Chapter 6: Population-Specific HIV/AIDS Status Report: People living with HIV/AIDS - Current response

Chapter 6 - Current Response to HIV/AIDS

This chapter offers an overview of the strategies, coalitions, networks, and organizations that have a mandate to serve people living with HIV/AIDS (PHA), as well as a programmatic response. Projects at the national, regional, and local levels are funded by federal, provincial, and territorial government funding programs. Most organizations that work along the continuum of education, care, treatment, and support of PHA are also involved in prevention work. To limit the scope of this report, however, this chapter only provides an overview of those Canadian strategies, coalitions, networks, organizations, and projects that include a focus on PHA. This chapter does not examine Canada-wide responses to the various determinants of health and their impact on the vulnerability and resilience of PHA.

6.1 Methodology

To obtain information on projects, coalitions, committees, plans, and policy initiatives in place between 2009 and 2011 that relate to PHA, information-gathering templates were circulated to federal, provincial, and territorial officials through the following committees or consultants: Federal/Provincial/Territorial Advisory Committee on AIDS (F/P/T AIDS) and the Public Health Agency of Canada's national and regional HIV/AIDS program consultants. In addition, templates were circulated to the First Nations and Inuit Health Regions through Health Canada, and the Heads of Corrections Working Group through the Correctional Service of Canada.

It is important to note certain limitations of the methodology for this chapter. First, the information-gathering method used in this report may not have captured some projects, programs, or initiatives delivered by provinces and territories. Second, the networks, coalitions, and programs identified in this chapter were active at some point between 2009 and 2011, though may no longer be active at the time of publication.

Only those projects, coalitions, networks, etc., that specifically mention work with PHA were included in this chapter. Projects that involved an integrated prevention, care, treatment, and support approach were included, but those that focus only on HIV prevention and education have been excluded from the analysis.

6.2 Overview

Canada's response to HIV/AIDS has grown in scope and complexity since the early 1980s. Governments, non-governmental and community-based organizations, researchers, health professionals, regional health authorities, front-line organizations, and people living with, and at risk of, HIV/AIDS are engaged in addressing the disease and the conditions that sustain it.

Through The Federal Initiative to Address HIV/AIDS in Canada, the Government of Canada promotes public health and disease prevention through the development of policy guidelines and programs, national and regional community funding programs, health research, knowledge transfer, surveillance, laboratory science, public awareness, social marketing, and global collaboration. (1) The federal government also provides health services, including HIV treatment, to First Nations on reserve and some Inuit communities, and to prisoners in the federal correctional system. Under its Interim Federal Health Program, Citizenship and Immigration Canada (CIC) also provides health services, including HIV treatment, to refugee claimants, resettled refugees, individuals detained under the Immigration and Refugee Protection Act, and victims of human trafficking who do not qualify for provincial or territorial health insurance or supplemental health benefits programs and who lack financial means.

The provinces and territories are primarily responsible for the provision of health and social services to people living with, or at risk for, HIV/AIDS. Provinces and territories also conduct surveillance, health research, knowledge transfer, and some fund projects and programs delivered by the voluntary sector.

Voluntary and public sector organizations operate in all provinces and territories to reduce vulnerability to, and the impact of, HIV/AIDS, and to provide diagnosis, prevention, care, treatment, and support services to those most at risk. Depending on the jurisdictions, regional or local public health authorities play a substantial role in addressing the epidemic. Voluntary sector organizations, at both the national and community levels, have been key to the response, delivering care, treatment, prevention, and support activities to the populations that they serve. These organizations conduct these activities through government and private funding. In addition, the private sector - including corporations, pharmaceutical companies, and faith-based organizations - is also involved in the response to HIV/AIDS in Canada.

6.3 HIV/AIDS Strategies

This section provides an overview of existing HIV/AIDS strategies that specifically address PHA at both the national and provincial or territorial levels. HIV/AIDS strategies specific to all populations living with HIV/AIDS are also identified here, but will be addressed in more detail in forthcoming Population-Specific Status Reports. As noted earlier, these strategies were in place between 2009 and 2011, although some may have been renewed by the time of publication.

6.3.1 Pan-Canadian Strategy

Leading Together: Canada Takes Action on HIV/AIDS (2005-2010) outlines a coordinated nationwide approach to HIV/AIDS in Canada, looking at the responses of governments at all levels, community, researchers and people living with, and at risk of, acquiring HIV/AIDS. Leading Together highlights the importance of community involvement in the response, as well as the need for sensitive and culturally appropriate services for people from various ethnocultural groups.

6.3.2 Government of Canada Strategy

The Government of Canada's response to HIV/AIDS is The Federal Initiative to Address HIV/AIDS in Canada. Through this initiative, the Public Health Agency of Canada, Health Canada, the Canadian Institutes of Health Research, and Correctional Service of Canada strive to prevent the spread of the disease, slow its progression, and improve the quality of life of PHA. The Government of Canada collaborates with provincial and territorial governments, non-governmental organizations, researchers, healthcare professionals, and people living with, and vulnerable to, HIV/AIDS. (1)

The Federal Initiative promotes public health and disease prevention through national and regional community funding programs, health research, knowledge transfer, surveillance, laboratory science, public awareness, social marketing, and global collaboration. It focuses on those populations most affected by HIV and AIDS - PHA, gay, bisexual, two-spirit and other men who have sex with men, Aboriginal peoples, people who use injection drugs, people in prison, women, youth at risk, and people from countries where HIV is endemic.

