[Recorded by Electronic Apparatus]
Wednesday, May 10, 1995
.1546 
[Translation]
The Acting Chairman (Mr. Ménard): I call this meeting to order. As we have a quorum, we'll start our work.
Welcome to the members of the Committee and to those who are joining us. I will chair the first part of the meeting until my colleague, Mr. Jackson, joins us, after which I will go back to my seat so as to have the pleasure of asking as many questions as possible, which I don't think is quite compatible with the role of the chairman.
Even if by statute, in the absence of our chairman, it's always the vice-chairman of the Committee who conducts the work, I asked our Committee yesterday to agree to this request so that I may use this privilege to benefit from the presence of deputy-ministers and their officials to get a greater understanding of your services.
While waiting for Mr. Jackson, would you like to make your opening remarks? I'd like you to know that your presence here is very much appreciated by us, that we will treat you kindly and with consideration, and that we will work with you towards a better understanding of the strategy. Madam Deputy Minister, I leave you to present your officials.
Ms Kay Stanley (Assistant Deputy Minister, Health Programs and Services Branch, Department of Health): Good afternoon, Mr. Chairman.
[English]
It gives me great pleasure to introduce the members of the team. Once again I was making a little joke that, like last week, we seem always to be an all-female delegation, but we're delighted that colleague Bob Shearer joins us at the table today as more than the token male. He's a key member of our team. The people represented here today of course respond to the subcommittee's request to look at specific areas within the AIDS strategy, so Bob will be saying a few words about AIDS care, treatment, and support.
With me also are the executive director of the AIDS Secretariat, Gweneth Gowanlock; Barbara Jones, who is acting on behalf of the AIDS education and prevention unit; Tracey Donaldson, from the AIDS Community Action Program; and Janice Hopkins, a colleague from the Medical Services Branch representing the Indian and Northern Health Services Directorate. That's the team.
I'm going to say a few words as an introduction and then ask my colleagues to give you a short overview of material that has been prepared specifically for this afternoon's meeting.
[Translation]
I'm very pleased with the opportunity given to me to meet the members of the Sub-Committee to explain in greater detail the National AIDS strategy and to answer your questions on technical and operational aspects.
[English]
I have brought with me the departmental representatives for four responsibility centres. As was mentioned, each will give the members of the Committee a brief description of the area they represent. I will be returning to the subcommittee next week with other departmental representatives, to focus mainly on issues related to research.
[Translation]
For my part, as assistant deputy-minister in charge of monitoring the implementation of phase II of the National AIDS Strategy, given that HIV infection and AIDS are complex and still poorly known illnesses, I think that this area is very important. I want to make sure that there is efficient co-ordination and implementation of the activities of the branches of all departments and federal organizations, and ensure that there's cooperation between all stakeholders.
.1550
[English]
I work closely with the other assistant deputy ministers within the department, because each program branch plays a pivotal role in the overall strategy. For example, the AIDS program targeting first nations and Inuit people is delivered by Indian and northern health services in the Medical Services Branch. In addition, the AIDS coordinators, representing over ten responsibility centres throughout the department, meet every three weeks to ensure effective implementation of the strategy.
[Translation]
Last February, Minister Marleau underlined the importance of partnership to Phase II of the National AIDS Strategy. This means continuing to strenghten cooperation among a variety of players, including our national partners, to maximize efforts against HIV/AIDS, avoid overlap and duplication and build on experience and sucesses.
[English]
As co-chair of the federal-provincial-territorial advisory committee on HIV and AIDS, one of my key roles is to bring together representatives from each jurisdiction to examine HIV/AIDS issues. Together, members examine common strategies that will foster national direction and intergovernmental cooperation.
The non-governmental organizations' Partners forum, which is coordinated by the National AIDS Secretariat, is supported by departmental resources. This quarterly forum brings together the Canadian AIDS Society, the Canadian Public Health Association, the Canadian Hemophilia Society, the Canadian Association for HIV Research, and the Canadian Foundation for AIDS Research.
[Translation]
Within the National AIDS Strategy, there are three particularly significant projects involving partnerships and cooperation that I would like to bring to your attention today.
First, there is the National AIDS Clearing House which provides resources to educate Canadians and others about HIV/AIDS. This important project, funded through the AIDS education and prevention unit, is administered by the Canadian Public Health Association.
[English]
The Canadian HIV Clinical Trials Network is another major initiative with the strategy. This network is funded through the AIDS Care, Treatment and Support Unit.
Treasury Board recently approved Health Canada's submission to enter into negotiations for a three-year agreement to fund the AIDS treatment information service. This important initiative will be administered by the Community AIDS Treatment Information Exchange, commonly called ``CATIE'', in Toronto, which is a member of the Canadian AIDS Society. It will provide a vital information service to Canadians living with HIV/AIDS.
[Translation]
In closing, I would like to point out that, for the 1995-96 fiscal year, no funding reductions was made to the National AIDS Strategy as a result of the February Budget. This is a significant achievement, given the government's financial realities.
[English]
These are my opening comments. I'm going to turn now to the members of the team to give you a brief overview of the areas in which you have expressed interest. We'll start with Bob Shearer.
[Translation]
Mr. Bob Shearer (Acting Chief, AIDS Care, Treatment and Support Unit, Health Programs and Services Branch, Department of Health): Thank you, Mrs. Stanley. It is a pleasure for me to be here today to speak about our unit and our work.
I prepared the document which was handed out and which will provide you with more information on our work. I also prepared overheads, which will speed up my presentation. It is difficult to describe everything we do in a few minutes.
[English]
The mission statement of the AIDS Care, Treatment and Support Unit is to build and enhance capacities to respond to the changing care, treatment, and support needs of persons living with HIV and AIDS, their care-givers, families, and friends.
