Public Record of Meeting - October 20 - 21, 2005
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 May 6-7, 2005, 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 : Louise Binder and Lindy Samson (Co-Chairs); Mary Armstrong, Richard Elliott, Dionne A. Falconer, Deborah Foster, Jacqueline C. Gahagan, Michael Grant, Marie Anésie Harérimana, Brian Huskins, Kenneth Monteith, David M. Nelson, Anita Rachlis, Sheena Sargeant. Ex-officio: Frank McGee, Provincial Co-Chair, Federal/Provincial/Territorial Advisory Committee on AIDS (FPT AIDS) .

Regrets: Frank Plummer (ex officio)

Public Health Agency of Canada (PHAC) : Grafton Spooner, Manager, Government and External Relations, HIV/AIDS Policy, Coordination and Programs Division; Jacqueline Arthur (October 20 PM), Program Development and Evidence Based Interventions, HIV/AIDS Policy, Coordination and Programs Division.

Secretariat: Monica Thibault, Nina Elkin.

Recording and Facilitation Services : Wylie Thomas, Hajo Versteeg.

Presenters: Fernand Comeau, Government and External Relations, HIV/AIDS Policy, Coordination and Programs Division, Public Health Agency of Canada; Françoise Bouchard, Director General, Health Services Branch, Correctional Service Canada; Catherine Bélanger, Portfolio Manager, Strategic Policy, Correctional Service Canada; Alan Sierolawski, Health Services Branch, Correctional Service Canada; Mary Beth Pongrac, Health Services Branch, Correctional Service Canada; Susan Tolton, Population Section, HIV/AIDS Policy, Coordination and Programs Division, Public Health Agency of Canada.

Welcome and Approval of Agenda

The Co-Chairs of the Ministerial Council on HIV/AIDS opened the meeting with a few words of welcome. They noted that the agenda had been changed to accommodate a meeting with the Minister of Health on Friday, October 21, 2005. The representative from the HIV/AIDS Policy, Coordination and Programs Division (HIV/AIDS Division) of the Public Health Agency of Canada (PHAC) introduced the Ministerial Council to new staff at the Ministerial Council Secretariat. The agenda was approved with modifications.

Report from Health Canada and the Public Health Agency of Canada

Fernand Comeau of the Government and External Relations Section, HIV/AIDS Division, PHAC, presented the Ministerial Council with the Health Canada / PHAC financial report on the Federal Initiative to Address HIV/AIDS in Canada (FI). He noted that the government was working toward resolving inconsistencies in the coding of expenditures against the programmatic areas of the FI. The Ministerial Council received assurances that the coding challenges would not impact the correct and timely disbursement of FI funds. The Ministerial Council provided PHAC with detailed suggestions for improving the information content and breakdown of financial data. It directed the Secretariat to ensure that all Ministerial Council members receive a copy of the reallocation guidelines developed several years ago to direct the disbursement of unspent funds at the end of the fiscal year.

Preparation for Meeting with Correctional Service Canada

The Ministerial Council on HIV/AIDS spent time preparing for its afternoon meeting with representatives from Correctional Service Canada (CSC). It was noted that the Ministerial Council had requested in earlier correspondence further information from CSC in three areas, namely: prison needle exchange; access to treatment; and, an accounting of funds received through the FI. The Ministerial Council considered the responses to a questionnaire sent out by the Championing Committee to groups working on HIV/AIDS in prisons regarding their experiences and to solicit their input on topics to address with CSC. Following the preparations, the Ministerial Council asked the Secretariat to advise the CSC representatives of the issues that it would raise.

Preparation for Meeting with the Minister of Health

The Ministerial Council on HIV/AIDS spent time preparing for its meeting with the Honourable Ujjal Dosanjh, Minister of Health. A summary of the issues that the Ministerial Council identified for the Minister is provided below. Members of the Ministerial Council were assigned to speak on each point.