6.3.3 Provincial and Territorial Strategies

Most jurisdictions have strategies that address HIV/AIDS, including care, treatment, and support of PHA. Increasingly, many jurisdictions have moved to an integrated approach to addressing HIV/AIDS as part of a broader sexually transmitted and blood-borne infections (STBBIs) strategy.

British Columbia's strategy Priorities in Action in Managing the Epidemics. HIV/AIDS in BC: 2003-2007 has guided the health system toward sustained improvements in HIV/AIDS prevention, harm reduction, care, capacity, treatment and support, and coordination and cooperation. Each regional health authority in the province develops its own regional service plans to complement provincial directions. Starting in the early 2000s, the BC Centre for Excellence in HIV/AIDS pioneered universal access to anti-retroviral therapy, which over time evolved into today's Treatment as Prevention protocol. The protocol promotes increased testing and facilitated access to antiretroviral treatment for all medically eligible HIV-positive people to stop the progression of HIV infection to AIDS or death, and simultaneously halt the spread of HIV and AIDS. As part of this, the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) was launched in 2010 to better engage hard-to-reach and vulnerable populations in Vancouver's Downtown Eastside and Prince George in HIV prevention, screening, diagnosis, treatment, and care.

Alberta's Sexually Transmitted Infections and Blood Borne Pathogens Strategy and Action Plan (2011-2016) provides provincial direction to focus and coordinate the efforts of all partners involved in sexually transmitted infection (STI) and blood-borne pathogen (BBP) prevention, control and management. The strategy has the following five strategic goals: increase prevention of STIs and BBPs; improve early detection and diagnosis; enhance management and control; strengthen support and counselling services for those infected and affected; and strengthen infrastructure to support the Alberta STI and BBP Strategy and Action Plan.

The HIV Strategy for Saskatchewan, 2010-2014 has as one of its goals improving the quality of life for HIV-infected individuals. The strategy has four pillars as follows: community engagement and education; prevention and harm reduction; clinical management; and surveillance and research. Components of these pillars include the following: the establishment of HIV-positive peer-to-peer networks to provide knowledgeable and acceptable supports to those HIV positive or at risk; reducing homelessness for those at risk or living with HIV; increasing access to testing, treatment, care, medication/formula for HIV-positive individuals (including those involved with Corrections); and incorporating metal health and addictions programming. The pillar on clinical management has as one of its foci, the adoption of cross-disciplinary teams to provide a continuum of support to HIV-positive individuals and increasing outreach and support services to areas of the province (including First Nations communities) where services do not exist.

Manitoba Health and Healthy Living, Youth and Seniors are co-leading the development of a new provincial Sexually Transmitted Blood Borne Infections Strategy 2012-2017. The province's wide approach integrates HIV into the overall STBBI prevention, treatment, and surveillance strategy. The strategy development process has been a result of key collaborations between provincial, regional, federal, and community partners and stakeholders. The strategy will address chlamydia, gonorrhoea, syphilis, hepatitis B, hepatitis C, human papilloma virus and HIV. This updated strategy is intended to create a more coordinated provincial response to STBBI prevention and control in Manitoba.

In Ontario, the Ontario Advisory Committee on HIV/AIDS has developed A Proposed HIV/AIDS Strategy for Ontario to 2008. The goals of the strategy include preventing the spread of HIV, and improving the health and well-being of PHA and their communities. The strategy adopts asocial determinants of health approach to treatment and prevention, and aims to address social justice issues.

In Quebec, the Quebec Strategy on HIV and AIDS, HCV and Sexually Transmitted Diseases, 2003-2009 (Stratégie québécoise de lutte contre l'infection par le VIH et le sida, l'infection par le VHC et les infections transmissibles sexuellement, 2003-2009)includes the mandate to respond to the needs of people living with HIV by providing services required by those infected with HCV and other STIs. Its mandate also includes promotion, prevention, surveillance, research, and evaluation. In addition, the strategy defines vulnerable populations for HIV, HCV and other STIs, and proposes population-specific interventions. The Quebec Public Health Program (2003-2012) includes a goal to reduce the incidence of infection for HIV, Hepatitis C and other STIs by 2012, and provides an overview of the epidemiology of these infections in the province.

Coordination for the implementation, monitoring and evaluation of Nova Scotia's Strategy on HIV/AIDS is carried out by the Nova Scotia Advisory Commission on AIDS. The strategy identifies the need to work with PHA, including Aboriginal populations, African Nova Scotians, newcomers to Nova Scotia, and Francophone and Acadian communities. The goals of the strategy relevant to PHA include the following: integrating HIV/AIDS policy development and service delivery, and providing Nova Scotians living with, and vulnerable to, HIV and AIDS with the best possible care, treatment, and support services available. Guiding principles include involving PHA in planning and implementing the services that affect them, and working to ensure that care, treatment, and support services respond to the needs of PHA, so that they are supported in making choices about their care.

Currently, Nunavut and the Northwest Territories are in the process of developing new sexual health and STBBI strategies. New Brunswick, Prince Edward Island, Nunavut, the Northwest Territories, Newfoundland and Labrador do not have strategies specifically addressing HIV/AIDS, although they may include approaches to HIV/AIDS as part of a strategy on STBBIs.

6.3.4 Population-Specific Strategies

In addition to the provincial and territorial strategies identified, some provinces and territories have developed strategies specific to the vulnerable populations in their jurisdiction. Many of these will be discussed in greater detail in each Population-Specific Status Report. Identified below are aspects of these strategies that are relevant to PHA within a specific vulnerable population.

