial Council’s attention to a preliminary breakdown of spending under the operations and management budget line of the Federal Initiative which his office had provided.

The Ministerial Council discussed its participation in the April HIV Prevention Forum, and identified a number of potential representatives to that meeting. It asked the Secretariat to obtain a list of participants to the meeting to help it decide which members should attend. It also agreed on criteria to help determine who from the Ministerial Council should attend.

HIV Counselling and Testing

Michael McCulloch, Senior Policy Advisor, External and Government Relations Section, HIV/AIDS Division, PHAC, and Marc-André Gaudreau, Manager, Program Development and Evidence-Based Interventions, HIVAIDS Division, PHAC, joined the meeting to present on new developments and emerging issues in HIV testing and counseling and work underway by the Government of Canada to develop a framework for testing and guidelines.

Mr. McCulloch described international efforts to develop testing and counseling guidelines. He noted that there were a number of initiatives aimed at addressing the hidden epidemic of people living with HIV/AIDS who were unaware of their infections. In particular, he noted new guidelines for provider-initiated HIV testing and counseling (PITC) issued by the US Centers for Disease Control and Prevention in the Fall of 2006, which appear to move away from the three Cs of confidentiality, informed voluntary consent and pre- and post-test counseling. As well, he described work being carried out by UNAIDS and WHO to develop operational guidelines for PITC, which also appear to move towards an opt-out model of testing.

Mr. Gaudreau provided an update on work underway in Canada to develop a comprehensive policy framework for HIV testing. The work which is being led by PHAC comprises three inter-related projects that will be completed in 2007: 1) revisions to the Point of Care HIV Testing Using Simple Rapid Test Kits: Guidance for Health Care Professionals; 2) revisions to the Canadian Guidelines on HIV Counselling and Testing, which will cover VCT and PITC; and, 3) guidance for home HIV testing.

Mr. Gaudreau noted that a discussion paper on testing and counseling was being developed and would be shared with stakeholders in preparation for a national dialogue on testing policy planned in the Spring/Summer of 2007.

In the discussion with the presenters that followed, the Ministerial Council expressed its hope that PHAC would continue to take the position that public health and human rights were complementary concepts and advised that it should consider gender and culture at an early stage in the development of the policy framework. Members of the Ministerial Council informed the presenters of the concerns raised by stakeholders in other fora regarding the WHO/UNAIDS revised guidelines.

Following the departure of the presenters, the Ministerial Council drafted thank-you letters to the presenters in which it reiterated the points made in the session and confirmed its desire to participate in the national testing dialogue. It asked the Secretariat to obtain further information on the dialogue to help it make a decision with respect to representatives to send to the meeting.

Evaluation of Vancouver’s Supervised Injection Facility

Thomas Kerr, British Columbia Centre of Excellence in HIV/AIDs, joined the meeting to provide the Ministerial Council on HIV/AIDS with an overview of InSite, Vancouver’s supervised injection facility, and reviewed the results of a number of studies conducted to evaluate various aspects of the facility’s process and outcomes. InSite is located in the 100 block of East Hastings Street in Vancouver’s Downtown East Side (DTES), which has been the epicentre of drug-related harm in Canada for many years. InSite opened its doors in the Fall of 2003 as a research project under a legal exemption from the Controlled Substances Act granted by Health Canada on condition that an external scientific evaluation of its impacts be conducted. Approximately 8000 unique individuals have used the site since it opened. The original exemption that allowed the site to operate expired in September 2006. Although an extension has not been granted, the decision on whether or not to grant an extension has been postponed until December 31, 2007. In the meantime, the site is being allowed to operate, but without funding from Health Canada to continue the research. Dr. Kerr expressed concerns that the lack of funds could result in the loss of a valuable database that has been built up by the researchers. Dr. Kerr reviewed the findings to date and the studies supporting these conclusions:

• The SIS has attracted and retained a high risk population of IDUs who are at heightened risk for HIV infection and overdose (Wood et al., American Journal of Preventative Medicine, 2005, and Wood et al., American Journal of Public Health, 2006);
• The SIS has been associated with reductions in public disorder related to injection drug use. (Wood et al., Canadian Medical Association Journal, 2004);
• Use of the SIS has been associated with reductions in HIV risk behaviour (syringe sharing) (Kerr et al., The Lancet, 2005, Wood et al., American Journal of Infectious Diseases, 2005);
  SIS staff have successfully managed hundreds of overdoses (Kerr et al., IJDP, 2006, and Kerr et al., IJDP, 2007);
• Many individuals at risk for HIV infection are receiving safer injection education at the SIS, and increases in safe micro-injecting practices have been observed (Wood et al., International Journal of Drug Policy, 2005 and Stoltz et al., Journal of Public Health, 2007);
• Use of the SIS has been associated with increased uptake of detoxification services and other addiction treatments (Wood et al., New England Journal of Medicine, 2006, Wood et al., Addiction, in press);
• The establishment of the SIS has not prompted adverse changes in community drug use patterns (Kerr et al., British Medical Journal, 2006);
• The establishment of the SIS has not prompted initiation into injection drug use (Kerr et al., American Journal of Public Health, in press);
• The establishment of the SIS has not led to increases in drug-related crime (Wood et al., Substance Abuse Treatment. Prevention, and Policy, 2006).

Dr. Kerr noted that despite these findings, comments continue to be made in the press claiming that the evidence for the public health benefits of InSite is inconclusive. He described an expert advisory committee established by the Minister of Health, which is to oversee the process for reviewing the evidence on supervised injection sites.

In the discussion that followed, the Ministerial Council expressed its support for harm reduction in the response to HIV/AIDS in Canada. It thanked Dr. Kerr for coming to present on the weekend and advised him that this was an area it considered important.

Following the departure of Dr. Kerr, the Ministerial Council asked the Secretariat to obtain electronic copies of the presentation and the various published papers he mentioned in his presentation and forward them to members. It also drafted a letter to Health Canada to request a meeting with the expert advisory committee. It also asked the Secretariat to draft a letter to Dr. Kerr thanking him for his presentation and indicating that the Ministerial Council is committed to harm reduction and that it would like to be kept updated regarding InSite.

AIDS Community Action Program

Members of the Ministerial Council on HIV/AIDS reported problems related to the implementation of the AIDS Community Action Program (ACAP) in the regions. The Ministerial Council noted that the roll-out of ACAP appeared to vary across the country and asked the Secretariat to obtain further information on the matter and to convey the concerns raised by the Ministerial Council’s members to the appropriate people within government. The Ministerial Council asked its members to forward the details of their concerns to the Secretariat.

Review of the Federal Initiative to Address HIV/AIDS in Canada

The Ministerial Council on HIV/AIDS received a briefing from some of its members on the status of the Minister of Health’s review of the Federal Initiative and discussed its role in the exercise and its position on various aspects of the process to prepare itself for responding to queries from the Minister and others. It agreed on a number of recommendations related to transparency of the process and the importance of involving persons living with HIV/AIDS and people working in the field in the review process. It agreed that the Co-Chairs should raise these recommendations in their eventual meeting with the Minister of Health.

Accountability Under the Federal Initiative

The Ministerial Council on HIV/AIDS received an update from Marsha Hay-Snyder and Sandiran Premakanthan of the Accountability and Evaluation Section of the HIV/AIDS Division on work underway to evaluate the Federal Initiative and mechanisms in place to ensure accountability of federal partners. Their presentation included an overview of the logic model that has been developed to guide the development of short-, medium- and long-terms indicators. The Ministerial Council provided specific advice regarding aspects of the planned evaluation, including the need to consult stakeholders as the evaluation is implemented and stressed the importance of evaluating the Federal Initiative in the context of its contribution to Leading Together: Canada Takes Action on HIV/AIDS. Following the departure of the presenters, the Ministerial Council asked the Executive Committee to consider setting aside time in the agenda of the next face-to-face meeting to discuss and formulate advice on the logic model and accountability.

