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37th PARLIAMENT, 2nd SESSION

Standing Committee on Health

EVIDENCE

CONTENTS

Wednesday, March 19, 2003

1535

The Chair (Ms. Bonnie Brown (Oakville, Lib.))

Dr. Howard Njoo (Director General, Centre for Infectious Disease Prevention and Control, Population and Public Health Branch, Department of Health)

1540

1545

Dr. Howard Njoo

The Chair

Dr. Françoise Bouchard (Director General, Health Services, Correctional Service Canada)

1550

1555

1600

The Chair

Mr. Rob Merrifield (Yellowhead, Canadian Alliance)

The Chair

Mr. Rob Merrifield

The Chair

Mr. Rob Merrifield

The Chair

Mr. Rob Merrifield

The Chair

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ)

The Chair

Mr. Svend Robinson (Burnaby—Douglas, NDP)

1605

The Chair

Dr. Bhagirath Singh (Scientific Director, Institute for Infection and Immunity, Canadian Institutes of Health Research)

1610

1615

The Chair

Mr. Rob Merrifield

Dr. Bhagirath Singh

Mr. Rob Merrifield

Dr. Bhagirath Singh

1620

Mr. Rob Merrifield

Dr. Bhagirath Singh

Mr. Rob Merrifield

Dr. Bhagirath Singh

Mr. Rob Merrifield

Dr. Bhagirath Singh

Mr. Steven Sternthal

Dr. Howard Njoo

Mr. Rob Merrifield

Dr. Howard Njoo

1625

Mr. Rob Merrifield

Dr. Françoise Bouchard

Mr. Rob Merrifield

Dr. Françoise Bouchard

Mr. Rob Merrifield

Dr. Françoise Bouchard

Mr. Rob Merrifield

The Chair

Ms. Hedy Fry (Vancouver Centre, Lib.)

1630

Dr. Howard Njoo

Ms. Hedy Fry

Dr. Françoise Bouchard

Ms. Hedy Fry

Dr. Françoise Bouchard

Ms. Hedy Fry

Dr. Françoise Bouchard

Ms. Hedy Fry

Dr. Françoise Bouchard

Ms. Hedy Fry

The Chair

Mrs. Carol Skelton (Saskatoon—Rosetown—Biggar, Canadian Alliance)

The Chair

Mr. Svend Robinson

The Chair

Mr. Svend Robinson

1635

The Chair

Mr. Svend Robinson

Mr. Steven Sternthal

Mr. Svend Robinson

Dr. Howard Njoo

Mr. Svend Robinson

Dr. Howard Njoo

Mr. Svend Robinson

Mr. Steven Sternthal

1640

Mr. Svend Robinson

Dr. Howard Njoo

Mr. Svend Robinson

Dr. Howard Njoo

Mr. Svend Robinson

Mr. Steven Sternthal

Mr. Svend Robinson

Dr. Bhagirath Singh

Mr. Svend Robinson

The Chair

Mr. Svend Robinson

Mr. Steven Sternthal

Mr. Svend Robinson

Dr. Bhagirath Singh

Mr. Svend Robinson

The Chair

1645

Dr. Bhagirath Singh

The Chair

Mr. Jeannot Castonguay (Madawaska—Restigouche, Lib.)

Mr. Steven Sternthal

Mr. Jeannot Castonguay

Mr. Steven Sternthal

Dr. Bhagirath Singh

1650

Mr. Jeannot Castonguay

Mr. Steven Sternthal

Mr. Jeannot Castonguay

Mr. Steven Sternthal

Mr. Jeannot Castonguay

Mr. Steven Sternthal

Dr. Howard Njoo

The Chair

Mrs. Carol Skelton

Dr. Françoise Bouchard

Ms. Sandra Black (National Infectious Diseases Program Coordinator, Correctional Service Canada)

1655

Mrs. Carol Skelton

Ms. Sandra Black

Mrs. Carol Skelton

Ms. Sandra Black

Mrs. Carol Skelton

Ms. Sandra Black

Mrs. Carol Skelton

Mr. Steven Sternthal

The Chair

Mr. James Lunney (Nanaimo—Alberni, Canadian Alliance)