6.3.5 Strategies pertaining to Aboriginal Peoples

The Canadian Aboriginal AIDS Network recently renewed its Aboriginal Strategy on HIV/AIDS in Canada for First Nations, Inuit and Métis Peoples from 2009 to 2014, which builds on the previous strategy, Strengthening Ties, Strengthening Communities, published in 2003. The renewed strategy identifies the following seven areas for action to address the needs of Aboriginal people living with, and affected by, HIV/AIDS: holistic care, treatment and support; Aboriginal involvement in HIV/AIDS research; broad-based harm reduction approaches; capacity building; legal, ethical, and human rights issues; partnerships, collaboration, and sustainability; and prevention and awareness.

Pauktuutit Inuit Women of Canada, led by the Canadian Inuit HIV/AIDS Network (CIHAN) Steering Committee, launched the Inuit Plan of Action for HIV/AIDS in 2002. Aimed at Regional Inuit Associations, the plan includes in its goals promoting partnerships that enable Inuit living with HIV/AIDS to access appropriate care, treatment, and support.

Aboriginal-specific HIV/AIDS strategies currently exist in British Columbia, Alberta, Manitoba, Ontario, and Quebec. In 2006, British Columbia and First Nations Leadership Council signed the 10-year Transformative Change Accord: First Nations Health Plan, which identifies 29 actions, including one addressing HIV/AIDS, intended to close the gap in health status between First Nations people and other British Columbians. Following up on this plan, the province signed The British Columbia Tripartite Framework Agreement on First Nation Health Governance on October 13, 2011. The agreement paves the way for the federal government to transfer the planning, design, management, and delivery of First Nations health programs to a new First Nations Health Authority over the next two years. As these provincial tripartite initiatives come into effect, regional efforts like the Northern Aboriginal HIV/AIDS taskforce continue to operate. The taskforce was created as an outcome of a 2005 meeting of chiefs from northern communities, government officials, and service organizations. The taskforce brings all levels of government and non-governmental organizations together to address HIV/AIDS in northern BC.

In Alberta, Aboriginal strategies and actions are integrated into the Alberta Sexually Transmitted and Blood Borne Pathogens Strategy and Action Plan 2011 - 2016. Manitoba's strategy, As Long as the Waters Flow: An Aboriginal Strategy on HIV/AIDS, is a component of the provincial AIDS strategy and includes strategy for treatment and support for APHA, coordination of services, and research and evaluation.

The Ontario Aboriginal HIV/AIDS Strategy (OAHAS), an AIDS service organization (ASO), provides culturally respectful and sensitive programs and strategies to respond to the growing HIV/AIDS epidemic among Aboriginal peoples in Ontario through promotion, prevention, long-term care, treatment, and support initiatives consistent with harm reduction. OAHAS has developed a strategy for 2010-2015 that focuses on providing care, treatment, and support for APHA, including the following: establishing long-term and palliative care; facilitating knowledge development and exchange for people affected by HIV/AIDS; addressing the determinants of health, including those that impact the quality of life for APHA; focusing on key populations within the Aboriginal population, including women, children, youth, two-spirit people, people in prison, and people who use drugs; providing leadership; and reporting on the indicators listed in the strategic plan.

The First Nations of Quebec and Labrador Health and Social Services Commission's HIV/AIDS strategy, entitled The Circle of Hope: The First Nations and Inuit of Quebec HIV and AIDS Strategy, was created in 2000 at the request of the Assembly of the First Nations of Quebec and Labrador. The strategy includes addressing care and treatment, healthy communities, and coordination.

6.3.6 Strategies pertaining to People from Countries where HIV is Endemic

While many provincial strategies or advisory committees on HIV/AIDS identify people from countries where HIV is endemic or ethnocultural communities as key populations, Ontario is the only jurisdiction to have developed a population-specific strategy for its African and Caribbean Black population. The Strategy to Address Issues Related to HIV Faced by People in Ontario from Countries Where HIV is Endemic was developed by the African and Caribbean Council on HIV/AIDS in Ontario (ACCHO), a coalition of service providers, researchers, policy makers, and individual community members working to prevent the spread of HIV among African and Caribbean communities in Ontario. Its creation was supported by the AIDS Bureau, Ontario Ministry of Health and Long-Term Care. It is considered a key component of the Ontario HIV/AIDS Strategy. Launched in 2005, this strategy coordinates and guides actions to address issues related to HIV faced by people from countries where HIV is endemic living in Ontario; to reduce the incidence of HIV among African and Caribbean people; and to improve the quality of life for those infected with, and affected by, HIV/AIDS.

In Alberta, strategies and actions focused on populations from countries where HIV is endemic are integrated into the Alberta Sexually Transmitted and Blood Borne Pathogens Strategy and Action Plan 2011 - 2016.

6.3.7 Strategies pertaining to Women

Some provinces and territories have developed women-specific health strategies. British Columbia, for example, has a strategy called Advancing the Health of Girls and Women, which provides a gender-centred approach to priority conditions, including HIV/AIDS. Manitoba and Saskatchewan support an action plan for women's health, developed by the Prairie Centre of Excellence for Women's Health, which focuses on projects for women and includes sexual education related to HIV/AIDS.

In recent years, there has been progress toward developing the framework for an Aboriginal Women's Strategy Action Plan to address Aboriginal women's HIV/AIDS issues in Canada. The framework, which is the result of several months of consultations with Aboriginal women across the country, will provide an Aboriginal women-specific strategic action plan over the next five years for HIV/AIDS.

In terms of a multi-sectoral approach, The Blueprint for Action on Women and HIV/AIDS is a coalition of HIV-positive women, Canadian and international HIV/AIDS organizations, and a variety of women's and reproductive rights groups advocating for better prevention, services, and supports for women and girls infected with, and affected by, HIV/AIDS.