• Stakeholder Consultation on Allocations within the Federal Initiative --This will be an issue in the coming year.
• Pan-Canadian Research Plan --The Ministerial Council supports the development of a pan-Canadian research plan and hopes that Canada will have something to showcase at the XVI International AIDS Conference in August 2006.
• World AIDS Day --It is the Ministerial Council's hope that the Minister of Health and his colleagues, the Minister of State (Public Health) and the Chief Public Health Officer, will show a strong presence on World AIDS Day. Council offers to provide a list of World AIDS Day events to attend and help the Minister with his messaging.
• Federal Visibility at AIDS2006 -- Canada will be under international scrutiny when it hosts the XVI International AIDS Conference. It is the Ministerial Council's hope that there will be high-level attendance from the Government of Canada.
• Social Determinants of Health --The Ministerial Council is grateful for the Minister of Health's support for a social determinants of health approach to addressing the HIV/AIDS epidemic.
• Federal Initiative and Leading Together --The Ministerial Council is grateful for the Minister of Health's leadership in these initiatives and for facilitating the development of Leading Together which involved the input of many stakeholders and the participation of HIV-positive people.
• ADM Committee --The Ministerial Council supports the inter-departmental approach to the HIV/AIDS epidemic that the Government of Canada is taking. The newly established Government of Canada Assistant Deputy Ministers Committee on HIV/AIDS (ADM Committee) is an important step in this direction.
• Government of Canada Position Statement on HIV/AIDS --The Ministerial Council applauds this initiative and urges that the government consult with stakeholder groups in its development.
• Temporary Visa Application --The Ministerial Council worked with Citizenship and Immigration Canada (CIC), the local host organizations for the 2006 International AIDS Conference and others to revise the wording on temporary visa application forms so that HIV-positive visitors to Canada are no longer made to reveal their HIV status. This effectively secured the AIDS2006 Conference for Canada.
• Committee Review Process and Resources for Ministerial Council --The Ministerial Council understands that the role of federal advisory committees is under review. It is the Ministerial Council's hope that the Minister of Health will consider an expanded role for Council, including additional resources to support the work of the Ministerial Council.
• Integration with Other Diseases --While the Ministerial Council supports initiatives to reduce waste and duplication in the delivery of national programs, it is concerned that calls to integrate HIV/AIDS with other disease groups might come at the expense of HIV/AIDS programming dollars.
• Improvements in Health Care --The Ministerial Council is grateful for the initiatives that the government is implementing to improve the delivery of health care in Canada (e.g., consultation on hospital wait times). However, some programs are not working as well as they were intended.
• Prison Needle Exchange --The Ministerial Council supports increased funding for HIV/AIDS programming in prisons under the FI and urges the implementation of pilot needle exchange programs at multiple sites across Canada.

Presentation on HIV/AIDS and Other Infectious Diseases in Canadian Federal Penitentiaries

Françoise Bouchard, Director General of Health Services, Correctional Service Canada (CSC), presented to the Ministerial Council on HIV/AIDS on infectious diseases and HIV/AIDS in federal penitentiaries. Accompanying Dr. Bouchard were: Catherine Bélanger, Portfolio Manager, Strategic Policy, Knowledge Management and Policy Development, Mary Beth Pongrac; Project Manager, Health Services Branch; and, Alan Sierolawski, Manager, Health Services, Health Services Branch, CSC.

The Co-Chairs welcomed the guests on behalf of the Ministerial Council. They described the roles and responsibilities of the Ministerial Council, including advising the Minister of Health and providing oversight of the FI. They noted that CSC would be receiving a significant increase in funding under the FI and hoped to develop a good working relationship with CSC.

Dr. Bouchard thanked the Ministerial Council and described her background. As Director General of Health Services, she oversees the implementation of health policies within the federal prison system and provides information to decision makers. She provided an hour-long overview of the prison system and how health care is delivered, presented statistics on HIV/AIDS and hepatitis C in federal prisons, and described risk behaviours among prisoners and programs to address these. She also described broadly how CSC plans to use funds from the FI.

In the discussion that followed the presentation, a number of issues were raised:

• Prison Needle Exchange --The Ministerial Council informed Dr. Bouchard that it supports the piloting of prison needle exchange programs in prisons and commended CSC for piloting safer tattooing. It was noted that CSC and PHAC had signed a memorandum of understanding for advice on piloting prison needle exchanges in prison. The Ministerial Council offered its support in moving forward with implementing needle exchange.
• Access to Treatment --The Ministerial Council's position is that prisoners should have the same access to treatment as someone in the community. Dr. Bouchard noted that CSC's policy is to provide essential health care, which is defined by what is available in the jurisdiction of incarceration, and "reasonable" access to non-essential care. In practice, this has been interpreted to mean that if a drug or treatment is available anywhere in Canada, it will be made available to inmates, even if the drug is not on the formulary of the province of incarceration. Dr. Bouchard noted that CSC already provides services, such as physiotherapy and mental health care, that are not generally available free of charge to people outside prison. The Ministerial Council noted that there is significant anecdotal evidence that HIV-positive prisoners experience difficulty accessing treatment, suggesting a gap between policy and practice, and offered its support and cooperation in closing this gap.
• Community, Research and Monitoring --The Ministerial Council noted that researchers have reported difficulty accessing prison facilities for research and monitoring purposes. It was noted that community groups doing outreach with inmates have also had their access to facilities restricted and have not been adequately involved by CSC in the design and implementation of programs. The Ministerial Council offered its help facilitating dialogue between researchers, community groups and CSC.