Dr. Bhagirath Singh

Mr. James Lunney

1700

Dr. Bhagirath Singh

Mr. James Lunney

Dr. Bhagirath Singh

Dr. Howard Njoo

Mr. James Lunney

Dr. Howard Njoo

Mr. James Lunney

Dr. Howard Njoo

Mr. James Lunney

Dr. Howard Njoo

Mr. James Lunney

Mr. Steven Sternthal

Dr. Howard Njoo

1705

Mr. James Lunney

Dr. Françoise Bouchard

Mr. James Lunney

Dr. Françoise Bouchard

The Chair

1710

Mr. James Lunney

Ms. Sandra Black

The Chair

Mr. Réal Ménard

Mr. Steven Sternthal

1715

Mr. Réal Ménard

Dr. Bhagirath Singh

Mr. Réal Ménard

Dr. Howard Njoo

Mr. Réal Ménard

Dr. Howard Njoo

Mr. Réal Ménard

Dr. Françoise Bouchard

Mr. Réal Ménard

Dr. Françoise Bouchard

Mr. Réal Ménard

Dr. Françoise Bouchard

Mr. Réal Ménard

The Chair

Ms. Hedy Fry

1720

Dr. Françoise Bouchard

Ms. Sandra Black

Ms. Hedy Fry

Dr. Françoise Bouchard

The Chair

Mr. Svend Robinson

Mr. Steven Sternthal

1725

Mr. Svend Robinson

Mr. Steven Sternthal

Mr. Svend Robinson

Mr. Karl Tibelius (Director, Research Capacity Development, Canadian Institutes of Health Research)

Mr. Svend Robinson

Mr. Karl Tibelius

Mr. Svend Robinson

Ms. Sandra Black

Mr. Svend Robinson

Ms. Sandra Black

Mr. Svend Robinson

The Chair

Dr. Françoise Bouchard

The Chair

Dr. Françoise Bouchard

The Chair

Dr. Françoise Bouchard

The Chair

Dr. Françoise Bouchard

The Chair

Dr. Françoise Bouchard

The Chair

Dr. Françoise Bouchard

The Chair

1730

Dr. Bhagirath Singh

The Chair

Mr. Karl Tibelius

The Chair

Dr. Bhagirath Singh

Mr. Karl Tibelius

The Chair

Dr. Françoise Bouchard

Mr. James Lunney

The Chair

The Clerk of the Committee (Mr. José Cadorette)

Mr. Réal Ménard

The Chair

CANADA

Standing Committee on Health

NUMBER 025

2nd SESSION

37th PARLIAMENT

EVIDENCE

Wednesday, March 19, 2003

[Recorded by Electronic Apparatus]

¹ (1535)

[English]

The Chair (Ms. Bonnie Brown (Oakville, Lib.)): Good afternoon, ladies and gentlemen.

It is my pleasure to call this meeting of the Standing Committee on Health to order, and to welcome our witnesses who are here to help us with our study on the Canadian strategy on HIV/AIDS.

Before I introduce the first witness, I would ask my committee members to give me a little leeway, because should a full quorum of this committee arrive, I will stop the proceedings in order to have a vote on the committee's budget. I can't call it right now because we don't have a sufficient number here, but as soon as we have nine people present, I would like to get the budget out of the way so that I can take it to the liaison committee tomorrow. Thank you very much.

Today, in response to our witnesses of the other day, we have representatives from the Department of Health, from Correctional Service Canada, and from CIHR.

We'll begin with the Department of Health, with Dr. Njoo.

Dr. Njoo, the floor is yours.

Dr. Howard Njoo (Director General, Centre for Infectious Disease Prevention and Control, Population and Public Health Branch, Department of Health): Thank you very much, Madam Chairman and members of the committee. I'm very pleased to be here this afternoon to speak to you about HIV and AIDS.

My name is Howard Njoo and I am the director general of the Centre for Infectious Disease Prevention and Control within Health Canada's Population and Public Health Branch. I'm also accompanied by my colleague, Steven Sternthal, who is the acting director of the HIV/AIDS policy, coordination and programs division.

