HEAL Committee Report

Canadian Alliance Dissenting Opinion

Issued by Rob Merrifield, Senior Health Critic
Carol Skelton, Deputy Health Critic
Betty Hinton, Deputy Health Critic

INTRODUCTION

The HIV/AIDS epidemic continues to take a devastating toll on the health and lives of thousands of Canadians. This is all the more troubling when it is widely recognized that HIV/AIDS is 100 per cent preventable. In our minority report, we highlight the need within the Canadian Strategy on HIV/AIDS (CSHA) for a more aggressive emphasis on HIV prevention. The Canadian Alliance believes a more focused, coordinated and sustained effort needs to be undertaken by governments, health authorities and community organizations to prevent the spread of HIV. We are convinced that this will pay dividends in improved human health, spared lives and reduced health care expenditures.

FUNDING

The Canadian Alliance supports increased funding for the Canadian Strategy on HIV/AIDS. Because of the continuing severity of the epidemic, the reality of more Canadians living with HIV/AIDS and the fact that annual funding for the Strategy has remained unchanged for several years, we support a greater financial commitment for the CSHA.

But while the Committee recommended an increase in funding to $100 million per year, we think an increase to $85 million is reasonable and appropriate. We do so on the following grounds:

First, several of the witnesses from the Canadian HIV/AIDS community who appeared at committee specifically requested an approximate doubling of annual funding for the Strategy from $42.2 million to $85 million. While a greater increase is unlikely to be rejected, the federal government must weigh the spending needs of numerous competing health and non-health priorities.

Second, some of the at-risk populations for which the Committee recommended specific funding allocations (eg. $5 million for First Nations and Inuit, $5 million for inmates) represent not new spending priorities but ones already included in the Strategy. A doubling of the CSHA to $85 million using the existing distribution of spending priorities would result in a doubling of funds for these at-risk, sub-populations, including $5.2 million for First Nations and Inuit.

Finally, it must be recognized that success in the fight against HIV/AIDS is not a mere function of dollars spent. The United States, at $12 per capita, spends far more on HIV/AIDS than does Canada, at $1.40 per capita. And yet, the U.S. has an HIV prevalence rate 94 per cent higher than Canada’s. By contrast, Australia, at $1.25 per capita, spends less than Canada and has an HIV prevalence rate 60 per cent lower than in Canada. According to the Ministerial Council on HIV/AIDS, “Clearly, spending alone does not correlate with a country’s success in preventing the spread of HIV/AIDS.”¹ These findings point to the need to look beyond dollars and cents to early, effective and continually monitored HIV/AIDS prevention strategies.

Recommendation:

That funding for the Canadian Strategy on HIV/AIDS be increased to $85 million per year.

PREVENTION

The Canadian Alliance believes that a strategic and sustained focus on prevention should be the centrepiece of a renewed Canadian Strategy on HIV/AIDS. Many commentators have noted that HIV/AIDS is 100 per cent fatal and 100 per cent preventable. 

The Canadian Strategy on HIV/AIDS currently includes no clear, coordinated plan for HIV prevention. We consider this an important deficiency. Accordingly, we are calling for an HIV Prevention Strategic Plan, similar to that adopted by the U.S. Centers for Disease Control and Prevention (CDC) in January 2001.² Such a plan should include clear and measurable objectives, and be subject to regular monitoring and updating to ensure program efficacy.

We concur with the Committee’s recommendation that the CHSA set five-year measurable goals for decreasing the annual number of HIV infections. We note that the Ministerial Council on HIV/AIDS cited shortcomings with the CSHA in this area: “The Strategy has goals and policy directions, and it encompasses a broad range of activities. But it does not have clear, precise and quantifiable objectives.”³

The Canadian Alliance believes the Committee’s call for five-year measurable goals should be taken one step further. We are calling for a targeted reduction in the annual rate of new HIV infections in Canada from over 4000 to 2000, within five years. (A similar objective is included in the CDC’s strategic plan.) Such a reduction would save 10,000 lives and prevent additional financial stresses on the health care system of hundreds of millions of dollars.

Programs funded through the HIV Prevention Strategic Plan should include ones which reflect the “ABC” model of preventing HIV infection, an approach which has proven very effective in Africa and is being adopted elsewhere. The ABC approach — Abstinence for unmarried adolescents, Be faithful for married couples or individuals in committed relationships and Condom use for those involved in high-risk behaviours — provides a clear, consistent message while targeting specific groups.

Recommendations:

That the Canadian Strategy on HIV/AIDS include a five-year HIV Strategic Prevention Plan. The plan should include clear and measurable objectives, as well as a process for accountability and regular evaluation.

That the HIV Strategic Prevention Plan include the goal of reducing the annual rate of new HIV infections in Canada from over 4000 to 2000 within five years.

That the HIV Strategic Prevention Plan allocate funds for programs based on the “ABC” model (Abstinence, Be faithful, Condom use where necessary).

Correctional Service Canada and Harm Reduction

The Canadian Alliance opposes committee recommendation 4(d) calling for Correctional Service Canada (CSC) to provide “harm reduction” strategies for the prevention of HIV/AIDS among intravenous drugs users in correctional facilities. Such strategies would see the introduction of needle exchanges to our federal prisons. This represents a fundamental shift from CSC’s current official policy of zero tolerance for illegal drugs. It would also amount to an admission of defeat to the disturbing reality of heightened drug use and abuse among inmates.

Needle exchanges will contribute to increased drug use among inmates and consequently, higher levels of HIV/AIDS, hepatitis and other conditions. In addition, by increasing the number of needles in our prisons, guards will be subject to greater risk of injury and intimidation. We believe Correctional Services Canada’s official policy of zero tolerance for illegal drugs should be maintained.

Recommendation:

That Correctional Service Canada maintain an official and enforced policy of zero tolerance for illegal drugs. Federal prisons should not embrace “harm reduction” measures, such as needle exchanges, for the prevention of HIV/AIDS among Canadian inmates.