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The unit's activities are based on the following principles: to engage in a proactive, interdisciplinary approach to care, treatment, and support issues, responsive to the needs for consumer involvement. As an example of that, all of our projects that we are presently funding have members living with HIV as part of the development team and active participants in determining how these resources will be utilized.
We also plan to establish and strengthen partnerships and networks that facilitate the collaboration of health and social services. Respect for and awareness of needs of our clientele and our colleagues are crucial, and we promote the use of research outcomes for the development of responsive programs and policies.
We do work under five main project areas, and I'll briefly give you an example of some of the activities we are doing under each one.
Support for professional and non-professional education and training: This has been a very big part of our activities in the first two years of this phase of the strategy, and we've worked with a number of professional associations across the country to enhance their ability to work with their own memberships. An example of that is the comprehensive care series. It's six modules. Some have been completed and some are in the design phase. I understand that the College of Family Physicians was here and presented to you on modules 1 and 2, which were on adult therapies, as well as a new one for pediatrics.
We also work in the area of psychosocial and quality of life support. This is a very important area for us, as people are living longer with HIV and AIDS. An example of a project we've funded in this particular area is with the Canadian AIDS Society, which is housing and the needs of people living with HIV and AIDS. This project has established a national working group on housing issues to evaluate current regional efforts in this area, clarifying roles and responsibilities of stakeholders and developing action plans that will emphasize a collaborative approach to housing needs.
Another key area for our work is model program development, demonstration, and evaluation. The project I would like to highlight is a new one for us where we'll be working on research coordination on HIV/AIDS costing. This is done in conjunction with a coordinating body, the Canadian Policy Research Network. This project will seek to understand the economic dimensions of HIV and AIDS, with an objective to use the research outcomes for the development of cost-effective and responsive programs and policies. Research will be funded over the next three years and the network will be responsible for the dissemination of these research findings.
As Mrs. Stanley has already mentioned, we also are responsible for the AIDS Treatment Information Service. We're pleased that this will be up and running very shortly. The Treasury Board has allowed us to finalize negotiations with the Community AIDS Treatment Information Exchange, and we feel that this will be a very valuable service to people living with HIV in our country.
Last, but not least, is the Canadian HIV Clinical Trials Network, where we fund the infrastructure of this network and work closely with them to make sure that people living with HIV can gain access to trials when appropriate.
To help you to understand the breakdown of the budget, I thought I would quickly give you an overview of how we divide up the moneys that we have in our grants and contributions program. For the 1995-96 fiscal year we have a total of $8.2 million, again under the categories I explained earlier: professional and non-professional education and training, $1 million; psychosocial and quality of life support, $1.6 million; model development and evaluation, $700,000; the AIDS Treatment Information Service, $200,000; and the Canadian HIV Clinical Trials Network, $2.9 million.
I'd like to tell you a little bit about the staff who work with me and my colleagues at the AIDS Care, Treatment and Support Unit. They work to provide support and guidance to all of the projects. Presently we are actively involved in 45 different projects across the country. In this we have recruited specific medical, psychosocial, and community program development expertise, and I believe this has resulted in a proactive, multidisciplinary team. Also, financial guidance and advice are provided through the unit's contributions programs officer.
Again, this is a very short overview, but I hope that it will give you an idea. I'll be willing to respond to questions later. Thank you for this opportunity.
.1600
Ms Stanley: Did you mention that there are just eight members on your team?
Mr. Shearer: No, I didn't. There are eight active members.
Ms Stanley: That's right. I didn't want the members of the committee to think that 45 projects meant there were that many people working in that part of the project. There are 8 staff in that particular unit.
Thank you very much.
I would like now to turn to Barbara Jones and the AIDS Education and Prevention Unit. Barbara.
Ms Barbara Jones (Chief, AIDS Education and and Prevention Unit, Health Programs and Services Branch, Department of Health): Thank you.
The AIDS Education and Prevention Unit exists to help stop the transmission of HIV and to provide leadership for the development of national prevention education policies, strategies, and initiatives developed in consultation and collaboration with partners. I provided for you today a script that will give you many examples. However, I will only highlight specific areas of the unit so you will have an understanding of what the actual functional areas are. The examples are provided for you in the text.
[Translation]
The Unit is comprised of five functional areas: prevention and behavioural research, information synthesis and knowledge development, experimental programming or demonstration projects, interdepartmental initiatives and core funding and project support for non governmental organizations.
[English]
As for the staff of the AIDS Education and Prevention Unit, we have a total of seven. This includes five program specialists, a secretary, and myself as chief. I also have the overall chief responsibilities for the AIDS community action program.
The 1995-96 funding allocation by functional area is $1.5 million for prevention, behavioural research, information synthesis and knowledge development, and demonstration projects. An amount of $600,000 goes for intergovernmental initiatives of which the bulk, $400,000, goes to Correctional Service Canada for the follow-up and work for the ECAP, the Expert Committee on HIV and AIDS in Prison, recommendations. The amount of $2.8 million is allocated for core funding and project support for our non-governmental organizations.
I'll briefly describe the five functional areas, starting with prevention and behavioural research. Our prevention research agenda, which was developed in consultation with key stakeholders across the country, currently reflects the evolution that has taken place in our understanding of the dynamics involved in the transmission of HIV. We've moved away from baseline knowledge, attitudes, and behavioural studies to more qualitative, in-depth studies of the determinants of risk in selected populations.
A special research competition is currently under way in collaboration with our national health research and development program, NHRDP, to support a new generation of innovative studies on marginalized women and men who have sex with men. These studies explore the interaction of risk factors such as personal history, poverty, self-esteem, power imbalances in relationships, friendship networks, and alcohol and drug use. We anticipate that there will be approximately eight of these studies funded this year.
