Government of Canada Report to the Secretary General of the United Nations on the United Nations General Assembly Special Session on HIV/AIDS Declaration of Commitment on HIV/AIDS

January 2006 - December 2007

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III National response to the AIDS epidemic

Canada’s response to the AIDS epidemic involves all levels of government, the voluntary sector, the research community, the public health sector, clinicians and those living with or at risk of HIV/AIDS. This multi-sectoral response requires close coordination amongst these different actors.

The pan-Canadian response
Canada is a federation, with responsibilities for health shared across federal, provincial and territorial governments. Provinces and territories deliver health care and hospital services for the majority of the population, while the Government of Canada is responsible for ensuring the availability of, and/or access to, health services for First Nations people living on reserve, the Inuit in northern Canada, federal prisoners and the armed forces. In partnership with provincial and territorial governments, the Government of Canada develops health policy, funds the health system, develops and enforces health regulations, and promotes disease prevention and healthy living. These shared jurisdictional responsibilities mean that coordination among many levels of government is necessary to ensure the most consistent, effective and comprehensive response to HIV/AIDS within Canada.

Leading Together: Canada Takes Action on HIV/AIDS (2005-2010)
provides a national framework for the pan-Canadian response and was developed by a broad range of stakeholders - including AIDS service organizations, clinicians and other health care professionals, researchers, national HIV/AIDS organizations and governments at all levels. It calls for consolidated action on all fronts and lays out specific actions and targets to achieve its bold vision, namely that "the end of the epidemic is in sight." The stakeholder-led document was developed after a large-scale consultative process involving community groups, people living with and/or at-risk of HIV/AIDS, health care providers, researchers, and governments across Canada.

The federal response
The Government of Canada has responded to the HIV/AIDS epidemic both domestically and internationally. Partnerships across the federal government facilitate the exchange of information, and aim to increase alignment, coordination and integration of a government-wide approach to address HIV/AIDS.

The domestic response – The Federal Initiative to Address HIV/AIDS in Canada
In January 2005, the Government of Canada launched the Federal Initiative to Address HIV/AIDS in Canada and committed further federal funding to support the evolution of the domestic response. The Federal Initiative is grounded in human rights and the determinants of health, and identifies the following goals:

• Prevent the acquisition and transmission of new infections;
• Slow the progress of the disease and improve quality of life; 14
• Reduce the social and economic impact of HIV/AIDS;
• Contribute to the global effort to reduce the spread of HIV and mitigate the impact of the disease.

The Federal Initiative reinforces the importance of partnerships and engagement to effectively respond to the epidemic. The Federal Initiative was created through a partnership of four federal departments and agencies: the Public Health Agency of Canada, Health Canada, the Canadian Institutes of Health Research, and Correctional Service Canada. Partnership and engagement with players in governments, civil society, the health care system, the research community, and with those living with/at risk of HIV are also key elements of the strategy.

The Federal Initiative aims to develop population-specific approaches to formulate and improve upon policies and programs which affect the lives of people from the following designated populations: people living with HIV/AIDS; gay men and men who have sex with men; people who use injection drugs; Aboriginal peoples; inmates; youth at risk; women; and people from countries where HIV is endemic. In addition, federal HIV/AIDS programs will be integrated with other health and social programs, as appropriate, to promote comprehensive and effective implementation. These programs will strive to address barriers to essential services for people living with, or vulnerable to, multiple infections and conditions that impact their health status.

The Canadian HIV Vaccine Initiative
In February 2007, the Canadian HIV Vaccine Initiative (CHVI) was announced by the Prime Minister of Canada and Bill Gates. This initiative represents a collaborative Canadian contribution to the Global HIV Vaccine Enterprise that is dedicated to accelerating worldwide efforts towards the development of safe, effective, affordable, and globally accessible HIV vaccines, which are essential to ultimately overcome the HIV/AIDS pandemic. The Government of Canada is contributing up to $111 million and the Bill & Melinda Gates Foundation is contributing up to $28 million over five years to support this initiative. This initiative builds on the Government of Canada’s commitment to a comprehensive, long-term approach to address HIV/AIDS, globally and domestically, including the development of new HIV prevention technologies. Participating federal departments and agencies are the Public Health Agency of Canada, Industry Canada, Health Canada, the Canadian Institutes of Health Research, and the Canadian International Development Agency.

The CHVI’s specific goals are to:

• strengthen HIV vaccine discovery and social research capacity
• strengthen clinical trial capacity and networks, particularly in low and middle income countries
• increase pilot scale manufacturing capacity for HIV vaccine clinical trial 15 lots
• strengthen policy and regulatory approaches for HIV vaccines, particularly in low and middle income countries
• promote the community and social aspects of HIV vaccine research and delivery
• ensure horizontal collaboration within the CHVI and with domestic and international collaborators.

The CHVI is an inclusive, global collaboration involving developed and developing countries, researchers, non-governmental organizations, the private sector and governments, with the needs of developing countries at its core.

The global response
On World AIDS Day, December 1, 2006, the Canadian International Development Agency (CIDA) committed to a long-term comprehensive approach to fighting HIV/AIDS globally, which will be multi-faceted, multi-sectoral and recognizes the importance of promoting and protecting human rights. The approach emphasizes action on four key areas:

• to advance effective, evidence-based HIV prevention, including linking HIV/AIDS with education and the development of new preventive technologies;
• to promote gender equality and women's empowerment to address the feminization of HIV/AIDS;
• to strengthen health systems in developing countries to ensure equitable access to essential care, treatment and support for all those who need it; and
• to promote the rights of children and to protect and support those children affected by HIV/AIDS.