Following Dr. Bouchard's departure, the Ministerial Council agreed to debrief and identify follow up actions in the afternoon of October 21.

Presentation on Population-Specific Approaches Under the Federal Initiative

The Ministerial Council on HIV/AIDS received an update from David Hoe of the Populations Section of the HIV/AIDS Division of PHAC on work underway to develop a framework for population-specific approaches to addressing HIV/AIDS. He noted there were a number of drivers for the initiative, including the FI, which calls for the development of discrete approaches for populations most vulnerable to HIV/AIDS, and recommendations of UNAIDS, which calls for governments to target prevention programs at specific populations and take into consideration their specific vulnerabilities as they develop these programs. The goal is for specific approaches for each population to be in place by 2008/09.

Following the presentation, the Ministerial Council provided Mr. Hoe with feedback and suggestions for improving the framework. It was noted that the Blueprint for Action on Women's Issues Coalition had been asked to advise PHAC on the development of women-specific approaches.

Meeting with the Minister of Health

The Ministerial Council on HIV/AIDS met with the Minister of Health, the Honourable Ujjal Dosanjh in the morning of October 21, 2005.

Debrief on Meeting with the Minister of Health

The Ministerial Council on HIV/AIDS held a one-hour debriefing in camera following its meeting with the Minister of Health. It identified a number of actions for follow up, including a letter to thank the Minister of Health for meeting with the Ministerial Council and to reconfirm commitments made during the meeting. It was noted that the Minister of Health had asked the Ministerial Council for suggestions for events to attend on World AIDS Day and its advice on messages he could deliver. The Ministerial Council identified members to develop a bulleted list of World AIDS Day messages and events to forward to the Minister of Health. It asked the Research Committee to draft a letter to the Minister of Health outlining the Ministerial Council's concerns about ensuring the process to develop a pan-Canadian research plan includes all relevant stakeholders and that something be ready in time for at the XVI International AIDS Conference in 2006. It also asked the Secretariat to draft letters to the Chief Public Health Officer and the Minister of State (Public Health) requesting an opportunity to meet with them.

Debrief on Presentation from Correctional Service Canada

The Ministerial Council on HIV/AIDS debriefed on its meeting with Dr. Françoise Bouchard of CSC. It noted that Dr. Bouchard had invited the Ministerial Council to communicate with her office directly. Members of the Ministerial Council were identified to work with PHAC on developing options for improving communications between the Ministerial Council and CSC. The Ministerial Council agreed to write a letter to Dr. Bouchard thanking her for the presentation and reconfirming her invitation for Council to correspond directly with her office. It was noted that the letter should express the Ministerial Council's desire to work with her to address HIV/AIDS in prisons and offer to be a resource on these issues.

The Ministerial Council discussed the responses to the questionnaire on HIV/AIDS in prisons and asked the Championing Committee to prepare a synthesis and analysis for presentation to the Ministerial Council at its next face-to-face meeting.

Debrief on Presentation on Population-Specific Approaches

The Ministerial Council on HIV/AIDS directed the Secretariat to draft a letter to David Hoe of the Populations Section of the HIV/AIDS Division of PHAC to thank him for his presentation. It asked the Championing Committee to take Mr. Hoe's presentation under advisement and report back to the Ministerial Council with recommendations.

Update on Blueprint for Action on Women's Issues Coalition

The Ministerial Council on HIV/AIDS received an update on the Blueprint for Action on Women's Issues Coalition and on the North American Group for AIDS2006.

The Blueprint Coalition is a growing group of individuals from around the world who are working on women's health and social issues. The Coalition has developed a manifesto of demands aimed at addressing issues that affect women in Canada and around the world, which it will launch on World AIDS Day at a number of events across the country. The manifesto deals with issues of prevention, diagnosis, care, treatment and support, research, human rights and stigma and discrimination. Among the demands of the Coalition is a call for complete equality for women at the XVI International AIDS Conference. The Coalition is also developing a report card against which it will grade countries' progress on each of its demands and which it will launch at the conference.