The second functional area is synthesis of information and knowledge development, and it includes the tracking and synthesizing of research results, program evaluation, and new program approaches for developing models for priority populations in the prevention field.
Let me describe an example in the area of programming for gay men. We have AIDS service organizations across the country who have been involved in developing a variety of programs to prevent HIV infection among men who have sex with other men. The Canadian AIDS Society, community organizations, and the AIDS Education and Prevention Unit are currently working together to document, refine, and evaluate the most innovative and effective of these models. The result of this initiative will result in a publication of models so that community groups wishing to implement new programs can adapt these and target young gay men, men within various ethnocultural backgrounds, and projects in bathhouses or public sex venues, and the gay community development in both urban and rural areas.
The third area is experimental development programming. This area directs contribution funding for the development and implementation of leading-edge demonstration projects to help prevent HIV transmission among women, injection drug users, street-involved people, and men who have sex with men, as well as to develop supportive environments.
Fourth, the functional area of interdepartmental initiative includes projects undertaken with other departments within the federal government under the national AIDS strategy. An example would be the development of a training model for all the immigration and customs officers. This program, currently under way, will train several thousand officers to accurately interpret and implement current policies and procedures relating to travellers carrying medication and equipment used in the treatment of HIV/AIDS.
.1605
Ultimately, the intent of the course is to ensure that persons living with HIV/AIDS or believed to be infected are treated with the same respect and concern for their rights as any other visitor entering Canada. This training will be completed prior to the 1996 international conference on AIDS being held in Vancouver.
The fifth functional area is core funding and project support to non-governmental organizations. This, of course, includes the provision of core and operational funding to the Canadian AIDS Society, the Canadian Public Health Association, and the Canadian Hemophilia Society for programming done by these organizations in the support of the national AIDS strategy goals.
Additionally, the National AIDS Clearinghouse project funding is made available to the CPHA. Project funding to the Canadian AIDS Society is given for the development and coordination of the National AIDS Awareness Week. I'm pleased to indicate that they have chosen their theme for this year. It'll be the reduction of homophobia. Their submission has just come into the department for departmental review.
[Translation]
I have given you a very brief overview of the unit's work and functional areas, but I believe I have given you an idea of the wide variety of federal initiatives in prevention. Thank you very much for the opportunity.
Ms Stanley: Thank you, Barbara. I will now give the floor to Tracey Donaldson.
[English]
with the AIDS Community Action Program Unit.
[Translation]
Ms Tracey Donaldson (Manager, AIDS Community Action Program Unit, Health Programs and Services Branch, Department of Health): It is a pleasure for me to be here today.
[English]
The AIDS community section program provides national leadership and governmental efforts to support community-based action against HIV and AIDS. It is delivered through national and regional offices.
[Translation]
The ACAP supports community based efforts under Phase II of the National AIDS Strategy and is focused on two goals of the strategy, i.e. stopping the transmission of HIV and providing care, treatment and support to persons living with HIV or AIDS.
[English]
ACAP has several objectives, strategies and priorities. The objectives or general goals for the program are as follows:
The first is to provide targeted prevention education for hard-to-reach populations such as men who have sex with men, street-involved youth, gay youth, marginalized women, and others.
The second objective is to provide health promotion for people living with HIV and AIDS. For example, ACAP supports activities to help persons living with HIV and AIDS to delay the onset of symptoms.
The third objective is creating supportive social environments; for example, projects that address barriers such as discrimination that prevent people from improving and maintaining their health.
The first strategy - that is, the specific tactics - that ACAP funding supports is strengthening community development. Community development is essentially a process whereby communities identify their concerns, develop plans to address these concerns, and take action as necessary. The second strategy is strengthening collaboration among organizations, largely through the establishment of partnerships with a broad range of different sectors.
The priority areas that are eligible for ACAP funding are prevention education, strengthening organizations, reducing barriers, and evaluation.
ACAP is a community-driven project, meaning that we are responsive to needs that communities identify. The regional and national offices solicit proposals from community groups around the country, and we establish review committees, which include community representation such as persons living with HIV and AIDS and the staff of AIDS service organizations.
The staff of provincial AIDS programs are also represented on our external peer review committees.
As you can see on the overhead, we have a staff of ten for the program; three are in the national office - myself as acting manager - and we have a national program consultant and secretarial support in the national office. Each of the regions also has program consultants who provide expertise in areas such as proposal development, program implementation, evaluation, etc. So they assist groups in the development of their proposals and the ultimate implementation of their work.
.1610
The total budget for the program is $7.5 million. It is divided into regional allocations, as shown on the overhead. The national office receives $650,000. The Atlantic region has a total of $1,380,160. The Quebec region has $1,429,100, and so on, as you can see on the overhead. Those are the regional allocations that were determined through a process involving community input.
ACAP provides two types of funding. The first is project funding, which provides time-limited funding for specific activities that are either local, regional or national in scope. Project funding is provided both through the regional offices and through the national office of ACAP.
The second type of funding is operational funding, which is provided only through the regional offices. Operational funding supports ongoing delivery of program activities that respond to the emerging issues of HIV and AIDS. For example, using their operational funding, community groups develop volunteer support initiatives, and they develop and evaluate the programs and services that they implement.
ACAP provides approximately 50 community-based organizations with operational funding each year. We fund approximately 150 projects throughout the country each year.
In terms of ACAP's value to the community, through ACAP funding we see organizations better able to strengthen their links in the community. We see community-based organizations that are better able to respond to the epidemic through preventive efforts and through support to persons infected and affected by HIV and AIDS.