In Alberta, strategies and actions focused on women are integrated into the Alberta Sexually Transmitted and Blood Borne Pathogens Strategy and Action Plan 2011 - 2016.

6.4 Networks, Coalitions, and Advisory Bodies

This section provides an overview of national and provincial or territorial PHA-specific networks, coalitions, and advisory bodies that were in place between 2009 and 2011. It should be noted that some may no longer be active at the time of publication. These bodies undertake a variety of activities, such as providing advice, advocacy, and undertaking research. Some of the networks and coalitions listed below also deliver projects. The existence of these organizations indicates the importance of working in partnership across community, organizational, and government sectors to address HIV/AIDS among PHA. Most of the organizations below also have a broader mandate, including prevention and education; however, only the aspects of their work related to PHA are discussed in this report.

For the purposes of this report, a network or coalition is defined as an organization that has member organizations and/or individual members and was formed to represent the interests, goals, or objectives of these member organizations at provincial, national, or international forums. An advisory body is defined as an organization that provides advice on the development and/or implementation of strategies, policies, and programs. (See Appendix C for a list of these networks, coalitions, and advisory bodies.)

Canadian national networks, coalitions, and advisory bodies related to HIV/AIDS with a specific (though not exclusive) mandate to support PHA, include federal advisory bodies and national HIV organizations. They have been identified on the basis of information provided by the data collection templates and by the Public Health Agency of Canada.

6.4.1 Networks and organizations supporting PHA

Nationally, both CAS and CAAN have forums for PHA, to which only PHA are invited. In the past few years, there has been a reduction in the number of PHA-specific organizations. As well, many PHA-specific organizations have considered changing the name of their organization to better reflect an emphasis on "positive living." These changes may be related to the increasing integration of prevention, care, treatment, and support within organizations.

The Global Network of People Living with HIV North America (GNP+NA) is the North American affiliate of the Global Network of People Living with HIV (GNP+). GNP+NA is an independent regional organization that aims to address the global AIDS pandemic by creating and sustaining an active North American network of PHA. GNP+NA endorses the vision of GNP+ to improve the quality of life of PHA.

The International Community of Women Living With HIV/AIDS (ICW), like GNP+, has North American representation.

In British Columbia, Positive Living BC is dedicated to empowering PHA through mutual support and collective action. Positive Living BC delivers a wide range of services, programs, and events, and produces a variety of resources and publications. The Positive Women's Network provides education, support, and resources for women living with HIV in British Columbia and for service providers in health and social services across the country.

In Saskatchewan, the Persons Living with AIDS Network Inc. of Saskatchewan is a community-based, non-profit organization that provides care and support services for PHA. These services are also available for care providers, family, and friends.

The mission of the Manitoba PHA Caucus is to help PHA help themselves by offering its membership skills building, networking opportunities, information sharing, and informal support.

The Ontario AIDS Network, in collaboration with the British Columbia government, has created the Positive Leadership Development Institute, which supports PHA in realizing their leadership potential and increasing their capacity to participate meaningfully in community life. The Toronto People With AIDS Foundation exists to promote the health and well-being of all PHA by providing accessible, direct, and practical support services. Until it ceased operation in 2010, Voices of Positive Women was a community-based organization directed by, and for, women living with HIV/AIDS that provided confidential support, outreach, information, and advocacy in Ontario.

AIDS Action Now! (AAN!) is a Toronto-based HIV activism organization. It maintains an on-line presence, holds regular meetings open to the public and organizes community forums and events. The organization does not receive government funding. Its mandate includes improving the availability of medications for PHA; improving the standard of care for PHA; supporting progressive AIDS-related initiatives launched by other organizations and individuals; and undertaking any other activities that AAN! believes will improve the quality of life for PHA.

In the Atlantic region, AtlanticPoz is an online discussion group for PHA in Atlantic Canada.

6.4.2 National Bodies

The Pan-Canadian Public Health Network was established by Canada's Federal, Provincial and Territorial (F/P/T) Health Ministers in 2005, as a key intergovernmental mechanism to: strengthen and enhance Canada's public health capacity; enable F/P/T governments to better work together on the day-to-day business of public health; and anticipate, prepare for, and respond to public health events and threats.

Until 2011, the Federal/Provincial/Territorial Advisory Committee on AIDS provides policy advice on issues and high priority initiatives related to HIV/AIDS in Canada. It also promoted timely, effective, and efficient intergovernmental and interjurisdictional collaboration on issues related to HIV/AIDS in Canada.

In 2011, the Communicable and Infectious Diseases Steering Committee (CIDSC) comprised of federal, provincial and territorial government Ministry of Health representatives was set up to provide recommendations on priorities and issues of relevance to the Public Health Network. Issues include sexually transmitted and bloodborne infections, including HIV.

The Leading Together Championing Committee promotes the widespread use of Leading Together throughout Canada. This blueprint for action influences and guides all sectors of Canada's response to overcome the HIV/AIDS epidemic and improve the lives of people at risk of, and living with, HIV/AIDS. Its membership includes non-governmental organizations, researchers, PHA, and government.

6.4.3 Federal Advisory Bodies

The CIHR HIV/AIDS Research Advisory Committee (CHARAC) has a mandate to make recommendations to the Institute of Infection and Immunity and to the Research Priorities and Planning Committee (RPPC) of CIHR regarding research priorities for HIV/AIDS. In particular, CHARAC provides advice to the CIHR Institute of Infection and Immunity Advisory Board regarding strategic initiatives in HIV/AIDS research to aid in the development of future targeted strategic funding opportunities.

