Meeting of September 12- 13, 1999, Toronto - Public Record of Meeting

Executive Committee
Special Working Group on Aboriginal Issues
Ad hoc Committee on Communications
Ad hoc Commitee on Canadian Institute for Health Research
Standing Committee on Monitoring and Evaluation
Championing Current and Emerging Issues
Business Arising
Additional Items
Presentations
Workplans

EXECUTIVE COMMITTEE

Report from Executive Committee

Greg Robinson presented his year-end review, highlighting the Council's activities and achievements. Council thanked him for his excellent report and for his work over the previous year.

• Council was alerted to significant problems with levels of ACAP funding.
  
• Council agreed to give priority to issues related to the drug approval process.

 SPECIAL WORKING GROUP ON ABORIGINAL ISSUES

-to look at the recommendations made during the Round Table on HIV/AIDS Affecting Aboriginal People and develop draft recommendations for consideration by Council at its next meeting.

Albert McLeod reviewed the Special Working Group's activities. Council adopted the following new terms of reference for the Group:

• to inform the Ministerial Council on HIV/AIDS about emerging HIV/AIDS issues affecting Aboriginal people;
  
• to consult and collaborate with Aboriginal people and other stakeholders on HIV/AIDS issues affecting Aboriginal people;
  
• to prioritize actions that address HIV/AIDS issues affecting Aboriginal peoples and the Aboriginal components across the
    Canadian Strategy on HIV/AIDS;
  
• to recommend actions to the Ministerial Council that address issues affecting Aboriginal people;
  
• to assist the Ministerial Council with reporting on the work being undertaken to address HIV/AIDS issues affecting Aboriginal people

 AD HOC COMMITTEE ON COMMUNICATIONS

Need for additional committees

The Committee is instructed to: advise on and develop systems for internal communications and to follow up on CSHA communications outstanding for the Council. Be the Council's focal point for World AIDS Day and other important events or issues. Develop procedures for increasing awareness of the Council's role and purpose. Provide a communications strategy for linking with other government departments.

AD HOC COMMITTEE ON CANADIAN INSTITUTE FOR HEALTH RESEARCH

No News

STANDING COMMITTEE ON MONITORING AND EVALUATION

Terrence Stewart reported that the Committee had worked with members of the Centre for Health Promotion to develop an accountability framework. The Committee received a draft in June 1999, and the next draft will be available shortly. There was concern that the current draft does not deal adequately with coordination and collaboration or with issues related to correctional services.

• to hold a conference call with the Centre for Health Promotion to address information related to coordination, collaboration and correctional institutions that is missing from the performance reporting framework. The secretariat will arrange the call.
  
• to develop a process to enable reviews of CSHA allocations. These reviews will form the basis of a half-day discussion at the next Council meeting.

STANDING COMMITTEE ON CHAMPIONING OF CURRENT AND EMERGING ISSUES

Louise Binder provided a detailed outline of the Committee's activities, as a result of which the Council made the following decisions.

• The Committee will send a letter to the organizers of the National Conference on Women and HIV (Toronto, May 2000) to tell them that the Council is interested in the outcome of the Conference, particularly broad policy issues.
  
• The Ministerial Council co-chairs, and appropriate members of the Championing Committee, will meet with representatives of the HIV/AIDS Division to discuss current program initiatives and the Division's development of the National Reference Group on Women. The secretariat will make the necessary arrangements.
• With respect to the Council's request to meet with senior management of Correctional Services Canada (CSC), several members will participate in a teleconference with CSC's national HIV/AIDS coordinator. The secretariat will arrange the call. Following the teleconference, Louise Binder and the CO-chairs will discuss a proposed meeting with the Commissioner of the CSC.
  
• Health Canada will send information on the Canadian Institutes for Health Research to the Council. Council members will give their comments and recommendations to the Chair of the Championing Committee, who will put together a package for the consideration of the Council. (Council continues to endorse a separate institute for HIV issues.)
  
• Council endorses the recommendations of the Consultative Workshop on Drug Review in Canada with respect to the Therapeutic Products Programme Drug Review Process. A letter in support of the recommendations will be prepared for the signature of the CO-chairs Council reappointed Louise Binder to continue her involvement with the Working Group on the Therapeutic Products Programme Drug Review Process.

BUSINESS ARISING

i) Membership and mandate of standing committees and working groups

Council agreed that the following committees' mandates include continuing or completing work from last year. In addition, Council identified new priorities and issues for the various committees to address.

Special Working Group on Aboriginal Issues
Members: Albert McLeod (Chair), Keitha Kennedy, Bryce Larke, Andrew Johnson, Marilyn McCrea
to look at the recommendations made during the Round Table on HIV/AIDS Affecting Aboriginal People and develop draft recommendations for consideration by Council at its next meeting.