The North American Group for AIDS2006 is a platform of issues that is being developed by the Canadian Treatment Action Council, the Canadian AIDS Society and others for showcasing at the XVI International AIDS Conference in August 2006. The draft list of 7 items will eventually be consulted more broadly before being finalized.

Next Face-to-Face Meeting of the Ministerial Council on HIV/AIDS

The Ministerial Council on HIV/AIDS considered the agenda for its next face-to-face meeting. Due to the large number of agenda items, it agreed to extend the meeting by a day. The meeting dates were confirmed for December 9, 10 and 11, 2005, in Ottawa.

Presentation on Pan-Canadian HIV Research Plan

The Ministerial Council on HIV/AIDS received a presentation from Steven Sternthal and Ingrid Wellmeier of the Knowledge and Awareness Section of the HIV/AIDS Division, PHAC, on work underway to develop a pan-Canadian research plan.

Following the presentation, the Ministerial Council provided feedback to the presenters. It noted that the XVI International AIDS Conference was an opportunity for Canada to show leadership on the international stage and urged the government to work towards having something ready in time for the conference. It noted there were a number of ongoing processes and initiatives with which the research plan should align and offered to provide advice on the many stakeholders with which the developers of the research plan should consult.

Following the departure of the presenters, the Ministerial Council discussed follow-up to Ms. Wellmeier's and Mr. Sternthal's presentation. It agreed to write a letter thanking the presenters for the meeting and advising them to ensure that they consult broadly in the development of the research plan. The Ministerial Council asked the Research Committee to take the presentation under advisement and present recommendations at the next face-to-face meeting.

Update on Government of Canada Preparations for the XVI International AIDS Conference

The Ministerial Council on HIV/AIDS received an update on federal government preparations for the XVI International AIDS Conference from Susan Tolton of the Populations Section of the HIV/AIDS Division, PHAC. Ms. Tolton conveyed regrets from Gail Steckley, International Affairs Division, Health Canada, who was not able to join the meeting as planned.

Following the presentation, the Ministerial Council asked for clarification from Ms. Tolton on aspects of her presentation. It noted that the deadline for scholarship applications coincided with the day that attendance fees for the conference go up. The Ministerial Council conveyed its hope that there would be high-level participation from the Government of Canada.

Following Ms. Tolton's departure, the Ministerial Council discussed follow-up actions. It established an ad hoc committee to consider its participation in preparations for the conference and at the conference itself and to report back with recommendations at the next face-to-face meeting. It agreed to write a letter to Ms. Tolton thanking her for her presentation and reconfirming its desire to see high-level representation from the Government of Canada at the conference and strong support for scholarships from the Government of Canada.

Update on World AIDS Day Report

The Ministerial Council on HIV/AIDS received an update on the World AIDS Day Report from its representative on the editorial board for the report. He noted that the report was in final draft form and that there would be one more opportunity to provide comments. As a result of inconsistencies in the length and style of submissions from report contributors, a recommendation had been made to develop guidelines on length. The Ministerial Council asked its members to provide any final comments on the draft report by the end of day Monday, October 24, 2005.

Update on Committee Review Framework

The Ministerial Council on HIV/AIDS received an update on work to develop a framework for reviewing PHAC's advisory and coordination committee structure from its representatives in the process to develop the framework. They reported that a draft framework had been circulated to stakeholders for comment and that PHAC would be engaging a consultant to carry out the review in the new year. The Ministerial Council asked the Secretariat to arrange for an update on the c ommittee review process at its meeting on February 23 & 24, 2006.

Approval of the May 2005 Record of Decision

The Ministerial Council on HIV/AIDS approved the Record of Decision from its meeting in Montreal on May 6 and 7, 2005, subject to a number of changes.

Business Arising From the May 2005 Meeting

The Co-Chairs of the Ministerial Council on HIV/AIDS asked the committees to review the summary of actions from its May 2005 meeting and report back for discussion at the December face-to-face meeting.

Template for Public Records of Meeting

The Ministerial Council on HIV/AIDS received an update from the Communications and Liaison Committee on the status of the Public Records of Meeting (PROMs). The committee noted that a model PROM had been developed and circulated to members. Due to limited time, the Ministerial Council asked members to provide comments by email so that the model PROM could be readied for consideration at the next face-to-face meeting. Once approved, the model PROM will provide the template for future meetings and for preparing the PROMs that are in arrears for the reasons discussed at earlier meetings.

Close of Meeting

The Co-Chairs thanked members of the Ministerial Council on HIV/AIDS for their work during the meeting and the Secretariat and PHAC for their support.