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada provides evidence-based strategic policy advice to the Minister of Health on pan-Canadian aspects of HIV/AIDS. The main focus of its work is to monitor current and emerging issues, and propound a long-term vision for addressing HIV/AIDS in Canada. The Council's membership reflects a broad range of experience and knowledge including several Canadians living with HIV/AIDS.

The National Aboriginal Council on HIV/AIDS (NACHA) acts as a national advisory body, providing policy advice to Health Canada and the Public Health Agency of Canada about HIV/AIDS and related issues among all Aboriginal peoples (First Nations, Inuit, and Métis) in Canada.

6.4.4 National Non-Governmental Organizations and Networks

These organizations are funded by the Public Health Agency of Canada and other sources to support capacity building, provide support for PHA, undertake knowledge transfer and exchange (KTE) activities, and deliver other projects, which are listed with brief descriptions in Appendix C.

The Canadian Aboriginal AIDS Network (CAAN) is a coalition of individuals and organizations that provides leadership, support, and advocacy for APHA, regardless of where they reside.

The Canadian AIDS Society (CAS) maintains a national coalition of over 120 community-based AIDS organizations across Canada, dedicated to strengthening the response to HIV/AIDS across all sectors of society, and supporting people and communities living with HIV/AIDS.

CATIE is a national knowledge broker for information about HIV and hepatitis C. CATIE connects people living with HIV or hepatitis C, at-risk communities, healthcare providers, and community organizations with the knowledge, resources, and expertise to reduce infectious transmission and improve quality of life.

The Canadian Association of HIV Research (CAHR) is a Canada-wide organization, which represents people who conduct HIV/AIDS research. CAHR's mission includes the following: fostering collaboration and cooperation among HIV research communities, including basic science, clinical science, epidemiology and public health, and social science; promoting education and the development of new researchers; and providing a unified voice for Canadian HIV researchers to engage diverse stakeholders in ongoing dialogue and knowledge exchange to ensure that HIV research remains responsive to their needs.

The Canadian HIV/AIDS Black, African and Caribbean Network (CHABAC) is a national network of service providers offering support and programs to the African and Caribbean diaspora and Black communities across Canada. CHABAC's mandate includes strengthening the capacity of front-line health and social service providers.

The Canadian HIV/AIDS Legal Network (CHLN) promotes the human rights of people living with, and vulnerable to, HIV/AIDS, in Canada and internationally, through research, legal and policy analysis, education, and community activism. CHLN provides AIDS service organizations with tools to enhance their knowledge of the legal aspects of HIV non-disclosure to better support their clients and promote healthier behaviours among PHA.

The CIHR Canadian HIV Trials Network (CTN) is a partnership of clinical investigators, physicians, nurses, PHA, pharmaceutical manufacturers, and others who facilitate HIV/AIDS clinical trials.

The Canadian Public Health Association (CPHA) is a national, independent, voluntary association representing public health in Canada. With links to the international public health community, the CPHA advises decision-makers about public health system reform and guides initiatives to help safeguard the personal and community health of Canadians and people around the world.

The Canadian Treatment Action Council (CTAC) promotes informed public policy and creates awareness about issues that impede access to treatment and health care for PHA. CTAC views treatment as a broad concept, which includes Western, traditional, complementary, and alternative medicine. CTAC is run by, and for, PHA.

The Canadian Working Group on HIV and Rehabilitation (CWGHR) brings together the traditionally separate worlds of HIV, disability, and rehabilitation through multi-sectoral partnerships. Through these partnerships, CWGHR works to increase the capacity of research, education and cross-sector partnerships, and the rehabilitation needs of PHA.

The Interagency Coalition on AIDS and Development (ICAD) is a coalition of AIDS service organizations (ASOs), non-governmental organizations (NGOs), faith-based organizations, educational institutions and labour unions. Its mission statement includes providing leadership in the response of Canadian international development organizations and Canadian HIV organizations in reducing the impact of the global HIV and AIDS epidemic. ICAD does this through improving public policy, providing information and analysis, and sharing lessons learned.

6.4.5 Provincial and Territorial Networks, Coalitions, and Advisory Bodies

In British Columbia, the Pacific AIDS Network (PAN) coordinates community responses to HIV/AIDS by convening forums for PHA to discuss issues and formulate programming and policy recommendations for the organization, government, and regional health authorities.

Alberta has a regional HIV/AIDS network, the Alberta Community Council on HIV (ACCH), which is a non-profit, provincial network of 11 regional harm reduction and AIDS service organizations (ASOs), with a primary mandate of HIV/AIDS prevention, care, treatment, support, as well as the prevention-education needs of PHA. ACCH is funded by Alberta Health and Wellness and the Public Health Agency of Canada through the Alberta Community HIV Fund. Its members include community- based AIDS service organizations, such as the AIDS Calgary Awareness Association (ACAA), which provides support for PHA and engages in community outreach.

Manitoba and Saskatchewan have a few collaborative networks. The MAN/SASK Network addresses and represents the regional needs of agencies working in the prevention, care, and treatment of HIV/HCV. In Northern Manitoba and Saskatchewan, the Play it Safer Network's goal is to implement a community-based strategy to address HIV/AIDS, STIs, hepatitis C, and healthier lifestyle choices through education, prevention, treatment, and medical and social supports.