Standing Committee on Monitoring and Evaluation
Members: Terrence Stewart (Chair), Greg Robinson, Liviana Calzavara, Caroline Ploem, Jennifer Hebert

• to hold a conference call with the Centre for Health Promotion to address information related to coordination, collaboration and correctional institutions that is missing from the performance reporting framework. The secretariat will arrange the call.
• To develop a process to enable reviews of CSHA allocations. These reviews will form the basis of a half-day discussion at the next Council meeting.

Standing Committee on Championing of Current and Emerging Issues
Members: Louise Binder (Chair), Ralf Jürgens, Jennifer Hebert, Rick Marchand, Kelly MacDonald, Don Kilby

• to commission a paper on economic investment in the HIV/AIDS epidemic, and to look at vaccine research, rapid testing, rehabilitation, drug pricing and approval, and immigration issues.

ii) Need for additional committees

Council discussed the need for new committees and established the
Ad Hoc Committee on Communications
The Committee is instructed to:

• advise on and develop systems for internal communications and to follow up on CSHA communications outstanding for the Council.
  
• be the Council's focal point for World AIDS Day and other important events or issues.
  
• develop procedures for increasing awareness of the Council's role and purpose.
  
• provide a communications strategy for linking with other government departments.

iii) Membership of the Executive Committee

Executive Committee
Members: Roger Le Clerc and Liviana Calzavara (co-chairs), Albert McLeod, Terrence Stewart, Louise Binder, Andrew Johnson

• The Executive Committee will continue to comprise the Council's co-chairs and the chairs of the various committees and working groups.

iv) Observers

• It was reiterated that observers are not normally allowed to attend Council meetings. Council will decide on observer status as needed.

ADDITIONAL ITEMS

Standing Committee on Long-Term Visioning

Roger Le Clerc gave a review of the Committee's achievements, noting that the Visioning Committee had fulfilled its mandate to develop and have the Council adopt its vision statement.

Update on the National Health Research and Development Program (NHRDP)

• An update was provided on the NHRDP. Council asked Health Canada to advise the Executive Committee if funds for 1999-2000 were likely to lapse.
  
• Council addressed the following correspondence issues: Council hopes to see a faster response from Health Canada on letters to the Minister. the response to the May 13, 1999, letter from the Canadian Working Group on HIV and Rehabilitation (CWGHR) will state that HIV/AIDS rehabilitation is an issue that the Council's Championing Committee will address. Bryce Larke will report back to the Council on the CWGHR presentation. The response to the August 30, 1999, letter from the Hassle Free Clinic concerning rapid testing will state that it is an area that will be addressed by the Championing Committee. Bryce Larke will give the information to the co-chairs. A letter will be sent to the organizers of the National Conference on Women and HIV to wish them well.

Budget for the Ministerial Council (1999-2000)

• Council approved the budget allocations for 1999-2000.
  
• David Hoe presented the year-end financial statement for 1998-1999 and the CSHA financial status reports for 1998-1999 and 1999-2000 (as of August 24, 1999).
  
• Health Canada is to give the Council details of Health Protection Branch expenditures as they appear in the 1998-1999 financial status report and in forecasted expenditures for 1999-2000.
  
• Financial statements will not be made public until they are approved by Health Canada.

Honoraria

Council discussed the pros and cons of awarding honoraria, recognizing that attendance at meetings should not create hardship or prevent full participation by all members. The secretariat will draft a policy statement on the issue for approval by the Council and inclusion on the website.

Consensus on Sunday and Monday meetings

• For the foreseeable future, Council meetings will continue to be held on Sundays and Mondays.
  Time and place of the next Council meeting
• Council agreed to hold the next meeting in Ottawa (November 28-29, 1999) and the following meeting in Montreal (March 19-20, 2000).

PRESENTATIONS

Importance of cultural perspective on health and healing

Art Shofley addressed the Council about the importance of culture on health and healing. He made the following recommendations:

Train aboriginal and non-aboriginal caregivers in cultural awareness

• Establish this as basic training for HIV/AIDS caregivers, with continuous refresher training.
  
• Use qualified Aboriginal trainers to provide education and supervise training, ensuring that medical doctors, chaplains and training supervisors are included.
  
• Hire and train Aboriginals more actively to administer programs.

Establish a hospice or hospices to allow culturally appropriate palliative care in conducive surroundings

• The hospices should reflect Aboriginal traditions and beliefs and be able to accommodate clients of various tribal cultures, with services appropriate to the individual client's background
  
• Evaluate programs for Aboriginal prisoners with HIV/AIDS
  
• Examine the effectiveness of present programs and educate medical staff in prisons about HIV and AIDS.
  
