As you know, we are in the midst of a federal election that will conclude with voters making their choices on Monday, October 21, 2019. This is a crucial election and we have an opportunity to let all candidates, parties and voters know that the HIV/AIDS epidemic in Canada still requires a strong federal government response, and to seek their commitments to supporting the fight against HIV/AIDS in our community. We also require a strong government response to address criminalization, ensure a safe drug supply and meet commitments to harm reduction. So far, it seems to be a close election with no obvious outcome. This is perfect opportunity to persuade the candidates and parties who need every vote. Download our election package below and please watch for updates as we add resources over the coming days and weeks.
Elections are important opportunities to make our collective voice heard and Canada needs a government that is committed to sustained and effective investments in our work. While most of us work in charitable organizations that must avoid partisan activities (exclusive criticism of only one party or endorsement of any one candidate or party) it is important that we raise issues with all candidates and with voters. It’s important that Ontario’s HIV sector be a part of the conversation and there are a number of activities that the OAN is coordinating on behalf of our members. To start this work, the OAN has worked with a committee of Board members and representatives from our members to assemble a small toolkit and other resources and to develop some key messages to use throughout the campaign period.
The OAN has no political affiliation, but we feel an urgent need to make our members, affiliates and the people we serve aware of the political issues surrounding HIV in Ontario and nationally. The OAN’s members and partners have done and continue to do incredible work. With renewed commitment from political hopefuls as we move into the next term of federal leadership, we can ensure continued progress in the right direction!
Table of Contents
Our Regional Partners
Getting out the Vote
Questions for Candidates
Coordinating with our Regional Partners
The OAN is collaborating with the Coalition des organismes communautaires québécois de lutte contre le sida (COCQ-sida), the Pacific AIDS Network (PAN), the Alberta Community Council on HIV (ACCH), the Canadian Aboriginal AIDS Network (CAAN) and the Canadian AIDS Society (CAS) to send each party leader a letter asking them to commit to the following:
- Ensuring that people living with HIV, people with lived experience of hepatitis C and others with lived experiences are involved in significant roles in the Government of Canada’s response to HIV/AIDS and STBBIs in Canada and abroad.
- Reaffirming the commitment of Canada to the UNAIDS objectives for the elimination of HIV by 2030 (95-95-95)1 and to the elimination of HCV by 2030, while affirming the importance of HIV prevention and the quality of life of people living with HIV.
- Ensuring the sustainability of the front-line, community-based response to HIV, HCV and STBBIs through the stability and growth of the Community Action Fund and other such funding initiatives.2
- Democratizing access to testing for HIV, HCV and other STBBIs by encouraging the development and market availability of testing technologies, including point-of-care tests, dried blood spot tests and self-tests, developed in Canada.
- Ensuring that the Government of Canada does not create barriers to the provinces’ harm reduction public health interventions, including those aimed at preventing not only HIV but also overdoses and overdose deaths, in recognition of harm reduction as one of the four pillars of the Canadian Drugs and Substances Strategy.
Our goal is to host a signing of these commitments in each region of Canada in the coming weeks. As parties confirm their support, we will then report to our members on the progress of each party’s commitment. We recognize that this is not an exhaustive list and expect that Ontario’s election work will also be inclusive of issues such as the criminalization of HIV non-disclosure, treatment access, and more.
It is also worth noting that other HIV and LGBTQ advocates, including at the national level, are engaging the parties during the election on many of these same issues; it is important that we collectively amplify the voices and influence of the HIV sector with multiple, complementary activities targeting the parties and candidates seeking public support. For instance, information about the Canadian HIV/AIDS Legal Network’s harm reduction advocacy can be found here or the national Proud to Vote Campaign focused on LGBTQ advocacy can be found here.
For your part, we ask that you engage with your immediate community to let them know the potential impacts of this election and the commitments each party has made to address HIV. Reach out to your local candidates and let them know that the OAN has submitted a list of commitments to their party leaders.
Once the responses from the party leaders have been received by the OAN and our partners, we will share them with everyone.
Other Federal/National Issues
In addition to the five commitments identified above, the Ontario region has identified the following as additional commitments to be raised with each federal party:
- Ensuring the removal of HIV non-disclosure from the reach of sexual assault law, limiting the criminalization of HIV to circumstances of actual, intentional transmission only, and not extending the law to the transmission of other sexually transmitted infections.
- Ensuring an effective response to address the drug poisoning crisis and creating a safe supply of currently criminalized drugs, to prevent further overdoses and related deaths.
- Pursuing the decriminalization of sex work as a first step to protecting and respecting the human rights of all sex workers – this begins with the removal of criminal and immigration laws that criminalize sex work.
1 – 95-95-95 refers to targets to address the HIV epidemic (95 per cent of people living with HIV knowing their status, 95 per cent of people with diagnosed HIV on treatment, 95 per cent of people on treatment with suppressed viral loads)
2 – For more please refer to the Missing Millions document from the Canadian HIV/AIDS Legal Network found here.
