Strengthening Federal Action in the Canadian Response to HIV/AIDS
The Canadian Response to HIV/AIDS
Since the early days of the HIV/AIDS epidemic when fear was widespread and little was known about the disease, Canada's response to HIV/AIDS has grown in both scope and complexity. Today, governments, non-governmental and community organizations, researchers, health professionals and people living with and vulnerable to HIV/AIDS are engaged in addressing the disease and the conditions that sustain the epidemic.
Canada can point to a number of important successes during the past two decades. Research advances have given us a better understanding of HIV/AIDS transmission, disease progression and treatment options. Mother-to-child transmission of HIV has been nearly eliminated in Canada. New HIV infections among the general population have been minimized, and the blood system has been made as safe as possible from contamination by HIV and other infectious diseases. Steps have also been taken to increase public awareness of HIV/AIDS and tackle stigma and discrimination around the disease. Globally, Canada has responded to the HIV/AIDS pandemic with strong strategic leadership, a generous financial commitment and a comprehensive, coordinated approach to HIV/AIDS programming.
At the same time, Canada's HIV/AIDS response still faces challenges. Although the emergence of highly active antiretroviral treatments in the late 1990s has prolonged and improved the quality of life of many HIV-infected Canadians, difficulties in accessing treatment, treatment failures, toxic side effects and drug resistance have become more and more common, presenting barriers to getting ahead of the epidemic. HIV/AIDS is still a fatal disease. There are no vaccines to prevent new infections. There is no cure. In 2003 alone, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 3 million people died due to AIDS, while 5 million were newly infected with HIV.
Moreover, gains in HIV prevention made in the late 1990s have not been sustained and the epidemic prevails. Although gay men remain the group most affected by HIV/AIDS in Canada, the epidemic has also gained a foothold in other vulnerable populations, including Aboriginal people, inmates, injection drug users, at-risk youth and women, and people from countries where HIV is endemic. At the end of 2002, an estimated 56 000 people in Canada were living with HIV infection - 12 per cent more than at the end of 1999. About 30 per cent of these individuals were unaware of their infection. This "hidden" aspect of the epidemic means that about 17 000 infected individuals are not able to access treatment, support or prevention services.
The evidence is clear. We must strengthen federal action in the Canadian response to HIV/AIDS to achieve better public health outcomes for Canadians. As our understanding of the causes and impacts of the epidemic improves, Canada's response to HIV/AIDS must continue to evolve.
From Community Mobilization to National Engagement
HIV/AIDS first appeared in Canada in the early 1980s among the gay male population and people infected through the blood supply. In response to this new threat, the gay community mobilized into small, volunteer-based organizations, and the safety of the blood supply was improved. AIDS Vancouver and the AIDS Committee of Toronto were incorporated as the first community-based AIDS organizations in Canada. As the threat of HIV/AIDS grew, governments at all levels, the health care system, non-governmental organizations, researchers and other sectors of society became involved.
By 1990, the federal government recognized the need for a more formal, interconnected approach to HIV/AIDS and launched the National AIDS Strategy. Initially established for a three-year period, in 1993 the National AIDS Strategy was renewed for five years, with an increase in annual funding from $37.3 million to $42.2 million.
By 1997, this funding had helped to further broaden and deepen the Canadian response. Nevertheless, there was widespread recognition that the programs in place were insufficient and that the epidemic would continue to be an important health and social problem for the foreseeable future. It had become evident that the spread of HIV and its impact on individuals were influenced by social, economic and political factors as well as biological conditions.
Following a period of extensive stakeholder consultations, the Canadian Strategy on HIV/AIDS (CSHA) was launched in 1998.
The CSHA set out to create an ongoing, nationally shared approach to HIV/AIDS, with increased collaboration across all sectors of society. It brought legal, ethical and human rights issues to the fore while continuing to support the work of local and national non-governmental organizations, HIV/AIDS researchers and epidemiologists. Communities became more involved in the research process, and increased attention was given to the epidemic among prison inmates, members of Aboriginal communities and in developing countries.
Toward A Pan-Canadian Response
The CSHA provided a unique framework through which diverse partners-governments, communities, non-governmental organizations, professional groups, researchers, institutions and the private sector-worked together on innovative approaches to the prevention, care and treatment of HIV/AIDS. It espoused the concept of pan-Canadianism, which recognizes that no organization and no government acting alone can ever successfully overcome the epidemic. The work of many participants from many different sectors is needed to ensure an effective response to HIV/AIDS.
Through the CSHA, it was acknowledged that:
- HIV/AIDS must be addressed not only from a biological point of view but also from social, economic and human rights perspectives, taking into account the root causes, determinants of health and other dimensions of the epidemic
- people living with HIV/AIDS and those vulnerable to HIV infection should be both at the centre of and key contributors to the response
- increased public accountability was needed to ensure that the response was adaptable to the changing epidemic
The important lessons learned from past strategies are affirmed by the United Nations General Assembly Special Session Declaration of Commitment on HIV/AIDS 2001. The Declaration of Commitment, endorsed by Canada, calls for reinforced regional, national and international responses to HIV/AIDS and, specifically, for national strategic plans.
Leading Together - An Action Plan by Canadians, for Canadians
Stakeholders and governments have come to the conclusion that a more strategic approach is needed, one that embraces social justice principles and envisions unprecedented engagement, increased collaboration and enhanced planning across society.
To this end, Leading Together: An HIV/AIDS Action Plan for All Canada, is being developed by a broad cross-section of organizations and individuals involved in the Canadian response1. Developed with the support of the Public Health Agency of Canada, it will set out a plan for strengthening and expanding HIV/AIDS policy, programming and research in Canada so that "By 2010, the end of the epidemic is in sight."
Leading Together points to a new beginning for Canada's HIV/AIDS response. No single organization or sector can claim ownership of Leading Together - it is a call to action for all Canadians and all sectors of society to become aligned in the HIV/AIDS response.
Federal leadership is a cornerstone of the way forward. In addition to providing continued support for the implementation of Leading Together, the Government of Canada has developed a renewed approach to dealing with the epidemic - the Federal Initiative to Address HIV/AIDS in Canada.
1 Leading Together is expected to be finalized in early 2005.
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