Back in 2014 I was in contact with Bob Bachas from British Columbia who, working with SGIAS and with the office of Elizabeth May MP assisting, wanted to petition the Canadian government in the following way:
“Your petitioners call on the House of Commons to recognize that all Canadians, no matter their location or socioeconomic status, deserve access to pro-active diagnosis and effective treatment for HIV/AIDS, and immediately implement a National AIDS Strategy based on the proven principle of Treatment as Prevention.”
This week Bob let me know he had received a response from Health Minister Jane Philpot, The text is below. You probably know that since the petition was formulated the government adopted global 90-90-90 targets, which do in fact incorporate a treatment as prevention approach which emanated from British Columbia.
(What has gone largely unnoticed is that Canada, despite its government’s endorsement, is not in a position to properly engage in 90-90-90 without adequate measurement tools to determine whether or to what extent such targets have been attained. Simply put, we don’t know how many people living with HIV are engaged, in treatment or have undetectable viral loads, for example. Measurement tools are just not there, although there is a move to correct that deficiency underway which will take several years to come to fruition.)
Also obscured in the Minister’s response is the fact that there is in fact no national HIV/AIDS strategy that reflects current realities. A new strategy is considerably overdue but we haven’t seen an appetite in an otherwise energetic Minister to make a new strategy a priority, despite community demands, including this petition.
Interesting too is that while the response makes specific reference to various communities which are disproportionally affected by HIV, a section of the response which extends over two long paragraphs, by far the largest of these communities - men who have sex with men is - not mentioned.
On the issue of funding you will note the Minister says the Government is “engaging with communities to strengthen prevention and access to testing, treatment and ongoing care.” But with no new money, one wonders how that will happen.
People living with HIV will be disappointed that the response is anything but GIPA-friendly, with no mention of the role of people living with HIV having any part in formulating or engaging in the federal response to HIV. And there’s no mention of PrEP of course, which has the potential to revolutionize our approach to HIV prevention.
In any event, here’s the text of the Minister’s response to the petition. It’s worth reading carefully – and with the proverbial grain of salt……
The federal initiative to address HIV/AIDS in Canada continues to guide the federal response to HIV/AIDS. The Federal Initiative involves the Public Health Agency of Canada, Health Canada, the Canadian Institute of Health Research (CIHR) and Correctional Services Canada. These four departments work to promote health and prevent disease through national and regional community funding programs, health research, policy and guideline development, public awareness and knowledge transfer, surveillance, laboratory science and global collaboration.
In 2016-17 the Government of Canada has planned investments of $72.6 million to prevent HIV and other sexually transmitted and blood-borne infections. Over $36 million of this funding will support community-based programming to increase access to prevention, diagnosis, care, treatment and support among those living with and at risk of HIV infection. Between 2010-2011 and 2014-15, CIHR invested more than $237M in HIV/AIDS-related research projects.
The Government of Canada has endorsed the United Nations Joint Programme on HIV and AIDS (UNAIDS) global treatment targets, known as the 90-90-90 targets. These global targets call for 90% of people living with HIV to know their status, 90% of all people diagnosed to be on treatment and 90% of people on treatment to successfully manage their infection by 2020. The targets are based on the British Columbia Centre for Excellence in HIV/AIDS “Treatment as Prevention” (TasP) approach. Achieving these targets will help eliminate AIDS as an epidemic by 2030.
The Public Health Agency of Canada is working towards the UNAIDS targets by providing HIV screening and testing guidance for health professionals, enhancing HIV surveillance to monitor progress and engaging with communities to strengthen prevention and access to testing, treatment and ongoing care.
Decisions regarding the provision of health care services, including HIV testing, care and treatment, fall under the jurisdiction of the provinces and territories and are most appropriately based on each jurisdiction’s unique context. The Government of Canada also recognizes the importance of primary prevention as well as interventions to address key determinants of health and vulnerability to HIV, such as stigma. The Government of Canada is working to refocus community investments and interventions to address these issues among key populations affected and at risk of HIV infection in Canada. Addressing the disproportionate impact of HIV/AIDS amongst indigenous communities and persons immigrating to Canada from countries where HIV is endemic also continue to be a priority.
Health Canada provides HIV/AIDS prevention education and awareness, and community capacity building activities. Health Canada also facilitates access to quality diagnosis, care, support and treatment to help reduce the spread of HIV among First Nations on reserve. In addition to the Federal Initiative Investment, Health Canada provides supplementary health benefit coverage through the Non-Insured Health Benefits Program, such as for antiretroviral medications for HIV-positive clients to eligible First Nations and recognized Inuit. Health Canada also makes available primary health care services, such as HIV testing, for First Nations living on-reserve in some remote and isolated areas across Canada where access to provincial health services is limited. These investment complement the prevention efforts of PHAC and CIHR.
Health Canada and the Assembly of First Nations are collaborating with partners to develop a framework to address high levels of sexually transmitted and blood-borne infections (STBBIs) among First Nations living on reserve. This framework is expected to guide the delivery of Health Canada’s programming for STBBIs in First Nations communities through culturally relevant approaches and the use of evidence. The framework will focus on preventing new cases, supporting early detection and early access to treatment, improving quality of life and fostering community well-being to reduce the rates of STBBi’s in First Nations on reserve.
Currently, CIHR is working with its partners in the Federal Initiative to address HIV/AIDS in Canada to develop Implementation Science for the prevention of HIV, HCV and STBBIs – Component 1, a new funding program focused on the prevention of HIV, Hepatitis C and sexually transmitted infections. This program will support research projects focused on the implementation and scale up of evidence-based interventions. It will emphasize the importance and relevance of primary HIV prevention, HIV testing and linkage of those infected to appropriate treatment and care.
The most successful responses to HIV/AIDS, both within Canada and internationally, involve the collective actions of multiple stakeholders, communities, affected populations and levels of governments. The Government of Canada remains committed to sustained action to address HIV/AIDS, domestically and internationally, and is interested in identifying potential areas and concrete actions where it could work jointly with stakeholders, including interested provinces and territories, to address the UNAIDS strategy to end AIDS as an epidemic by 2030, including the global 90-90-90 targets.
The Government of Canada will continue to take action to promote HIV prevention, education and awareness and to facilitate access to diagnosis, care, treatment and support for those living with or affected by HIV and AIDS.