• Seek ways to reduce the stigma against prisoners with HIV/AIDS.
• Enhance the liaison between the justice system and the health care system.
  

Arlo Yuzicapi-Fayant provided an overview of the Canadian Aboriginal AIDS Network's activities and mandate. She shared with the Council some of the problems that the Network has encountered in dealing with the epidemic among Aboriginal people and recommended that the Minister intervene and ensure that:

• NHRDP funds directed for Aboriginal community-based research are allocated within the 1999-2000 fiscal year.
  
• the political agenda of the national Aboriginal organizations does not impede the work of the Aboriginal AIDS initiatives.
  
• resources directed to Aboriginal AIDS programming remain guided by the spirit of the CSHA, that is, that programming and resources are community-driven and directed.

Métis National Council

Deborah Baron-McNabb gave an overview of Métis history. It was recommended that Council:

• support the recognition of the appropriateness of working specifically with the national governing bodies of the three peoples (First Nations, Inuit and Métis vs. numerous Aboriginal organizations) and provide and facilitate forums and structures for doing so.
  
• provide support and financial and other resources for a Métis-specific HIV/AIDS capacity building, focussing on priorities, programs and services with Métis self-determined governing structures and systems. There is an Inuit-specific HIV/AIDS network and there are First Nation HIV/AIDS forums, but there are none that are Métis-specific.
  
• support the facilitation of a Métis-specific HIV/AIDS health-needs assessment within an overall comprehensive health-needs assessment process.

Assembly of First Nations

Allen DeLeary, who is responsible for the HIV/AIDS file for the Assembly of First Nations (ASF), provided an overview of the AFN, its mandate and its activities. While HIV/AIDS is a priority, it has been difficult to convince the leadership of the gravity of the situation facing Aboriginal people. Mr. DeLeary made the following recommendations:

• Aboriginal leadership needs to be made aware of the magnitude of the epidemic facing their people so that they can begin to take appropriate action.
  
• Processes for addressing HIV/AIDS need to be community-driven.
  
• Aboriginal people need to have the tools to obtain and control their own surveillance and epidemiological data.

Inuit Tapirisat of Canada

Roda Grey presented on the Inuit experience with HIV/AIDS and the activities of the Inuit Tapirisat of Canada and Pauktuutit (Inuit Women's Association). She made the following recommendations:

• Pauktuutit and the Inuit Tapirisat of Canada must be jointly consulted and fully involved in the design, development and delivery of all policies related to the issue of HIV and AIDS for the Inuit.
  
• Sustainable, ongoing funding for the Inuit HIV/AIDS network should be guaranteed, and this funding should reflect the vast cost differential of providing accessible materials, networking possibilities and the need for capacity building.
  
• A separate Inuit funding stream should be established.

Human Dimensions of the epidemic among Aboriginal People in British Columbia

Lou Demerais described the epidemic in Vancouver's downtown east end, which is Canada's poorest neighbourhood. Mr. Demerais is Director of the Vancouver Native Health Society, which provides services to primarily though not exclusively Aboriginal people living in this area. He described the dimensions of the epidemic and the extreme frustration of accessing the resources needed to address the crisis. HIV/AIDS is highest among young Aboriginals who are very mobile. The disease is a threat to the survival of First Nations as a people. Hepatitis C and tuberculosis are also widespread.

Canadian Strategy on HIV/AIDS

• Laura Commanda presented on the CSHA and Aboriginal programs and activities in the Health Promotion and Programs Branch.
• Debra Gillis gave an overview of the activities of the Medical Services Branch in the area of HIV/AIDS and Aboriginal people.

General themes arising and general discussion

• Debra Gillis will provide Council with information about the assessment of the programs or where they are in the process. The secretariat will follow up.
• Council recommended that Minister Rock meet with his cabinet colleagues and appropriate Council members to discuss issues related to HIV/AIDS and the larger, underlying causes, such as social housing, human resources and unemployment. The discussions should concentrate primarily on Aboriginal HIV/AIDS issues. The Special Working Group will draft a letter to Minister Rock for the co-chairs' signature.

 WORKPLANS

Work plan for the next meeting

Council decided that the following will be discussed on November 29:

• The Monitoring and Evaluation Committee will develop, for the approval of the Executive Committee, a proposal for a half-day session focussing on a process for the review of the CSHA allocations.
• The Championing Committee will develop, for the approval of the Executive Committee, a proposal for a half-day session focussing on injection drug use issues.
• Council members will submit information and ideas to the committees for inclusion in their planning process.
• The secretariat will look into giving the Monitoring and Evaluation Committee available background information on reallocation processes in other departments.
• The secretariat will give Council members a copy of "Toward a Healthy Future: Second Report on the Health of Canadians".