We will tell you a little bit more about the role our centre plays in the Canadian strategy on HIV/AIDS, or CSHA for short, a little later.

Before I begin I would also like to express my appreciation to this committee for considering this important global and national public health issue. Thank you also for meeting with our partners from the non-governmental organizations working on HIV and AIDS.

In the next few minutes we hope to provide you with a snapshot of the background of how the CSHA came to be; the major trends in the HIV/AIDS epidemic here in Canada and internationally; the role Health Canada currently plays in collaboration with its partners in the CSHA; selective highlights of Health Canada's contribution to fighting the epidemic over the past five years; some key challenges Health Canada and its partners are facing collectively; and finally, the way we are currently reviewing the CSHA with a view to strengthening Health Canada's federal leadership of the CSHA.

For those of you who are interested in the epidemiological statistics or would like further details, we have provided everyone with a handout, which is available on the desk just behind us.

In terms of background, the federal government initially concentrated on getting to know the epidemic providing basic prevention information to Canadians along with our partners in helping to build the services for those already infected who are rapidly dying. In the late 1990s, two factors brought a change that caused us all to rethink our approach. The advent of new treatments slowed down illness progression and prevented early death for many, but evidence showed that prevention information alone was insufficient to truly stem the epidemic. We had to consider a future with increasing numbers of people living with HIV/AIDS for a longer time.

With our partners we designed a new strategy to do just that. We agreed that we must address the underpinnings of the epidemic--stigma, discrimination, and marginalization--and learn more about behaviours. We had to think long term, as most of the epidemic still lay ahead.

The CSHA, which was launched in 1998, sets in place a long-term approach that calls on the pan-Canadian response, recognizing that the federal government cannot fight the epidemic alone. The CSHA involves two other federal departments as partners: Correctional Service Canada and the Canadian Institutes of Health Research, who are also here today.

The HIV/AIDS epidemic is unprecedented globally. It presents challenges for governments and communities worldwide. It's an epidemic that has devastated developing nations and is now threatening most aspects of global progress. In developing countries, it is affecting national economics, human rights, and national security.

As a result, the United Nations held a special session on HIV/AIDS in June 2001. Canada sent a delegation made up of both government and non-governmental representatives and endorsed a declaration of commitment to address HIV/AIDS worldwide. The declaration calls for global action to fight the epidemic and the social, economic, and human rights factors that give rise to it.

I would now like to talk to you about some broad trends in Canada. As I pointed out earlier, there has been a sharp decrease in deaths from AIDS because of advances in treatments and therapies. At the same time, new HIV infections continue to occur in Canada at a rate of about 4,000 per year. As more Canadians live with HIV and AIDS, there is an increased demand for care, treatment, and support, and there's an increased economic and social burden.

The face of the AIDS epidemic is also changing. The early epidemic was primarily among men having sex with men, and they continue to be the most affected. However, injection drug users became a significant risk population during the mid to late 1990s, and the proportion of cases attributed to heterosexual transmission has also steadily increased over the past decade.

The environment in which HIV/AIDS thrives is also becoming increasingly more complex. There is no cure. There is hope that vaccines will eventually both prevent and treat HIV infection, but they appear to be many years away. The virus continues to mutate and find new ways to get around all current drugs.

Though there have been major advances in treatments, they are not effective for everyone. We are not yet able to ensure that everyone has equitable access to treatments because the regimens are demanding, have serious side effects, and require a stable life to be managed effectively.

On the prevention front, recent rises in the rates of sexually transmitted infections show that many people are having great difficulty preventing infections acquired through sexual behaviours. Canadians also appear to have lost their sense of urgency about HIV and AIDS and do not view the epidemic as either a significant personal threat or a significant public policy or health issue. This is thought to be due to a misplaced trust in treatment advances and a disturbing willingness to adjust to a future with HIV and AIDS.

¹ (1540)

HIV/AIDS is more than a health issue. It must be tackled at its roots. This means addressing stigma and discrimination that impede prevention of HIV transmission. Addressing the socio-economic factors will reduce the risk of acquiring the disease, early disease progression, and death.