[Translation]
Thank you for this opportunity to give you a brief overview of the mandate, the objectives, the strategies and the priorities of ACAP.
[English]
Ms Stanley: Thank you, Tracey. I'm sure the members of the Committee will have questions. This is the area that always generates a lot of interest because it's close to their various communities and constituencies.
Director general Janice Hopkins from the Indian and Northern Health Services Directorate is going to speak to us now about that component of the AIDS strategy.
Ms Janice Hopkins (Director General, Indian and Northern Health Services Directorate, Medical Services Branch, Department of Health): Thank you, Kay.
Monsieur le président and committee members, I'm happy to be here this afternoon to share information about the AIDS program and the services that are delivered by Indian and Northern Health Services to first nations and Inuit clientele.
I will speak briefly about the mandate of the program, give you a very brief program description including funding and staffing levels, and speak briefly about the priorities for 1995 and 1996. There is a fuller version of remarks tabled with the committee that should provide additional information for you.
I'll speak briefly about the mandate we exercise. This mandate includes public health programs and services for Inuit people and for registered Indian people who are living on reserves across Canada. Those aboriginal people who do not live on reserves or who are not part of this mandate receive services and can also apply for funding from my colleagues' programs on the same basis as other Canadians across the country.
How do we carry out this program? We work in close partnership with the first nations and Inuit organizations and communities in carrying out our mandate. As well, we work closely with other parts of Health Canada, with other federal departments, including the Department of Indian Affairs, and with provincial and territorial governments.
The MSB AIDS program has both national and regional streams. At the national level, we have two staff members involved with the program. One is an HIV/AIDS program specialist, and one is support staff. In areas across the country we have regional contact persons who are employed by Medical Services Branch, but who perform other duties in addition to their AIDS responsibilities.
.1615
As well, we have a service program that is part of the regional communicable disease control and health education services delivered directly by Medical Services Branch-employed nurses and health education staff, as well as by nurses and community health representatives who are employed by first nations and Inuit communities.
AIDS contribution funding - that is community-based funding - is available to first nations and Inuit community groups and Indian leadership through a contribution program that operates on a regional basis.
In total in 1995-96, we have devoted from the national AIDS strategy $2.5 million to programs for first nations and Inuit people; in total, we have devoted $12 million over five years. The funding is divided between the national stream and the regional stream, with 68% of the funding being used for community-based initiatives.
We have spent considerable time developing mechanisms for sharing information, working in partnership, and coordinating services and activities for aboriginal people. Recognizing that MSB's mandate is limited to providing services and programs to on-reserve clientele, in a number of parts of the country there are inter-agency aboriginal and AIDS coordinating committees, which include not only Health Canada partners but also provincial government agencies and aboriginal organizations, including aboriginal first nations AIDS organizations.
As in previous years, our priorities for 1995-96 are derived from consultations across the country with first nations organizations. They are in two particular areas.
With respect to program funding, we will continue to emphasize the development of culturally appropriate programs and to place emphasis on linkage between AIDS programs and programs that address other aboriginal health problems, in particular STD programs, tuberculosis control, injection drug use, health promotion and disease prevention.
As I am sure committee members are aware, aboriginal communities place great emphasis on holistic solutions to address health problems, and it is our intention to place emphasis on that in this fiscal year.
Second, we will continue to provide HIV testing and counselling services in first nations and Inuit communities. There is an increasing awareness of AIDS and the many issues surrounding this disease among first nations leadership and among community groups. Certainly the testing services will continue to support that growing awareness.
Finally, we will continue to place emphasis on strengthening cooperation and collaboration; or as the minister has described it in her remarks to this committee, the emphasis will be on partnerships, both internally and externally. It is important that we work very closely and very much in a partnership mode with first nations communities and organizations.
That is a brief summary of our program. I would like to conclude at this point, Mr. Chairman.
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[Translation]
The Acting Chairman (Mr. Ménard): Thank you very much, Mrs. Stanley. You must be very proud of the quality of the presentations given by yourself and your officials this afternoon.
I would like to begin by asking two general questions and one specific one. I suggest that members begin with a 10-minute round of questions, starting with the opposition and moving on to government. We will then have a second round. At that point, other members might join us.
As you know, we met with four or five of the national parters who, in cooperation with yourself and the Minister, are mandated to develop national policies. They told the Committee that, regarding each of the existing services, it was extremely difficult to get a concrete action plan. Some partners even told us that event the National AIDS Secretariat did not have an action plan.
Will you provide an action plan for every service represented here within the next few days? We have received an exhaustive description which will help us understand what you do in each area. How is the strategy implemented in each of the areas you are involved in?
So, if the Secretariat has such a document, it would be interesting to see it; and it will be also interesting to see the action plans for each area of involvement, if they exist. That's my first question. Would you like to respond, Mrs. Stanley?
[English]
Ms Stanley: Yes, I will. I'm also aware that Dr. Patry had written to the minister in February. One of the points in that rather long and detailed letter asked a similar question with respect to work plans.
I should take the opportunity to say that we are in the final stages of preparing for the chair the comprehensive response to the subcommittee's letter, and the committee should have that very shortly. It has required us to do a fair amount of research. It was quite a detailed submission and we wanted to do justice to the questions.
I've heard the representative of the Canadian AIDS Society and others mention the question of work plans. As a manager in the public service, I know the executive director of the secretariat, in her capacity as one who has to coordinate all the elements of the strategy, has a knowledge of what happens in the various sectors at each time.
However, in terms of our planning cycles within the department, we're near completion because we have been preparing our business plan in accordance with the new expenditure management system. Work plans are in the final stages of approval and we hope we have a synthesis document prepared. It will be forwarded to the committee very shortly.