The Ontario AIDS Network (OAN) includes the following among its objectives: maintaining and enhancing the existing network of PHA within the OAN and community partnerships that support PHA; increasing the knowledge and skills of PHA related to care, treatment, and support; increasing the number of PHA involved with community-based organizations, including member groups of the OAN; and maintaining and increasing effective PHA inclusion and meaningful involvement in the OAN. The Ontario HIV Treatment Network (OHTN) is a collaborative network of researchers, health service providers, policy makers, community members, and PHA who work together to promote excellence and innovation in HIV treatment, research, and education in Ontario. The Ontario Advisory Committee on HIV/AIDS (OACHA) provides ongoing policy advice to the provincial health minister on all aspects of HIV/AIDS-related policy. One third of the committee members are PHA; one third are from community-based AIDS organizations; and the final third are healthcare providers involved in the response to HIV/AIDS.

In Ontario, the Gay Men's Sexual Health Alliance (GMSH) is a provincial network made up of front-line workers, researchers, public health officials, policy makers, and community members. The GMSH aims to respond to the sexual health needs of Ontario's diverse communities of gay, bisexual, two-spirit, and other men who have sex with men, and includes the development of resources, production of campaigns, and the creation of working groups.

In Quebec, the Coalition des organismes communautaires québécois de lutte contre le sida (COCQ-SIDA) includes in its goals support and consolidation of community action within Quebec, bringing together organizations concerned with HIV/AIDS, and uniting the action and resources of these organizations while respecting their autonomy.

The Atlantic Provinces have the Atlantic Interdisciplinary Research Network, a group of university-based researchers (from Dalhousie, Memorial, the University of New Brunswick) working in collaboration with other government and community stakeholders in the areas of HIV and HCV.

In the Atlantic Provinces, the Regional Atlantic AIDS Network (RAAN) develops collaborative strategies in supporting PHA in the region. The Nova Scotia Advisory Commission on AIDS is an arm's length body of the Nova Scotia government. It exists to provide policy advice regarding HIV/AIDS to the provincial government, as well as to act as a link between government and community. The Commission is responsible for the implementation, monitoring, and evaluation of Nova Scotia's Strategy on HIV/AIDS, and works closely with the three AIDS service organizations in Nova Scotia.

The Northern region is supported by the Northwest Territories HIV & Hepatitis C Support Network, which provides educational resources, support networks, and capacity building.

6.5 Program Analysis

This section describes the distribution of programs and projects addressing HIV/AIDS among PHA across Canada. These projects were identified through the data-gathering process outlined in Section 6.1. This section also analyses to what extent the current response reflects the realities and needs of the population based on available evidence.

6.5.1 Geographic Distribution of Projects

Table 5 shows the distribution of projects across Canada. Between 2009 and 2011, there were 155 projects funded through federal and provincial/territorial initiatives. Note that provinces with larger populations may have more funded projects.

The geographic distribution of projects across the provinces and territories is as follows. Eight projects funded by the Public Health Agency of Canada are delivered by national NGOs. Two of the national projects address specific populations. The Canadian Aboriginal AIDS Network [P1] supports and addresses the needs of Aboriginal ASOs, and the Interagency Coalition on AIDS [P8] provides national support to new immigrants and engages Black Canadian, African and Caribbean communities. Two projects focus on delivering information about treatment. The Canadian Treatment Action Council [P4] works to enhance national HIV/AIDS policy development specific to treatment access issues. CATIE [P6] provides information about treatment options. The Canadian Working Group on Rehabilitation [P5] works to develop best practice guidelines on HIV for rehabilitation professionals. The Canadian HIV/AIDS Legal Network [P3] enhances national HIV/AIDS coordination and planning, policy development and capacity building, and communications as it pertains to the legal, ethical, human rights of individuals, AIDS service organizations, and members of the general public affected by HIV/AIDS. CATIE [P7] also has a project funded to support its role as the national knowledge aggregator - i.e., as a single point of access to information on prevention, care, treatment, and support knowledge for front-line organizations working in HIV/AIDS. Finally, the Canadian AIDS Society supports AIDS service organizations, and acts as a national voice in the development and implementation of national policy, communication, and capacity-building strategies throughout the voluntary sector.

In British Columbia, 29 projects are currently funded by the Public Health Agency of Canada or the province. Common themes in programming across nearly all the projects include creating access to care and support for PHA. Other predominant themes include access to food [P9, P10, P21], housing [P12, P21, P22, P23, P37], income [P16, P18], cultural programming [P28], advocacy [P12, P16, P21, P31, P34], and programming for rural regions [P13]. One project supports access to complementary therapies [P19], while another provides spiritual counselling services to PHA [P14]. The primary type of organization delivering the projects is ASO.

Alberta has 11 funded projects delivered by ASOs. All of the projects funded include providing access to care and support for PHA. Two projects provide advocacy for PHA [P38, P42], and one provides spiritual support for PHA [P39], as well as promoting community-based research [P39, P43]. Another project supports housing for PHA [P43].

In Saskatchewan, six ASOs deliver funded projects, all of which promote access to care and support for PHA. One project aims to develop regional capacity-building initiatives for non-reserve Aboriginal community-based programming [P51].

There are five funded projects in Manitoba delivered by ASOs. Four projects support access to care, treatment and support for PHA, including peer support, knowledge translation and awareness [P55, P56, P58, P59]. One project aims to develop national and regional capacity-building initiatives for non-reserve Aboriginal community-based programming [P57]. One funded project supports the PHA Caucus, although this network has since dissolved [P55].