As the first in a series of concrete commitments under this new strategy, CIDA announced $120 million to combat the epidemic in developing countries. CIDA will build on existing programs and will continue to identify opportunities for increased investments in concrete, results-driven initiatives in each of the four priority areas. As an example, CIDA is a major contributor to the Canadian HIV Vaccine Initiative, demonstrating its commitment to invest in the development of new HIV prevention technologies,. This investment complements CIDA's ongoing support to the International AIDS Vaccine Initiative, the African AIDS Vaccine Programme and the International Partnership for Microbicides.

CIDA also supports several large bilateral and regional programs in Africa, Asia and the Caribbean. The Government of Canada, through CIDA, will continue to support key global partners such as: UNAIDS; UNFPA, to ensure strong linkages with sexual and reproductive health, access to condoms and other reproductive health commodities; the WHO, through their plan to scale up universal access to prevention, care, treatment and support; and the Global Fund to Fight AIDS, TB and Malaria, providing a total of almost $530 million since its foundation.

Foreign Affairs Canada has implemented Commitment and Action, the Department of Foreign Affairs and International Trade Canada’s HIV/AIDS strategy to address the foreign policy dimensions of HIV/AIDS on issues such as: human security; human rights; multilateral and bilateral advocacy; workplace guidelines; and complex humanitarian emergencies. The Department initiated a series of bilateral discussions on HIV and human rights and has advocated for stronger language in the areas of human rights, gender and the protection of vulnerable groups in multilateral settings such as the June 2006 UNGASS on HIV/AIDS, UNGA and the G8.

A series of research papers and workshops were commissioned exploring the foreign policy and human security dimensions of HIV/AIDS including research conducted by the AIDS, Security and Conflict Initiative which is examining HIV/AIDS in military forces, humanitarian operations, and HIV/AIDS as a cause of instability. The Department is also funding the development of a set of standards for the design, conduct and reporting of ethical research in fragile states and countries affected by armed conflict and a series of training sessions for policy makers and field workers to strengthen knowledge and capacity in infectious disease surveillance in countries affected by armed conflict.

In addition to utilizing the Canadian Missions abroad to promote awareness and the use of Canada's Access to Medicines Regime, a survey and assessment of HIV/AIDS policies at Canadian Missions was completed in order to provide recommendations on the next steps required to ensure Canadian Missions are in compliance with the International Labour Organization's code of practice on HIV/AIDS and the world of work. DFAIT has also been working to increase the number of Canadian companies who are effectively addressing HIV/AIDS in areas of high HIV/AIDS prevalence.

Provincial and territorial responses
Provinces and territories in Canada are responsible for the provision of health care. Treatment is available across Canada, and programs are in place to ensure that low income does not prevent people from accessing anti-retrovirals. The majority of provinces and territories have adopted some form of a strategy to address HIV/AIDS. For example, in Quebec, Alberta, Saskatchewan and the Northwest Territories, an integrated approach has been adopted. By incorporating issues relating to both blood-borne pathogens and sexually transmitted diseases, the approach recognizes that HIV/AIDS, hepatitis C and sexually transmitted infections affect similar population groups. In other situations, provinces and territories have developed specific HIV/AIDS initiatives, such as in British Columbia, Manitoba, Ontario, Nova Scotia, Newfoundland, Nunavut and the Yukon. Most provinces and territories promote principles related to population health and the respect for human rights as a means to reduce vulnerability to HIV and to address the epidemic in the long term.

The community response
From the very beginning of the epidemic, Canadian civil society mounted a vigorous response to the challenge of HIV/AIDS. With resource support from government and across society, community organizations continue to play a key role in designing and delivering front-line services, identifying emerging policy issues and developing appropriate policy responses. Community organizations participate in national planning and expert panels, the development and championing of innovative approaches in prevention and support, and the delivery of programs.

The following national non-governmental HIV/AIDS organizations are key to the HIV/AIDS response in Canada:

• Canadian Aboriginal AIDS Network
• Canadian AIDS Society
• Canadian AIDS Treatment Information Exchange
• Canadian Association for HIV Research
• Canadian Foundation for AIDS Research
• Canadian HIV/AIDS Information Centre
• Canadian HIV/AIDS Legal Network
• Canadian HIV Trials Network
• Canadian Treatment Action Council
• Canadian Working Group on HIV and Rehabilitation
• Interagency Coalition on AIDS and Development
• International Council of AIDS Service Organizations

Under the Federal Initiative, the Government of Canada supports nongovernmental organizations at the national, regional and community levels through a variety of funding programs. Many provinces and larger municipalities also fund community organizations. National HIV/AIDS funds contribute to the goals of the Federal Initiative by: supporting a strong voluntary sector response; supporting the engagement and meaningful involvement of those living with and at risk of HIV/AIDS; encouraging strategic collaboration and partnerships; enhancing capacity; gathering and exchanging information and knowledge; enabling the development of policies and programme interventions, and; enhancing a broader response to the HIV/AIDS epidemic by addressing the underlying causes.

For example, the Non-Reserve First Nations, Inuit and Métis Communities HIV/AIDS Project Fund, a funding program under the Federal Initiative, supports community-based organizations aiming to reduce HIV incidence and to facilitate access to quality diagnosis, care, treatment and social support for Canada’s Aboriginal population.

As well, the AIDS Community Action Programme (ACAP), a regionally managed funding program under the Federal Initiative, supports community-based organizations across Canada: to create supportive environments to reduce or eliminate social barriers that prevent people living with or at risk of HIV/AIDS from accessing health care and/or social services; to carry out health promotion for people living with HIV/AIDS; to carry out prevention initiatives; and to strengthen community based organizations. While regional differences exist, the ACAP-funded projects target populations most at risk and those already living with the disease, which is consistent with the approach outlined in the Federal Initiative.

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