I call it a synthesis document because it's going to highlight program directions for 1995-96. It's going to take the kinds of summations you have today and say that this is where we're focusing our attention in this current fiscal year. It will also describe the major initiatives under way.
In the interim, I would hope what we have talked about today, with the presentations you've received, will give you an indication of how each component deals with the day-to-day work.
I have to be candid with you, Mr. Chairman, in the sense that I, as a manager, expect my staff to always keep the strategy in front of them and to be guided by the elements of the strategy. So the work plans or the planning cycle naturally flow from that.
I am somewhat reticent to put into the public domain plans that would say that on Tuesday of the third week of May this is what we will do. That kind of specificity is not what I think the committee is asking for. I would assume that you want to know generally what my colleagues are doing on a specific area in the context of the 1995-96 year and that's -
[Translation]
The Acting Chairman (Mr. Ménard): Of course, we don't want to know the details of your daily work. It would not be reasonable to ask for that kind of information, and I don't think that the national partners, be it the Canadian Hemophilia Society or any other one of the five partners... Since the beginning of the epidemic, we have not seen it slow down in Canada. It may have affected other groups, or new groups, but the epidemic is not slowing down.
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There certainly is a paradox given the fact that we need to know what measures will be taken in every sector. There was some concern because the money available - it is certainly the case for 1992-1993, and it's hard to get the most recent figures - has not been completely allocated yet.
All of us - you, the senior officials, and us, the Committee members - are counting on receiving this information, and we trust that you will develop consensual policies with your partners which will be appreciated by the victims of the disease.
I would like to raise a second issue before giving the floor to a member of the government. It concerns the ACAP. I'm very worried about this program because I believe in community initiatives, and I'm sure you agree they are a great thing.
In the case of AIDS, as in other cases, the work the government cannot do must be carried out by community groups who do an excellent job. I am sure you know that the life of HIV-infected persons and their fight against their disease would be much worse without the support of the community group.
There is a big rumour going around. Apparently your program is going to recommend that the Minister abolish project funding and operational funding, so that there would only be a single AIDS Community Action Program, whose mission would be to reduce operational funding and increase project funding.
Let me give you an example. Yesterday, we heard from the COCQ-SIDA, a group which represents 31 organizations that work in Quebec and made the exact opposite recommendation. They told us to transfer a quarter of the operational funding to project funding.
In fact, organizations really want operational funding because they are often the first to intervene on site. Can you tell us what direction you will recommend the minister take? In your opinion, what is the future of ACAP?
[English]
Ms Stanley: I thank you for that question because it enables me to clarify something that came out of some discussion we had when the minister appeared before the subcommittee some months ago.
In most of our contribution funding in the department we are moving toward more project-oriented, demonstration project type of funding of a limited nature. I think the minister was thinking about that the day she was appearing before this committee, because she deals with many contribution programs. She made some references to a shift away from core funding.
But as you know from the strategy - and I'm going to ask Barbara Jones to speak to this - certainly the members of the forum, the AIDS Partners group, have specified right in the budget a designated amount for their sustained core funding. The operational funding that was referred to in her area is ongoing. There has not been a change in policy or direction with respect to the disbursement of those funds.
So if it helps to clarify, certainly on a broader scale in other contribution programs, yes, Health Canada is moving away from core-type funding, but because of the need to build capacity and to support infrastructure in the fight against AIDS, there has not been a change in this particular area.
Barbara, I'll ask you to comment a little bit on it because you're at the operational end of it.
Ms Jones: Basically within the core funding to national organizations we have maintained the funding levels for the first two years now and we have indicated to them that those amounts will remain relatively stable for this year. This is at the national level, although we are currently in a departmental review of the three applications from our national partners.
Within ACAP, we have 50% of our ACAP budget going directly to AIDS service organizations. I think it's $3.75 million that's directed toward operational, day-to-day funding for the organizations to run. We have not indicated any change of that and plan to continue that throughout phase two of the national AIDS strategy; that would remain constant.
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The other allocation then goes for the solicitations to respond to what the communities are telling us their community project needs are, but we have not indicated any change within core funding and I think the allocations across the country remain relatively stable at those levels.
Ms Stanley: Mr. Chairman, I'll make just one final point. I know - and this is one of the reasons we're delighted to be here today - that the committee will be making some recommendations at the completion of its study. We are in the early stages of a mid-term review of the national AIDS strategy and therefore will be receptive to the recommendations coming from the subcommittee up through the standing committee on this particular issue. It might be a decision of the subcommittee to make some commentary on that particular situation so that can be taken into consideration while we do our mid-term review.
[Translation]
The Acting Chairman (Mr. Ménard): Before giving the floor to my colleague, Mrs. Ur, I want to make sure I understood.
ACAP has a total budget of 7 million dollars: half of it goes to project funding and half of it goes to operational funding. What is your response rate? How many groups can you help with a budget of 7 million dollars? How many requests for funding do you get? Do you get more requests than you can afford? What is ACAPS funding situation?
[English]
Ms Stanley: I will ask Barbara to answer that question directly.
Ms Jones: You're correct. Actually, in the budget $7.5 million goes to ACAP, and part of that is the $3.75 million. But you see, the allocation for who receives operational funding was developed after a national consultation with all of the community organizations from all provinces.
Prior to phase two and the identification of funding formulas and how that would work, a national consultation was undertaken. For specific details of the number of projects, Tracey has hands-on experience, so if you don't mind, I will pass the floor to her to give you the actual specifics of the demand or the numbers we have, because we do have a breakdown.
Ms Donaldson: Each year ACAP funds approximately 200 initiatives. As I mentioned in the presentation, about 50 of those are to operational funding for community-based organizations and about 150 projects are funded across the country each year.