Of all provinces, Ontario has the most funded projects - 54 in total. Most provide access to care and support for PHA. Seven projects promote access within rural communities [P61, P63, P64, P66, P72, P73, P109]. One provides services geared towards the Asian population [P78], while another provides services for the Spanish-speaking population [P83]. One project serves the deaf population in Ontario [P97]. One project supports people who acquired HIV via blood transfusion [P88]. Five projects are funded to build capacity within the context of GIPA, providing opportunities for PHA to contribute to program development or prevention work. Six projects in total are funded to support capacity building within ASOs. Two projects were funded to fight stigma against PHA [P63, P100]. One project promotes access to food for PHA [P106], while three projects address the issue of housing for PHA [P79, P82, P91]. Project P91 provides hospice options specifically for PHA. One project provides free legal services to people affected by HIV [P89].

Quebec funded 21 projects delivered by ASOs. These projects provide access to care and support for PHA. One in particular supports the deaf population of PHA [P120]. Two fight against stigma [P124, P125], and one is funded to increase involvement of PHA in program delivery [P121].

In the Atlantic Region, five projects are funded in New Brunswick, six in Newfoundland and Labrador, five in Nova Scotia, and one in Prince Edward Island. All projects are delivered by ASOs providing access to care and support for PHA. In Newfoundland and Labrador, two projects are funded to provide temporary [P145] and long-term [P144] housing for PHA.

In the Northern Region, there are two funded projects in the Yukon [P154, P155] and one in the Northwest Territories [P152]; all three projects provide support services and access to care for PHA and those affected by hepatitis C. Nunavut funded one project with a sexual health focus [P153].

Four projects specifically serve rural regions. In British Columbia, the AIDS Network Kootenay Outreach and Support Society [P13] provides programs and services specifically designed to address regional issues facing rural communities. In Ontario, the Wellington and Grey Bruce Rural Prevention Outreach Program [P63] works to decrease stigma and discrimination experienced by rural Aboriginal people, the gay, lesbian, bisexual, and transgender community, the mental health community, and PHA. The Outreach Program also works to increase knowledge, skills, and ability among rural physicians in the care and treatment of PHA and provides information on treatment to the rural community. Until the program's conclusion, the Voices of Positive Women [P109] supported a project that created a referrals list for both urban and rural communities. Finally, the Yukon's Council of Yukon First Nations includes a mandate to facilitate access to diagnosis, care, and treatment and to create social support opportunities for those infected with HIV and other related diseases and conditions, and to provide general HIV/AIDS awareness in Northern rural remote areas [P155].

6.5.2 Populations within the PHA Population

Although all of the projects funded address the needs of PHA, some organizations have projects that address the needs of a specific population. All the projects mentioned below include supporting PHA as part of their mandate.

Gay, bisexual, two-spirit, and other men who have sex with men

There are five clearly identified projects that address the needs of gay and other men who have sex with men who are living with HIV. The AIDS Calgary Awareness Association has a community outreach project for men who have sex with men [P39]. In Ontario, three of the funded projects provide support for gay and other men who have sex with men. The Wellington and Grey Bruce Rural Prevention-Outreach Program works to reduce stigma and discrimination faced by gay and other men who have sex with men [P63], as well as other populations. The Toronto People with AIDS has a project called PHA Engagement in POZ Prevention for Gay Men, with a mandate of positive prevention among men who have sex with men [R107]. Ontario also has a working group, the Groupe de travail pour hommes gais, bisexuels, et HAH francophones (Working Group for gay, bisexual and MSM Francophones), which provides support on the development of strategies aimed at improving services to Francophones living with HIV [P88]. In Quebec, the Mouvement d'information, d'éducation et d'entraide dans la lutte contre le sida (LE M.I.E.N.S.) has one project identified as serving men who have sex with men [P127].

People who use injection drugs

There are five organizations that clearly identify that they serve the population of people who use injection drugs. The Vancouver Native Health Society has programming for people who use injection drugs, although it is not exclusive to people who use injection drugs [P33]. In Calgary, the AIDS Calgary Awareness Association identifies programming for outreach to people who use injection drugs [P39], as does the HIV North Society [P43]. AIDS St.John serves the population of people who use injection drugs along with other populations [P138].

Aboriginal peoples

As discussed earlier, there is one national project that addresses the needs of Aboriginal peoples [P1], the Canadian Aboriginal AIDS Network. In British Columbia, the Positive Women's Network provides culturally appropriate programming for Aboriginal women who face multiple barriers [P28]. The Vancouver Native Health Society responds to the specific needs of Aboriginal people, delivering medical, counselling and social services [P33]. In Alberta, the AIDS Calgary Awareness Association identifies programming for outreach to Aboriginal peoples [P39]. In Saskatchewan, the All Nations Hope AIDS Network works to share knowledge and resources in support of APHA [P51]. Manitoba's Nine Circles Community Health Centre provides culturally appropriate programming for Aboriginal youth [P58]. In Ontario, the Wellington and Grey Bruce Rural Prevention-Outreach project works to decrease isolation among APHA [P63]. In addition, the Ontario AIDS Network has programming specifically for Aboriginal youth [P96], and the Ontario Aboriginal HIV/AIDS Strategy [P93] provides off-reserve outreach and services. Two-Spirited People of the First Nations [P108] provides support for two-spirited PHA. In Quebec, the Commission de la santé et des services sociaux des premières nations du Québec et du Labrador has a sharing circle project for APHA [P122]. The Atlantic Region does not have projects specifically identifying services for APHA.

