OANBackgrounder

A) The need for a federal response to HIV/AIDS is as crucial as ever. Consider:

• The number of people living with HIV/AIDS continues to grow. In Ontario, 32,547 persons (26,378 males, 4,941 females and 1,228 of unknown sex) were diagnosed with HIV infection from November 1985 to December 2011. An estimated 67% of people living with HIV in Ontario know their HIV status. That means that 33% of people who have HIV do not know it. It is estimated that there are currently 27,420 people living with HIV in Ontario.
• Although transmission rates of HIV in Ontario have stabilized or decreased, there are still far too many people being newly infected with HIV each year. In 2011, there were 946 positive HIV tests reported in Ontario: a slight decrease from the 1,023 in 2010. Each of these infections was entirely preventable. Each HIV infection is estimated to cost between $253,000 and $402,00 (figures in USD)
• The burden of the HIV epidemic continues to be shouldered disproportionately by marginalized populations. Of the diagnoses in Ontario in 2011,

i. Gay and bisexual and other men who have sex with men (MSM) accounted for 51.1%
ii. People from countries with high rates of HIV infection accounted for 21%, African, Caribbean and Black people are disproportionately overrepresented. Federal statistics indicate that Canadians from African, and Caribbean countries where HIV prevalence is high are 9.2 time more likely to be HIV positive than the general population.
iii. Injection Drug Users (IDU) accounted for 6.3%
iv. Aboriginal people are disproportionately overrepresented. Federal statistics indicate that Aboriginal people are 3.6 times more likely to be HIV positive than the general populations.
v. Prisoners are disproportionately overrepresented. Federal statistics indicate that 1.72 % of prisoners are HIV positive, compared to roughly .2% in the general population.
vi. 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 time 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.

B) We are making progress; now is not the time to disinvest. Despite the grim realities presented above, we are making progress in responding to HIV/AIDS in Ontario. Consider:

• Infection rates in Ontario have held steady or declined in most of recent years.
• 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.
• A recent study from St. Michael’s hospital in Toronto demonstrated that Ontario is on track to meet one of the UNAIDS goals: 90 percent of people diagnosed with HIV on treatment. The study found that 87.3% were receiving care, 77% were on anti-viral treatment, and 70% had a suppressed viral load.
• The toolkit for HIV prevention continues to expand. It now includes:

i. Traditional programs to educate people about safer sex and drug use, and to support them in making behaviour change
ii. Providing anti-viral treatments. Taken properly, most people on medications will experience “undetectable” viral load (the amount of HIV in their body). Not only will this make them healthier, it means it is virtually impossible for them to infect other people.
iii. Providing “Pre-exposure prophylaxis” (PreP) to those who wish to pursue it. The science is increasingly clear that HIV negative people taking PreP properly are well protected from HIV infection. The manufacturers of the PreP drug have recently filed for licensing with Health Canada.

C) 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.

D) Funding processes matter: The community has grave concerns about a current proposal to collapse existing funding models for both HIV and Hepatitis C into a new “Community Action Fund.” Among many outstanding questions:

• Will the funding for HIV programs be reduced in order to support Hep C programs?
• Will there still be a specific strategy for HIV?
• Will agencies be restricted to accessing only one funding stream? Many agencies have accessed multiple funding streams in past to allow for a variety of responses appropriate to the many communities we serve.
• Will the criteria for accessing the fund include a demonstrated track record in responding to HIV?
• Will our agencies continue to be supported to provide quality of life, volunteer development and other services to HIV positive people?
• Will innovative funding processes and partnerships be encouraged? For example, funding processes that bring provincial and federal funders to the table along with community based agencies (a model currently successful in Alberta)

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.

To access the study of the economic impact of community-based HIV prevention programs go to: http://link.springer.com/search?query=Economic+Evaluation+of+Community-Based&previous-end-year=2016&facet-end-year=2016&date-facet-mode=between&facet-discipline=%22Public+Health%22&previous-start-year=1863&facet-start-year=2015
To access the St Michael’s research go to:
http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2015/20150813_hn