When we do our solicitation, it's generally the norm that the demand for funding exceeds the funds available. Oftentimes that demand can be up to two or three times greater than the funds available, so the review committees have a challenge ahead of them in terms of working with the review committee to identify the proposals that will go forward in funding recommendations. But yes, there is considerable demand across the country for ACAP funding that exceeds the capacity to fund.
Ms Stanley: Again, the review committee has members of the organizations or the review committees, so they get a chance to maybe ensure that operational funding considerations are always kept in the forefront of those. So in addition to the recommendations of the national conference, there's that ongoing support for that aspect of the program given by the participation of the people on the review committees.
[Translation]
The Acting Chairman (Mr. Ménard): Since this round lasted 13 minutes instead of 10, I will make sure, dear colleagues, that you have as much time to ask your questions. It's only fair. You have the floor, Mrs. Ur.
[English]
Mrs. Ur (Lambton - Middlesex): Thanks, Mr. Chairman. I have several questions, so I will go through them and maybe some will overlap.
Could you explain to me how you feel the NAS program should be differently, or are they differently, applied to aboriginal populations as opposed to non-aboriginal populations? You were saying x dollars were diverted to the aboriginal population and I'd like expansion on that.
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Also, it has been suggested that the incidence of new HIV infection in mature gay men has declined while there continues to be a high infection rate among the younger gay men. What are the reasons for that? Do the messages have to change? What is the problem there?
I realize there are programs out there for the needle exchange, for condoms, etc. I don't profess to have knowledge in any of those areas, but has there been any consideration given to research into seeing that they are actually doing the job they're supposed to do? Something was brought to my attention by a group that made a presentation to me in my office. I don't know where they got their research because I didn't go into it with them, but they felt the HIV virus could actually penetrate through condoms. I don't know, so I'm asking you that question.
Also, what criteria are used by Health Canada in funding the various projects?
Ms Stanley made the statement that Dr. Patry had written a letter three months ago and that you were still tabulating a response. I find that interesting because I think when you go into anything you should have a plan. You shouldn't make the plan once you're already into it. I do think three months is a tad long for a response. I know that as a member of Parliament, I would get raked over the coals by my constituents if I waited that long to respond to letters.
Another question I have has to do with administration costs versus funding allocation. How many staff people in Health Canada work on HIV and AIDS programs? How do you prove your accountability?
Those are some of my questions.
Ms Stanley: Thank you. I'm going to use good management tactics here and delegate some of these to the members of the team.
I will start with the overall numbers. As is shown in the main estimates, I think the national AIDS strategy has a total of 64 full-time equivalents, of which eleven are in the AIDS Secretariat; twenty would be the culmination of the numbers given to you by Tracey, Barbara, and Bob; Janice mentioned two for the Medical Services Branch; and the Health Protection Branch has 31. It has the biggest block, and you'll be seeing some of those people next week. We also have one person who is on secondment to Correctional Service Canada as part of that.
I agree with you that three months to answer a letter is much too long. It's one of those ones the minister's office has been starring on lists because it's overdue for her signature.
Mrs. Ur: I'd like to interrupt for a minute. You answered half the question as to the numbers involved in Health Canada. What is the cost ratio for administration costing-to-funding? What is the breakdown on that?
Ms Stanley: Do you mean what percentage would go to administration in terms of the overall $40 million strategy?
Mrs. Ur: Yes.
Ms Stanley: I'll ask Gweneth to fish that out of the existing numbers, and if she can't, we'll have to get back to you.
As I look at other grant and contribution programs per se, I can tell you that in this one, in terms of efficiency and effectiveness, a few people have responsibility for a very wide area. You saw the provincial breakdown - one person for the entire B.C.-Yukon area. Given the high incidence of HIV/AIDS in areas like Greater Vancouver or in Metro Toronto, which Mr. Graham will be familiar with, the deployment of people is not great when you consider the size of the problem.
With respect to the letter, I will apologize on behalf of the department. Because of the open-ended nature of some of the questions - for example, what is the success rate of jointly run federal-provincial programs - with due respect to the chair of the committee, it would not be appropriate for me, or for any us, to answer that without some consultation and some discussion with the other partners here, meaning the provincial government.
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So this was not a letter for which a response could be composed solely within the confines of the federal health department. As a result, we've had to take a little bit longer in responding to some of the rather complex questions that your chair proposed in his two-page letter, one of which has about 15 different parts to it. So we are at the draft stage of replying to that.
On the question of whether our research and some of the work we're doing really produces change and how we know that, I think that when Dr. Mary Ellen Jeans will be here next week I will flag that question for her.
I think we know, because we're in phase two of the strategy, that some of the things that were initiated in phase one produced the kinds of results that caused us to recommend that they be replicated, continued, or enhanced in phase two. But I'm going to ask each of the members of the panel to speak about success rates, and then I want to end up with Janice with respect to whether there are different approaches to aboriginals and non-aboriginals.
In terms of the question of research and whether our efforts are making for change, and the criteria - my note-taking isn't as strong as some people's - I will ask Bob to comment on those aspects related to the AIDS care and treatment.
Mr. Shearer: As I mentioned in our mission statement, promoting the use of research outcomes is very important in our program planning, as well as working with recommendations to the AIDS Secretariat for policy.
We have worked very closely with a lot of the professional associations, not only in the production of documents and resource materials but also in research planning, so that these can be prepared to meet the needs of their membership. So research has been very much a part of our program planning, and we're quite pleased with that.