Getting out the Vote
To help get out the vote, the OAN has created (available soon):
- A 2019 graphic that we suggest you attach to emails and print and display prominently in your agency and on social media pages.
- Postcards to share with your members.
- Branded “I voted” social media shareables/filters for profile photos, etc.
Other Suggested Strategies
There are a number of opportunities we urge you to consider in raising HIV issues during this election:
- If you are unsure who your local candidates are, go here to find out.
- If you are a newcomer to Canada or work with newcomers go here to learn more from settlement.org.
- Urge community members to ask candidates about their commitments to the fight against HIV/AIDS (some suggested questions follow). You could use newsletters, emails, meetings or social media to spread the word.
- Write letters to the editor urging voters to consider candidate’s commitment to the fight against HIV/AIDS.
- Have a Board member or supporter attend all-candidates debates to ask questions (note that in most formats people are only allowed one question each). You may want to write several questions down in advance so that you are ready. Be strategic, sit in the front of the room or next to a microphone. If you don’t get a chance to speak, wait until the end of the meeting and ask each candidate their position and give them a copy of the questions you would like answered. Some sample questions are included below.
- If you are unsure when candidate debates will take place reach out to you local candidate’s office for details. Once you have confirmed debate dates share the time and location with your members. Consider meeting up with members at debates and coordinating your response.
- Write or email candidates in your area asking their response in writing to the questions (in this case you should feel free to add background information).
- Drop by your candidates’ campaign offices in person to drop off material and ask questions. A friendly exchange can make an impact on campaign workers and the candidates themselves.
- Ask community members if they are registered with Elections Canada and encourage them to vote early.
- If you haven’t already done so, consider contacting community members on election day (or leading up to it) to ask if they have voted.
- If not, remind them how important it is to do so.
- If yes, provide them a branded “I voted” shareable for their social media filter so their networks will do the same.
- If they need assistance (getting to the polls, for example), offer it if you have the resources.
- Remind, remind, remind. Then remind again. It often takes several reminders before people actually vote. Create a schedule for social media posts and emails with a building narrative to encourage action. (“Only 10 days until the election”, etc.)
Suggested Questions for Candidates
Given the competition for attention during this period, we suggest that you focus your efforts on a small number of key issues.
Federal Funding – While we are thankful for the government’s recent investment of $930 million in the Global Fund – a 16% increase over last year – the national HIV response is chronically underfunded. Recent governments have underfunded and diverted funds earmarked for the national HIV response to the tune of $100 million between 2004 and 2016. This is at a time when rates of HIV have increased by 17% over the past five years, in sharp contrast to the significant decrease in new HIV transmissions seen in many other countries with comparable health care systems to Canada’s. What is your commitment to deepening the Federal government’s investment in the HIV epidemic in Canada and will your party keep this commitment? If elected, what will you do personally to ensure it is kept?
Universal Treatment Access – Several parties have announced their commitment to a national pharmacare program. A significant number of Canadians living with HIV do not have access to effective treatments, free of significant deductables and co-pays. In addition, many Canadians do not have access to effective prevention tools such as Pre-Exposure Prophylaxis (PrEP) for the same reason. What are your thoughts about ensuring that universal HIV treatment and PrEP are included in such planning?
HIV Testing – About 14% of Canadians living with HIV have not yet been diagnosed (that’s about 9,000 people) and once diagnosed many experience barriers to accessing effective treatment. These issues are compounded for newcomer and Indigenous communities, as well as for people who use substances. How does your party plan to address this reality?
Harm Reduction – Canada’s overdose epidemic is a national crisis and more than 11,000 Canadians have died of overdose since 2016. What is your commitment to ensuring that supervised consumption and harm reduction services, are available in every community?
HIV Stigma – HIV continues to be a very stigmatized disease. In all instances the stigma and discrimination associated with HIV has a direct and negative impact of the health and wellbeing of all those living with and affected by HIV. This stigma also affects people’s willingness to be tested and (if needed) to seek treatment and support. Fear of criminalization for failure to disclose HIV prior to any sexual contact prevents people from coming forward to test and drives the epidemic underground. Stigma can also affect public policy and support for HIV prevention initiatives, particularly harm reduction services. How can your government address HIV-related stigma and discrimination in meaningful ways?
Our success – Would you say that Canada is making meaningful progress to address the HIV epidemic on every level? Including the quality of life of those living with HIV? If not, what else in your mind needs to be done to make meaningful progress and what are you going to do to get us there?
Determine your agency’s spokesperson in advance of any media outreach. If you need someone to offer comment on province-wide or national issues, feel free to recommend the following:
If you have questions or comments related to our election package please let us know by sending an email to firstname.lastname@example.org.
A Background on the Issues
The need for a federal response to HIV/AIDS is as crucial as ever. Consider:
- There are more than 65,000 persons living with HIV currently in Canada; however, about 9,000 are unaware of their diagnoses. In addition, there are approximately 14,000 people who are undiagnosed and are not currently accessing effective treatment.
