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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I Status at a glance

(a) Inclusiveness of stakeholders in the report writing process

The Public Health Agency of Canada (PHAC) was the lead agency in preparing the 2008 submission of the UNGASS Report. The initial drafts of the Main Section, Part A of Annex 2 (the National Composite Policy Index), and Annex 3 were prepared by PHAC in consultation with other government departments participating in the federal response to the HIV/AIDS epidemic and with representatives of the provinces and territories. A draft was sent out for consultation in late November to key national partners, provincial and territorial government representatives and national non-governmental organizations. Enhancements were made to the document based on the feedback received.

In a separate process, PHAC initiated a contract with an external consultant to prepare Part B of Annex 2 (the National Composite Policy Index) concerning human rights and civil society participation in consultation with national HIV/AIDS non-governmental organizations and human rights experts. This draft document was sent to national HIV/AIDS non-governmental organizations for feedback and input in late November, followed by a teleconference, in order to review and discuss the findings of both reports as an assessment of the consistency and tone, the accuracy of the Canadian response and to recommend future UNGASS reporting processes.

The report was submitted to the Chief Public Health Officer of PHAC for approval. Part B of Annex 2, prepared in consultation with national HIV/AIDS non-governmental organizations, will not be subject to changes by government as it is to be an independent work and reflect the perspectives of external to government stakeholders.

(b) The status of the epidemic

Estimated number of Canadians living with HIV at the end of 2005: 58,000 (48,000-68,000) Estimated number of Canadians who have died of AIDS as of 2005: 13,300 Populations most-at-risk: gay men and men who have sex with men, people who use injection drugs, Aboriginal peoples, prisoners, women, people from countries where HIV is endemic, and youth at risk.

(c) The policy and programmatic response

The federal government has consistently supported the response to HIV/AIDS in Canada. Since 2005, the federal government continues to call for an enhanced global response to HIV/AIDS, further announcing additional budget commitments to support domestic and international initiatives. The Standing Committee on Health monitors and reviews federal HIV/AIDS efforts to ensure that funding is used where it is most needed. In addition, as per its commitment to Treasury Board, planning for a review of the Federal Initiative has begun which will assess the performance, progress, continued relevance and priorities of the strategy.

The Canadian approach is grounded in human rights and social justice, aiming to protect the most vulnerable populations. A population-focused lens has been fundamental to assessing the needs and priorities in terms of research, policy development, monitoring and evaluation measures. Further, the Canadian approach is evidence-based and continues to invest in knowledge transfer and capacity building initiatives, to support strategic and effective policy and program development.

The federal response also acknowledges prevention as a key measure to mitigate the epidemic. All levels of government support prevention efforts, from social marketing initiatives, to the distribution of condoms and needle exchange programs. There has been increased emphasis to support new prevention technologies and strategies, evidenced by setting research priorities and by distinct investments in prevention interventions and program funds, such as screening initiatives that aim to reach the undiagnosed, the development of testing and counselling guidelines and collaborations and contributions to the Canadian HIV Vaccines Initiative.

d) UNGASS National Level Core Indicators – 2008

#	National Programmes	Detailed Comments and References
3	Percentage of donated blood units screened for HIV in a quality assured manner	100%1
4	Percentage of adults and children with advanced HIV infection receiving antiretroviral therapy	Greater than 80% of those with advanced disease are on ART.2
5	Percentage of HIV-positive pregnant women who received antiretrovirals to reduce the risk of mother-to-child transmission	Out of 192 perinatally HIV-exposed infants born in 2006, 171 (89%) received any perinatal ART prophylaxis3.
6	Percentage of estimate HIVpositive incident TB cases that received treatment for TB and HIV	Canada does not track this type of information. However, the most recent WHO global TB report has estimated HIV prevalence in adult incident TB cases in Canada in 2005 to be 8.3%4.
7	Percentage of women and men aged 15-49 who received an HIV test in the last 12 months and who know their results	32% of Canadians over the age of 15 years report having been tested for HIV (excluding testing for insurance, blood donation and participation in research)5
8	Percentage of most-at-risk populations that have received an HIV test in the last 12 months and who know their results	In Phase I of I-Track surveys conducted in Victoria, Edmonton, Regina, Winnipeg, Toronto, Sudbury, and the Quebec SurvUDI network, the proportion of injection drug users (IDUs) who were both eligible for testing (i.e. those who had already tested positive were excluded) in the last year and got tested was 59%6. In the M-Track ARGUS survey among men having sex with men (MSM) in Montreal in 2005, the proportion of MSM who reported getting tested within the last 12 months was found to be 42.6%. This percentage excludes respondents who had been HIV or HCV seropositive for more than 12 months7.
9	Percentage of most-at-risk populations reached with HIV prevention programmes	In Phase I of I-Track surveys, the proportion of IDUs who ever used any needle exchange program services was 84.7%; the proportion of IDUs under the care of a doctor for HIV was 82.3%; and the proportion taking medication for HIV was 58.4%8.
10	Percentage of orphaned and vulnerable children aged 0-17 whose households receive free basic external support in caring for the child	Not applicable.
11	Percentage of schools that provided life skills-based HIV education in the last academic year	Canada does not collect this data

