Section 5: Evaluation of the Federal Initiative to Address HIV/AIDS in Canada 2008–09 to 2012–13 – Conclusions

5. Conclusions

5.1 Relevance Conclusions

HIV/AIDS remains a public health issue for Canada that disproportionately affects vulnerable populations. Many needs persist almost a decade after the creation of the Federal Initiative. Prevention is still needed as new cases, while stable, continue to be diagnosed. As people are living longer with the disease and it progresses to a chronic condition, the need for diagnosis, care, treatment and support has increased. It is a costly disease. It is estimated that for each case of HIV prevented, an estimated $1.3 million can be saved.

The Federal Initiative aligns well with the mandate of each of the federal government partners. The federal government is perceived to have an important role in national and international leadership, coordination and knowledge translation for HIV/AIDS prevention, diagnosis, care, treatment, support and research. The Federal Initiative role aligns with the federal role of other countries such as Australia, the United Kingdom and the United States.

As the context for addressing HIV/AIDS has changed over the past decade, so has the Federal Initiative. The current direction of integrating appropriate activities should lead to efficiencies for partners and a broader approach to addressing the disease. Due to similar risk factors and transmission routes, evidence shows that people at risk of contracting HIV/AIDS are also at risk of contracting other sexually transmitted and bloodborne infections, such as hepatitis C, and are often co-infected. As such, many HIV/AIDS activities in the area of prevention, diagnosis, care and treatment can target multiple infections at once, as opposed to addressing HIV/AIDS in isolation. Furthermore, there is an international movement towards integrating HIV/AIDS work within broader approaches that address areas of co-infection, common risk factors and common transmission routes.

5.2 Performance Conclusions

The Federal Initiative recognizes that HIV/AIDS is a complex issue that requires a collaborative, multisectoral response that is informed by surveillance, research and community-based evidence. It assumes that increased knowledge and awareness of the nature of HIV/AIDS and ways to address the disease will help enhance individual and organizational capacity. These activities are expected to reduce stigma and discrimination associated with HIV/AIDS, which should lead to improved access to effective prevention, diagnosis, care, treatment and support. Ultimately, this should result in a lower infection rate and an improved quality of life for those living with the disease.

This is not a linear process and activities to address knowledge, for example, may also impact individual capacity, reduced stigma and improved access. There are also a number of activities, organizations and individuals, both internal and external to those conducted by Federal Initiative partners, that work towards the same goals.

The Federal Initiative is making solid progress in its efforts to address HIV/AIDS and there are many examples of success outlined in the body of the report. For example, there is evidence that Federal Initiative support has led to the creation of new and valuable knowledge which has helped to better understand and address HIV/AIDS in Canada and abroad. At the same time, the support of the Federal Initiative has helped Canadian researchers to achieve a standing of international excellence and knowledge created through these and other Federal Initiative supported programs has led to many positive steps forward in programming and practical settings.

There is also evidence that individual and organizational capacity to address HIV/AIDS has been enhanced through Federal Initiative activities, especially in the context of technical support and community work. Furthermore, there are lots of individual examples of capacity building activities and there is evidence that an increase in capacity is occurring, especially in the research field. Federal Initiative partners have made substantial contributions in the global community, where partners deliver training and provide advice to organizations abroad, and participate in the development of joint documents. Many collaborative activities have occurred, ensuring participation by targeted stakeholders.

In addition, there are some examples of successful local or community-based activities to reduce stigma and discrimination, and there are also many examples of improved access to more effective prevention,diagnosis, care, treatment and support as a result of Federal Initiative activities. Finally, there is evidence that federal coherence in the approach to HIV/AIDS is strong despite a lack of annual work plans and priority-setting exercises.

As the Federal Initiative evolves, activities should be enhanced to maximise benefits to Canadians. To begin with, joint planning should be strengthened to ensure that activities are strategic and aligned with Government of Canada and departmental priorities. Secondly, given the extensive knowledge that has been developed on the disease and ways to address it, the Federal Initiative should strengthen efforts to share and apply knowledge (including research and surveillance) to policy and practice to advance public health action in this area. Thirdly, additional opportunities exist to address the barriers outlined in the original program authorities (e.g. poverty and lack of housing). Finally, partners in the Federal Initiative should further develop tracking mechanisms to monitor activities against work plans and make adjustments based on learnings. As the Federal Initiative is evolving, so should the logic model that explains the program, along with any related performance measurement strategy.