- Looking at the latest national epidemiological data available, a total of 2,402 new HIV diagnoses were reported in 2017 in Canada; an increase of 3% compared with 2016 and an increase of 17.1% since 2014.
- While new HIV diagnoses have decreased over the past decade, there has been an increase in new diagnoses in Ontario since 2013. In 2017, there were 916 new HIV diagnoses in Ontario; up from the 784 diagnoses in 2013.
- Each of these infections was entirely preventable. Each HIV infection is estimated to cost between $253,000 and $402,000 (figures in USD).
- While about half (54%) of all diagnoses in Ontario were in Toronto, HIV continues to be a province-wide issue.
- While we’ve made progress over the past decade, only 86% of people living with HIV in our province have been diagnosed and only 81% are on treatment.
- Ontario’s most marginalized communities carry the burden of the HIV epidemic. Of the diagnoses in Ontario in 2017,
- Gay, bisexual, and other men who have sex with men (MSM) accounted for 60%.
- People from African, Caribbean and Black communities accounted for 27% of those diagnosed. African, Caribbean and Black people are disproportionately overrepresented.
- People who use injection drugs accounted for 12%.
- Women facing systemic risks for HIV accounted for 1 in 5 (21%) of those diagnosed – 55% of these are African, Caribbean and Black women.
- Indigenous peoples are disproportionately overrepresented and are 4% of diagnosed.
- Prisoners are disproportionately overrepresented. Federal statistics indicate that 1.72 % of prisoners are HIV positive, compared to roughly 0.2% in the general population.
- Transgender people, especially transgender women, are disproportionately overrepresented. Although Canadian data is limited, a 2015 World Health Organization report summarized global data to conclude that transgender women are 49 times higher than the general population to be HIV positive.
- This illustrates the continued urgent need for a national HIV/AIDS response with dedicated funding for community-based services, and also for public policy responses to the social determinants of health that can drive the epidemic.
- While the need for federal investments is clear, the Government of Canada has steadily eroded its investments in the work of our sector. By 2008/2009 the Federal Government was supposed to have increased annual investments to $84.4 million. Due to funding cuts we’ve experienced a cumulative funding loss of more than $100 million between 2004 and 2016.
We are making progress; now is the time to deepen Federal investments in HIV related work and for our federal government to meet its commitments to funding. Despite the realities presented above, we are making progress in responding to HIV/AIDS in Ontario. Consider:
- The need to innovate HIV testing – Canada could be on the verge of an HIV testing revolution. There is a new focus on exploring the feasibility of home-based and self testing that will hopefully result in regulatory change and move HIV testing out of clinical and medical environments. The future democratization of HIV testing requires both Federal leadership and a commitment to Federal/Provincial partnerships.
- A commitment to PrEP – We know that with PrEP comes the promise to significantly reduce the transmission of HIV; especially among those at the highest risk.
- Access to effective treatments – We know that people living with HIV who are on effective treatment can’t pass HIV on to a sexual partner. This reality makes it easier for service providers to promote the undeniable benefits of treatment, which could encourage more people with HIV to seek treatment, bringing the HIV community, in Ontario, across Canada, one step closer to achievement of 95-95-95 targets and to a reduction in the stigma faced by many people living with HIV today.
- Equitable access to treatment – Some communities have been left behind when it comes to treatment access and it’s important that the Federal government consider how it will ensure treatment access for all Canadians. This includes access through future national pharmacare programming.
- Criminalization of HIV non-disclosure – the Federal Government’s Standing Committee on Justice and Human Rights released a statement advocating to remove HIV non-disclosure from sexual assault law. They also recommended for the limitation of charges to reflect modern medical science and actual transmission as opposed to the current incorrectly interpreted and applied test of a “realistic possibility of transmission”.
- A recent study of the economic impact of community-based HIV prevention programs in Ontario demonstrated that, from 1987 to 2011 community-based programs helped to avert a total of 16,672 HIV infections, saving Ontario’s health care system approximately $6.5 billion. The researchers also concluded that for every dollar invested in these programs, the cost saving was $5.
Community engagement is crucial. Ontario’s and Canada’s responses to HIV/AIDS have been driven by community organizations and by people living with HIV/AIDS. They bring a depth of knowledge about the epidemic that cannot be matched by bureaucrats or academics. Their view from the front lines allows them to spot emerging trends, successes and failures in program responses, and critical gaps that require responses. They are nimble in adapting programs to respond to new needs. They also bring a crucial voice to the public policy table to help illuminate how public policy can either fuel or reduce the epidemic.
As we move forward to the next phase of the response to HIV, it remains crucial that those community voices be heard loud and clear in the development, implementation and monitoring of the national AIDS strategy.
Funding processes matter: Expectations about the new Federal Action Plan on STBBI and the importance of investments through the Community Action Fund and the role community plays in setting priorities and indicators of success. As we engage the Public Health Agency of Canada in these and other questions, we hope we can count on the support of our elected officials.