 

#	UNGASS: Knowledge and Behaviour	Detailed Comments and References
12	Current school attendance among orphans and among nonorphans aged 10-14	Not applicable.
13	Percentage of young women and men aged 15–24 who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission	84% of Canadians over the age of 15 years were able to correctly identify how HIV is transmitted. Some Canadians incorrectly believe that HIV can be transmitted through kissing (32%), from mosquito bites (29%), from a sneeze or cough (11%), contact with objects such as drinking fountains or toilets (10%), or from casual contact (5%). 82% of Canadians over the age of 15 years were found to have medium to high levels of HIV/AIDS knowledge. Knowledge was measured via an index that included knowledge of HIV transmission methods, methods of detecting HIV, natural history of HIV and prognosis9. Young people ages 15-24, however, score lower on overall knowledge of HIV, including transmission methods, than those who are in between the ages of 25 and 64.
14	Percentage of most-at-risk populations who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission	Canada does not collect these data.
15	Percentage of young women and men aged 15-24 who have had sexual intercourse before the age of 15	Among respondents 15-24, 61.3% reported that they had ever had sexual intercourse. Among respondents 15-17 only, 27.9% reported that they had ever had sexual intercourse10.
16	Percentage of women and men aged 15-49 who have had sexual intercourse with more than one partner in the last 12 months	13% of Canadians over the age of 15 years who were sexually active engaged in sexual activity with more than one partner in the last 12 months11.
17	Percentage of women and men aged 15-49 who had more than one partner in the last 12 months reporting the use of a condom during their last sexual intercourse	Two different surveys have asked the question of condom usage to those who were sexually active. Neither asked this question specifically to those who had more than one partner in the last 12 months. In the HIV/AIDS Attitudinal Tracking Survey 2006: 23% of Canadians over the age of 15 years who were sexually active used a condom the last time they had sex12. In the Canadian Community Health Survey: Among respondents 15-49, 74.8% indicated that they had sex in the past 12 months (*question asked of those who responded that they had ever had sex, incl. don’t know/ refusal) Among those who were sexually active in the past 12 months, 19.4% indicated that they used a condom the last time they had intercourse (22.5% of males, 16.3% of females)13.
18	Percentage of female and male sex workers reporting the use of a condom with their most recent client	Canada does not collect these data, however we do have data for IDUs engaged in sex work: Among female IDU participants with male client sex partners, 79.6% reported always having used a condom during vaginal sex in the previous 6 months. Among male IDU participants with female client sex partners, 60.5% reported always having used a condom during vaginal sex in the previous 6 months14.
19	Percentage of men reporting the use of a condom the last time they had anal sex with a male partner	In the M-Track ARGUS survey among MSM in Montreal in 2005, the proportion of MSM who reported using a condom during last anal sex out of those who had anal sex in the last 6 months was found to be 64.6%15.
20	Percentage of injecting drug users reporting the use of a condom the last time they sexual intercourse	Phase 1 I-Track (2003-2005): 43.4% of IDUs used a condom the last time they had sex16.
21	Percentage of injecting drug users reporting the use of sterile injecting equipment the last time they injected	Phase 1 I-Track (2003-2005): 67.7% of IDUs reported injecting without used equipment in the previous 6 months17.

 

#	UNGASS: Impact	Detailed Comments and References
22	Percentage of young women and men aged 15–24 who are HIV infected	The percentage of young men and women aged 15-24 who are HIV infected is estimated to be 0.24% or 15,824 people18.
23	Percentage of most-at-risk populations who are HIV infected	Phase 1 I-Track (2003-2005): 13.2% of all participants in this IDU study were HIV positive (average of seven sites)19. In Ontario, the HIV prevalence among IDUs was estimated to be 4.9% in 200520. In the M-Track ARGUS survey among MSM in Montreal in 2005, the HIV prevalence was found to be 12.5%21. In Ontario, the HIV prevalence among MSM was estimated to be 16.8% in 200522. In Ontario, the HIV prevalence among persons from endemic countries was estimated to be 0.87% in 200523. Among inmates in federal prisons, the prevalence rate was 1.67% in 200524. Enhanced Street Youth Study (1999-2003) 0.6% of all participants who were tested for HIV (N=3449) were HIV positive (among seven sites)25. In federal correctional facilities, the point prevalence of HIV infection amongst inmates in 2005 was estimated to be 1.66%26.
24	Percentage of adults and children with HIV known to be on treatment 12 months after initiation of antiretroviral therapy	Canada does not collect this data.
25	Percentage of infants born to HIV-infected mothers who are infected	Out of 169 perinatally HIV-exposed infants born in 2006 with confirmed HIV status, 5 (3.0%) were confirmed to be infected with HIV27.