Ms Gweneth Gowanlock (Executive Director, National AIDS Secretariat, Department of Health): One of the things I would signal in an overall sense is that in the mid-term review, the evaluation strategy as part of the national AIDS strategy, we're looking at results and indicators across the board - not on specific projects, like the program areas would have. That's one of the things for which by the end of this year, which is well into year three of the strategy, we will have some answers on indicators of success, leading to a final report on results at the end of the strategy. That's built into the program, and we're working on it now. But that's overall; that's not specific projects and behavioural change and those kinds of things, on which my colleagues may be able to speak.
Ms Stanley: I want to make the point, too, that there's a rather lengthy series of articles with respect to condoms and whether they're reliable or not, even in our clipping service today. I can't recall what magazine it is. Dr. St-John, in the Health Protection Branch, will be coming next week. That kind of question he and his colleagues will certainly be able to answer, because of their tests with respect to the reliability of medical devices, etc.
Do you want to comment on whether we know if it works or not, Barbara?
Ms Jones: I guess that when we start to look at sexually transmitted disease, we take a look at some of our older public health models and we find out whether or not they really were effective in reducing the rates of STDs across the country. So when we've started to do prevention for HIV, we've had to look at what didn't work in the public health, and sometimes we haven't had the proof ahead of time. So we've implemented programs and had to evaluate after they've been implemented, because we know we have to do something to get ahead of the transmission.
We now have, and have developed over the past three years, in collaboration actually with the Canadian Hemophilia Society, a hands-on approach to HIV program evaluation and planning. It's an evaluation model that looks at impact and results.
We have recently done training for all of the ACAP program recipients across the country who were available to do the workshop programming in specific regions. In some regions, such as Ontario, we've had a second training program. So within the next year we will have the results of how these programs that have been implemented are working at the community-based level.
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For programs like the cost-shared programs with our provincial counterparts that the federal government initiated in 1989 around needle exchange programs, we associated with those in collaboration with NHRDP in a $1.3 million evaluation component. It was across country. We extensively evaluated the impact the needle exchange programs were having, but we don't look at needle exchange as the answer to stopping transmission within the injection drug use community. It has to be used in combination with many different types of targeted programs.
We are working on these now. Also, when we start to see that just needle exchange and some of the programs in isolation don't work, the next phase is to look at determinants of behaviour and impacts around those behaviours.
We see, for instance, in some of our young gay cohort studies that are happening now, as well as the longer longitudinal studies with gay men, that sustained behaviour is limited to when interventions happen, whether they are educational or other interventions, service interventions, testing or some type of support intervention. We know that the intervention itself is as important as the behavioural change and the education component, so it has to be ongoing and sustained. We can't just do it and get out of it. They have to be long term, and that's where we see the need for looking beyond just needle exchange.
In 1989 when we started the needle exchange program with the provinces, there was one formal needle exchange in Canada. Now we have probably over 200 sites where needles are available to be exchanged by drug users. But that alone has to be implemented along with hands-on programming or access to program services, treatment and other kinds of initiatives at the same time. So when we fund those kinds of programs we are starting to put impact evaluation frameworks up front with them, so we will know how they work.
[Translation]
The Acting Chairman (Mr. Ménard): Since 12 minutes have gone by already, with your permission I will give the floor to Mr. Culbert so that everyone can have a turn. Mr. Graham, you have the floor.
[English]
Mr. Graham (Rosedale): I have two quick questions. You mention the community AIDS treatment information exchange in Toronto. Where is that going to be located in Toronto? Having a parochial interest in that matter, I thought I would ask that question first.
My second question has a rather broader scope. In the presentations I thought I would hear more about where Canada's AIDS information and general policy is going in relation to the international community. We're not operating in an isolated world in this respect by any means, and I was a little surprised that there wasn't some discussion in the presentations on the international dimensions to some extent.
How do we stack up against other countries? Where are we getting our other information? Who are we sharing it with? Who has more effective programs? What are we learning by comparing ourselves with what our partners - probably mainly the OECD partners - and other people in the world are doing? I'd be very interested in any comments you have on that.
[Translation]
The Acting Chairman (Mr. Ménard): I would like to say in defence of the deputy-minister that the Committee's mandate is to review policy and not external elements. There is information available and your question...
In any case you are a citizen of the world, as everyone knows, and you never forget your international concerns; but it is not part of our specific mandate. Obviously if the witnesses have information, they can give it to you.
Mr. Graham: My motivation to find out what is being done outside Canada is not just curiosity. I would like to know what impact it has on our situation in Canada. If we don't know what's being done elsewhere, then we are missing a very important element that would help us develop a better policy for Canada.
The Acting Chairman (Ménard): Quite right, Mr. Graham.
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[English]
Mr. Shearer: The AIDS Treatment Information Service is going to be based at the Community AIDS Treatment Information Exchange, which is a community group with the short form of CATIE. This is a group that has been recognized nationally for its leadership in treatment information. We've been working with it for a phased-in implementation of this service, and we're very convinced it is going to deliver an excellent service for us.
Ms Stanley: I think Mr. Graham has quite rightly said that this pandemic does not respect boundaries, geographic or otherwise. It is true that part of our work is related to our ongoing international effort.
The federal-provincial-territorial advisory committee I chair has done a sort of snapshot of current programs in Canada, province by province, and looked at them in the context of some of the figures coming out of the OECD. I would be pleased to provide Mr. Graham with a copy of that. It's in the final drafting stage and the various ministers of health across the country have to give it their blessing, but we hope to have it by early summer.
Mr. Graham: That would be very helpful. Thank you.
[Translation]
The Acting Chairman (Mr. Ménard): Does that answer your question, Mr. Graham?
[English]
Mr. Culbert (Carleton - Charlotte): Welcome, Ms Stanley and colleagues, this afternoon again.
If you could help me a little bit, I have quite a few questions. I'll try to be brief in my questions, and if you can be brief in your answers we will be able to get through them.