People from countries where HIV is endemic

As discussed earlier, there is one national project that addresses the needs of ASOs supporting people from countries where HIV is endemic [P8], which is managed by the Interagency Coalition on AIDS. In British Columbia, the Vancouver Native Health Society, by virtue of being located in the Downtown Eastside, also serves immigrants, as well as Aboriginal people [P33]. Manitoba's Sexuality Education Resource Centre has programming directed at people from countries where HIV is endemic. It focuses on improving access to services for new immigrants in Winnipeg [P59]. In Ontario, the AIDS Committee of Cambridge, Kitchener, Waterloo & Surrounding Area has programming for interpreters, which supports communication with people from countries where HIV is endemic [P60]. The AIDS Committee of Toronto has two projects that are directed at ethnocultural communities, including the Portuguese-speaking population [P70, P71]. The Alliance for South Asian AIDS Prevention has a project for South Asian PHA that aims to reduce barriers to accessing services [P77]. The African and Caribbean Council on HIV/AIDS in Ontario directs programming to address social isolation and discrimination experienced by people from countries where HIV is endemic [P76]. The Black Coalition for AIDS Prevention also provides projects including case management for PHA [P80]. Finally, the Women's Health in Women's Hands Community Health Centre in Ontario funds a project to support negotiating disclosure [P111]. In Quebec, the Centre d'action sida Montréal offers services for women from diverse cultures and funds a project that supports refugees who are PHA [P117, P118].

Women

In British Columbia, the Positive Women's Network has a support program for HIV-positive women, which has a mandate to provide effective programming and resources for women, their families, and service providers, including culturally appropriate services for Aboriginal women [P28]. Alberta's AIDS Calgary Awareness Association's client services provide support for women involved in the sex trade and youth [P39]. Manitoba's Kali Shiva AIDS Services has a Positive Women's Program that provides non-medical supports and services to PHA women and their children [P56]. The Voices of Positive Women project works to reduce the isolation, increase self-esteem, and enhance the quality of life of PHA women [P109]. The Women's Health in Women's Hands Community Health Centre's project Negotiating Disclosure, provides an HIV serostatus disclosure model for African and Caribbean Women [P111]. Also in Ontario, the Women's HIV/AIDS Working Group supports research on women living with HIV [P113]. In Quebec, the Centre d'action sida Montréal (femmes) provides services for HIV-positive women from multicultural environments [P117]. Par elles, pour elles, pour la vie (By them, for them, for life) responds to the needs of PHA women to create solidarity and support [P125].

Youth

In British Columbia, the Vancouver Native Health Society also provides programming for youth in Vancouver's Downtown Eastside [P33]. YouthCo AIDS Services provides support services to PHA youth [P35]. In Alberta, the AIDS Calgary Awareness Association delivers programs to youth as one of the target populations to which it provides support services [P39]. In Manitoba, the Nine Circles Community Health Centre funds a programmatic response directed at youth [P58]. In Ontario, the AIDS Committee of Toronto has a Positive Youth Outreach project to increase access to services for PHA youth [P69], and YOUTHlink inner city [P112] offers treatment support to Toronto's youth. The Aboriginal Youth Peer Prevention Project funds programming to increase its capacity to serve Aboriginal youth [P96]. Planned Parenthood of Toronto has a project funded to develop youth-led strategies supporting a common approach to HIV, hepatitis C, and STI prevention, which is geared to increasing the knowledge of PHA youth regarding their sexual health [P100].

Children and families

Three of the funded projects specifically address the needs of children. In Manitoba, Kali Shiva AIDS Services provides a support network for women living with HIV and their children [P56]. In Ontario, The Teresa Group has two funded projects supporting children [P104, P105]. The Infant Formula Program attempts to reduce the risk of HIV transmission through breast milk by offering free formula for a period of one year to new mothers in Ontario who are living with HIV. Another program provides training to volunteers to increase knowledge and awareness of HIV issues for affected children and families.

Ten projects provide support specifically to families affected by HIV. In British Columbia, the AIDS Society of Kamloops [P12] provides one-on-one counseling for families affected by HIV. The McLaren Housing Society of British Columbia [P22] provides safe, affordable housing to families living with HIV/AIDS, who are in financial need and yet are able to live independently. The Positive Women's Network [P28] provides culturally appropriate programming for women and their families. In Alberta, the Central Alberta AIDS Network (CAANS) [P41] works to reduce the negative effects of substance use and the sex trade on individuals, families, and communities through a harm reduction approach. In Ontario, AIDS Thunder Bay [P75] works to increase social contact for PHA and their partners/families. In Ottawa, Bruce House provides rent-geared-to-income housing units and apartments for PHA, along with support, such as counselling, coaching, and family support [P81]. The Teresa Group also provides support for families of PHA. In New Brunswick, AIDS St. John serves PHA and their families.

People in Prison

In British Columbia, Prisoner POSITIVE works with the population of people in prison through outreach activities [P17]. Alberta's AIDS Calgary Awareness Association includes programs for prisoners in its mandate [P39]. In Ontario, the Peel HIV/AIDS Network includes health promotion projects for people in prison [P98], and the Prisoners with HIV/AIDS Support Action Network (PASAN) works to provide support, outreach, and education to PHA in prison [P101]. In Quebec, the project Sentinelle Bleue [P116] works to consolidate all program information for prisoners who are about to be released back into the public, in order to facilitate their access to programs. The Commission de la santé et des services sociaux des premières nations du Québec et du Labrador has a sharing circle project for APHA who are in prison [P122]. In New Brunswick, the John Howard Society [P135] runs HIV/AIDS programs that connect youth with appropriate services. The Society has branches across Canada, with each region having specialized programming.

6.6 References

(1) Government of Canada. The Federal Initiative to Address HIV/AIDS in Canada: Strengthening Federal Action in the Canadian Response to HIV/AIDS. 2004.