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¹In Canada, it is mandatory that each donation is tested for HIV using two screening assays: 1) anti-HIV and 2) HIV RNA. Canadian Blood Services performs this testing using the Abbott PRISM anti-HIV 1/2 O plus assay and the Roche Ampliscreen HIV RNA assay using documented standardized work instructions in three GMP laboratories that are licensed by Health Canada. All three laboratories participate in external quality assessment schemes for all assays tested including the two HIV assays. Haemoquebec (responsible for blood services in the province of Quebec) follows the same protocols. There are of course situations where the samples from the donation are either not available or are unsuitable for testing. In this case the components manufactured from the donation are destroyed. Therefore 100% of donations released for transfusion have been tested (1) following documented standard operating procedures and (2) in laboratories that participated in an external quality assurance scheme.

² Public Health Agency of Canada - unpublished estimate, 2007.

³ Public Health Agency of Canada. HIV and AIDS in Canada: Surveillance Report to December 31, 2006. Table 10.

⁴ Global tuberculosis control: surveillance, planning, financing, WHO report 2006. Geneva, World Health Organization (WHO/HTM/TB/2006.362).

⁵ HIV/AIDS Attitudinal Tracking Survey 2006, Final Report. EKOS Research Associates, 2006

⁶ I-Track: Enhanced Surveillance of Risk Behaviours among People who Inject Drugs. Phase I Report, August 2006. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, 2006

⁷ G Lambert, J Cox, F Tremblay, MA-Gadoury, LR Frigault, C Tremblay, M Alary, J Otis, R Lavoie, R Remis, J Vincelette, C Archibald, P Sandstrom. ARGUS 2005: Summary of the survey on HIV, viral hepatitis and sexually transmitted and blood-borne infections (STBI) as well as on the associated risk behaviours among Montreal men who have sex with men (MSM). Montreal Public Health Department, Institut national de santé publique du Québec and the Public Health Agency of Canada. August 2006.

⁸ I-Track: Enhanced Surveillance of Risk Behaviours among People who Inject Drugs. Phase I Report, August 2006. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, 2006.

⁹ HIV/AIDS Attitudinal Tracking Survey 2006, Final Report. EKOS Research Associates, 2006

¹⁰ Canadian Community Health Survey 3.1, 2005.

¹¹ HIV/AIDS Attitudinal Tracking Survey 2006, Final Report. EKOS Research Associates, 2006

¹² HIV/AIDS Attitudinal Tracking Survey 2006, Final Report. EKOS Research Associates, 2006

¹³ Canadian Community Health Survey 3.1 (2005)

¹⁴ I-Track: Enhanced Surveillance of Risk Behaviours among People who Inject Drugs. Phase I Report, August 2006. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, 2006.

¹⁵ Public Health Agency of Canada, Centre for Infectious Disease Prevention and Control, Surveillance and Risk Assessment Division, Unpublished data. 2006.

¹⁶ Public Health Agency of Canada. I-Track: Enhanced Surveillance of Risk Behaviours among People who Inject Drugs. Phase I Report, August 2006. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, 2006.

¹⁷ I-Track: Enhanced Surveillance of Risk Behaviours among People who Inject Drugs. Phase I Report, August 2006. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, 2006.

¹⁸ Public Health Agency of Canada, 2007.

¹⁹ I-Track: Enhanced Surveillance of Risk Behaviours among People who Inject Drugs. Phase I Report, August 2006. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, 2006.

²⁰ Remis RS, Swantee C, Schiedel L, Fikre M, Liu J. Report on HIV/AIDS in Ontario 2005. Ontario Ministry of Health and Long-Term Care, March 2007.

²¹ G Lambert, J Cox, F Tremblay, MA-Gadoury, LR Frigault, C Tremblay, M Alary, J Otis, R Lavoie, R Remis, J Vincelette, C Archibald, P Sandstrom. ARGUS 2005: Summary of the survey on HIV, viral hepatitis and sexually transmitted and blood-borne infections as well as on the associated risk behaviours among Montreal men who have sex with men. Montreal Public Health Department, Institut national de santé publique du Québec and the Public Health Agency of Canada. August 2006.

²² Remis RS, Swantee C, Schiedel L, Fikre M, Liu J. Report on HIV/AIDS in Ontario 2005. Ontario Ministry of Health and Long-Term Care, March 2007.

²³ Remis RS, Swantee C, Schiedel L, Fikre M, Liu J. Report on HIV/AIDS in Ontario 2005. Ontario Ministry of Health and Long-Term Care, March 2007.

²⁴ Correctional Service Canada, internal data.

²⁵ Enhanced Street Youth Study (E-SYS). Community Acquired Infections Division. PHAC, 2007.

²⁶ Correctional Service Canada. Internal data.

²⁷ Public Health Agency of Canada. HIV and AIDS in Canada: Surveillance Report to December 31, 2006. Table 10.

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