Ms Stanley: I got that message after last week, Mr. Culbert.
Some hon. members: Oh, oh!
Mr. Culbert: first, how do you review the success of a particular program? Maybe it was touched on by Mrs. Ur's questions, but I want to follow up on it too.
I would particularly like to aim my second question at Ms Jones. Do you believe HIV/AIDS is a serious matter, possibly causing death? Obviously you do, I wondered about your comments about visits to Canada in the context of training customs officials and so on with ease - I guess that was the expression you used - and comfort level. I don't quite understand that aspect of it. I realize there's no quarantine. It's not a communicable disease, but at the same time I'm not certain I understand that one.
Third, how do you develop your educational programs? Do you develop them from the top down or from the bottom up? In other words, do you go to the community organizations that in a small way have been found to be successful and enlarge upon them to a greater extent?
Again, perhaps this touches on what was mentioned earlier. Can you give us a comparison percentage-wise between the administration cost and the actual education or other parts of the program cost? Can you give us a breakdown of what is going into the programs and what is being taken out by the administration of them? I appreciate you said there was a fairly low number of participants, but I'm talking about dollars and cents out of the total budget.
I will leave those with you to see how you do with them, first of all, and we'll see how much time we have.
Ms Stanley: I'll take the liberty of wading into the discussion.
[Translation]
The Acting Chairman (Mr. Ménard): I can tell that the answer cannot be succinct, despite our hopes.
[English]
Ms Stanley: I will ask my colleagues if they wish to comment on the question of how we know whether we've achieved success. I'm sure the member acknowledges that we're dealing here with behavioural change. This is not empirical science. It's very difficult to measure. Yes, we can measure how successful our health promotion or disease prevention initiatives - which we deem our population health strategies - have been, but when it comes right down to it, it's like mortality rates or extent of infection. It's often difficult to know and to be able to say, yes, this program has done it.
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The other aspect of it is that it's no one program. As Barbara Jones said, everything in this strategy reflects a multifaceted kind of approach. If public education won't do it, community action might, or the intervention of a physician, a knowledgeable nurse practitioner, or whatever. It's very hard to say one particular element resulted in success.
The only other comment I want to make on your questions is this business of visits to Canada. As soon as the training video is completed, I want to make it available to the members of the committee, because I think you would find it shows the kind of training there is and the collaboration between customs officials and ourselves in terms of providing this information to what we call the PIL workers, the primary inspection line workers, who are meeting people who are coming into Canada.
Often a person who is a victim of HIV/AIDS is carrying a lot of pharmaceuticals with them. To a customs or immigration officer it might appear to be excessive. How does that person know these are needed medical treatments for someone who has this condition? So it was an attempt to demystify the situation and educate.
Also, because we are hosting an international meeting on care and treatment in Montreal later this month, and we have the world conference in Vancouver in 1996, we know we will have many visitors to the country who will obviously be coming through Customs and Immigration facilities. So it was to prepare our Canadian officials to deal with this.
We've taken it seriously because as a department that has responsibilities in other departments...this is an aspect of our work.
[Translation]
The Acting Chairman (Mr. Ménard): Mrs. Stanley, allow me to clarify something for our colleagues who are getting concerned.
We all have to obey our whip. There may be a vote at 5:20 p.m. and if we could have a few more minutes to ask questions we might be able to conclude around 5:05 p.m.
I had hoped to ask two or three questions but I won't put them so that we can go to the House.
[English]
Ms Jones: Did you want further information on immigration?
Mr. Culbert: No, that's fine at this point.
I want to touch on another question. I know it's perhaps not your field, but it is on the research component of HIV/AIDS. It may touch on what Bill mentioned.
Are we working with other nations? I don't mean sending our dollars there, but are we working on the information flow so we can complement what they're doing and they can complement what we're doing in these areas? If they've specifically found an area that works for them, maybe it'll work for us, or vice versa. Do we have that interlocking?
Perhaps it is not fair to ask you this directly, but are we working with them in the area of research as well?
The other thing I wanted to touch on is aboriginal people's rates of increase. I understand our rates are still increasing in Canada generally, but for aboriginal people, is the HIV incidence increasing by the same percentage, or is it somewhat different?
Ms Jones: As for the international research and whether we are working with them, yes, we are working with them. I'll give you an example. When we undertook the national men who have sex with men study, we used all our opportunities with the World Health Organization collaborating centres to run our questionnaire designs through. Previously they had undertaken surveys that were not similar but with that same population. In fact, it helped us to build a better survey tool. We learned from experiences of other countries.
In particular, we're learning from what's worked in England...looking in the prison systems. We do a lot of international literature research, as well as international reviews of all research activities and programs that have resulted from that, as we're developing ours.
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A side effect of it is that Australia has recently developed their excellent gay men's campaign based on the Ottawa charter of health promotion. So I think we share both ways, back and forth.
[Translation]
The Acting Chairman (Mr. Ménard): Thank you, Mr. Culbert. Before closing, I wonder if we might ask our researcher to stay in contact with some designated person in your group. We could then get information on your assessment of the National Strategy on AIDS, Phase I, before we prepare our recommendations.
I know that you are doing progress evaluation. It might be interesting to have something on paper since we will have to start preparing our document within a few weeks. If our researcher, with our colleagues' permission, could keep in touch with one of you in order to get the result of your evaluations, it would be useful for our recommendations.
I now have the great privilege to thank you for coming. It has been a very pleasant meeting. You know that you are always welcome to our Committee. We will certainly see you again, Mrs. Stanley, next week. I hope I do not have to take the Chair then, but I will now have to conclude this meeting.
The meeting is adjourned.