Presentation on Communications and Social Marketing

Neil Burke and Maxxine Rattner of the HIV/AIDS Division and Karine Goneau-Lessard of the Marketing, Risk Communications and Public Involvement Division, PHAC, joined the meeting to update the Ministerial Council on HIV/AIDS on the development of the national social marketing campaign and related activities. Also in attendance was Yogesh Choudhri of the Surveillance and Risk Assessment Division of PHAC. Communications and social marketing are one of the five areas of the Federal Initiative, which outlines the need for “national and front-line communications and social marketing activities.” PHAC has developed a five-year communications strategy, which provides an overarching framework for communications. As part of this strategy, two types of social marketing campaign will be supported: 1) community-led national social marketing; and 2) PHAC-led national social marketing.

The presenters focused on the PHAC-led national social marketing, which will be based in part on the findings of the 2006 HIV/AIIDS Attitudinal Survey, which identified 5 segments of the population: 1) well-informed and very empathetic (38%); 2) well informed and moderately empathetic (22%); 3) moderately informed and moderately empathetic (22%); 4) moderately informed and not empathetic (11%); 5) uninformed and not empathetic (7%). The strategy of the social marketing campaign will be to focus on the “low-hanging fruit” of Segments 2 and 3 to move them into Segment 1. The target of the social campaign messages will be young men between the ages of 18 and 25 within these two segments.

Following the presentation, the Ministerial Council engaged in a discussion with the presenters and raised its concerns about the lack of a contingency plan to shield implementation of the social marketing campaign from the effects of an early election or other political events. Ministerial Council members provided a number of ideas for partnering with other organizations, leveraging the campaign with other initiatives and using new technologies to reach the target audience. Its members expressed concern that none of the focus group discussions took pace in Alberta, despite the potential epidemic among young heterosexual migrant workers in the Oil Sands Projects.

Following the departure of the presenters, the Ministerial Council asked the Secretariat to prepare, for Co-Chair signature, letters to the guests thanking them for their presentation and indicating the Ministerial Council’s strong support for this work and its wish to be kept updated and involved as the social marketing campaign is implemented. It also asked that the letter remind them to provide a break down of Segments 2 and 3 by target population (males 18 to 25).

Update on Population-Specific Status Reports

Geneviève Tremblay, Manager, Populations Section, PHAC, joined the meeting to provide the Ministerial Council on HIV/AIDS with an update on the development of Status Reports for each of the at-risk populations identified in the Federal Initiative. The Status Reports will provide information on the epidemic and the response to those epidemics in each of the 8 at-risk populations namely: people living with HIV/AIDS; gay men; people who use injection drugs; Aboriginal people; prisoners; youth at risk; women and girls; and, people from countries where HIV is endemic.

Two populations have been chosen to pilot the Status Reports: 1) gay men; 2) people from countries where HIV is endemic with a focus on Black Canadians. The completion of the Status Report for Black Canadians is expected in June 7, 2007, and with the Gay Men’s Status Report in the Fall of 2007. Work is also well underway on the Status Report for Women and Girls and just recently started for Aboriginal People.

The Ministerial Council engaged in a discussion with Ms. Tremblay following her presentation. The Ministerial Council identified a number of concerns which included:

• The potential epidemic among heterosexual transient workers in Northern Alberta’s oil industry.
• The rural-urban divide in terms of the level of services in prevention, diagnosis, care, treatment and support.
• The potential for the Status Reports to be bogged down in the approvals process. 

Following Ms. Tremblay’s departure, the Ministerial Council asked the Secretariat to prepare a letter to Ms. Tremblay thanking her for her presentation and reiterating the concerns it raised.

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 been approached by PHAC to participate in a number of working groups including several of the Status Report Working Groups mentioned by Ms. Tremblay. FPT AIDS would like to be involved but it is hindered by work loads and competing demands on its members’ time. So far, FPT AIDS has identified members to participate on the Gay Men’s Status Report Working Group and the Aboriginal Status Report Working Group, as well as the recently established Leading Together Championing Committee.

Next Meeting Dates

The Ministerial Council on HIV/AIDS agreed to hold its next face-to-face meeting in Ottawa on June 7 and 8, 2007, with a possible orientation session in the afternoon of June 6. The Ministerial Council agreed to let the Executive Committee decide whether the session on June 6th will be 2 hours or half a day. It asked the Secretariat to send an email out to members confirming the meeting dates. It also identified a number of items for the Executive Committee to consider when it meets to set the agenda for the June meeting.

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.