Now let me describe the role that Health Canada is currently playing in the CSHA, in partnership with others. Health Canada, through the Centre for Infectious Disease Prevention and Control, is the federal government's focal point for addressing HIV/AIDS nationally and for contributing to its international response. The centre is responsible for overall national leadership and coordination of the CSHA. With our partners in other federal departments, the provinces and territories, and the NGO sector, we develop programs and policies and undertake national surveillance and research.

Other areas of Health Canada are responsible for services and preventative programs for Inuit and on-reserve first nation communities; for promoting collaboration of the federal government's international efforts; and for monitoring and evaluating our efforts.

Internationally, we collaborate with many partners, both programatically and in surveillance. We have been commended for this work and have been recognized by the United Nations.

Mr. Steven Sternthal (Acting Director, HIV/AIDS Policy, Coordination and Programs Division, Centre for Infectious Disease Prevention and Control, Population and Public Health Branch, Department of Health): Let me just speak briefly to the contributions that Health Canada has made over the past several years under this strategy.

A key success for Health Canada has been the development of a collective approach. In line with the government's policy on citizen engagement, Health Canada continues to bring together people who know the epidemic best to help define the way forward. All of our national planning involves those living with HIV and AIDS and those at risk. This also extends to the membership of our various committees, including the Ministerial Council on HIV/AIDS and the National Aboriginal Council on HIV/AIDS.

We have also undertaken some specific initiatives for populations directly affected by HIV and AIDS. We have launched a human rights approach to the epidemic and have been able to encompass complementary alternatives and traditional medical approaches to the disease with our partners.

On the international front, as Howard has said, we've involved civil society and Canada's delegation to the United Nations, and we have demonstrated to the world Canada's commitment to work with its partners at all levels.

In 2000, Canada initiated, with UNAIDS, the first international policy dialogue on HIV and AIDS. This permitted governments from developed countries to examine complex barriers to national action. On the front lines, many Canadian organizations are now twinning with their counterparts in other countries, permitting the exchange of ideas and lessons learned.

Let me now speak briefly about the challenges. As Howard has said, we must prepare for the long term. We must be visionary and pragmatic in our approaches by using the best evidence available and by involving those who can make a difference. We must let Canadians know that HIV/AIDS remains a threat to their health. Above all, we must tackle the difficult issues; collectively address the stigma that feeds the epidemic; continue to involve the disenfranchised in the response, to let us know what is needed and influence how we all do our work together; and also draw upon available scientific evidence and research to build more effective prevention, care, treatment, and support programs.

For us this also means expanding the federal reach. Departments must be engaged beyond the existing federal departments that are here today to include Human Resources Development, Citizenship and Immigration, and Indian and Northern Affairs, among others. All of us working to address this epidemic need to sustain our existing capacity that we've built over the years and continue to build for the long term, knowing that the epidemic has become complex.

We'll continue to strengthen our international response to the epidemic. For example, we've developed a case to encourage Canadians to globally address the epidemic. We have a responsibility to also implement our commitment with the United Nations declaration of commitment here in Canada. This will help contribute to lowering infection rates; increasing access to care, treatment, and support services; and addressing factors that make Canadians vulnerable to HIV infection.

¹ (1545)

Dr. Howard Njoo: Finally, to lead the way forward, Health Canada, with the guidance and participation of its partners, is supporting the development of a five-year strategic plan for the country to address the epidemic and its root causes. We've also begun to review the federal role over the past five years and our successes and challenges. We expect this will help us identify our priorities for the next five years and ensure that our resources are used as wisely as possible with minimal duplication. Both of these steps are being undertaken in partnership with other governmental and non-governmental organizations, using the evidence and expertise of those who know the epidemic best.

Thank you very much for giving us the opportunity to speak to you. My colleagues and I will be very happy to answer any questions you might have, after all the presentations have been made.

Thank you.

The Chair: Thank you very much.

Now, from the Correctional Service of Canada, we have Dr. Françoise Bouchard.

Dr. Françoise Bouchard (Director General, Health Services, Correctional Service Canada): Good afternoon, Madam Chair and members of the committee.

I'm Dr. Françoise Bouchard, director general of health services for Correctional Service Canada. With me at the table is Ms. Sandra Black, who is our coordinator of the public health programs within Correctional Service Canada.

We're thankful for the opportunity to appear before this committee as a partner in the Canadian AIDS strategy.

Correctional Service Canada has a legislated mandate under the Corrections and Conditional Release Act to provide health services to Canadians who are sentenced to imprisonment for two years or more. This includes approximately 12,600 men and 360 women offenders. Health services are provided by registered professional staff, including approximately 700 nurses and 300 psychologists, contracted physicians, physiotherapists, dietitians, and other health professionals.

I will shift my presentation here. Over the past decade, I think it's important to notice that there has been an evolution in the HIV/AIDS epidemic in Canada, with a demonstrated shift from sexual transmission—men having sex with men—to an injection drug use epidemic.

Within and at the end of our speaking notes you have two graphs illustrating this correlation between the evolving community epidemic and the increasing prevalence of HIV/AIDS in our prisons. As a result, Correctional Service Canada has been an officially funded partner in the Canadian AIDS strategy since 1998. To us, this partnership reflects the evolution of HIV/AIDS in the community and its implications for the incarceration of individuals who are at high risk for acquisition and transmission of HIV.

The Canadian AIDS strategy's activities fall within our legislated mandate, mission, and strategic priorities, including aboriginal and women offenders; re-integration into the community; a healthy environment; partnership; the safety and security of our institutions; and the policy and accountability framework of our government. CSC has been actively advancing policies and programs to ensure a comprehensive response to the issues of HIV/AIDS and other infectious disease within correctional facilities, thus contributing to the goals put forth by the Canadian AIDS strategy.

We have learned some important lessons relating to the implementation of the Canadian AIDS strategy. Although the allocated funding of $600,000 a year for CSC, from a total annual allotment of $42.2 million for the strategy, provides an opportunity to initiate HIV/AIDS-related programs, sustaining a comprehensive implementation of a number of programs requires a significant investment of human and financial resources.

Correctional Service Canada has successfully submitted funding proposals to the Treasury Board and now has a large proportion of funds for HIV/AIDS-related programs and services. During 2002-03, this is illustrated now by an expanded $4 million for HIV/AIDS-related care, treatment, and support, and by $230,000 for infectious disease surveillance activities. Within our internal allocation of resources, we have also expanded a national methadone maintenance program, now costed at $5.3 million a year.

The other important lesson we have learned is that it's essential to build and maintain an institutional and regional health sector infrastructure. We have 53 institutions spread over eight provinces. The coordination, maintenance, and collaboration needed to maintain programs have to be supported by a coordination structure. We have accomplished this by staffing our institution and regional offices with infectious disease nurses, adding staff to address this particular problem. We have also striven to collaborate with and utilize existing community resources, such as local public health offices and community-based organizations.

Another important element in building our infrastructure has been to implement a multidisciplinary team approach to respond to HIV/AIDS within our institutions. CSC has dedicated much energy to this approach by ensuring that all levels of staff, from correctional officers to parole officers, have received training and education on issues such as comprehensive discharge planning, discrimination, and stigmatization. We believe this forms an integral component to providing service to offenders infected with HIV/AIDS.

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I take this opportunity to describe some of these goals of the strategy in relation to our activities. The goals of the strategy have been to prevent the spread of HIV/AIDS. We now have a number of harm reduction programs, such as the provision of bleach, condoms, dental dams, and peer education and counselling, as well as a methadone maintenance program within Correctional Service Canada. Another goal is ensuring care, treatment, and support for Canadians living with HIV/AIDS and for their families, friends, and caregivers.

We have to recognize that a lot of offenders who come to Corrections Canada prisons have often not been able to access a health care system outside, often due to their high-risk behaviours and criminal activities. So this is an opportunity, and we have programs such as the provision of highly active anti-retroviral therapies and now also a national palliative care program—as we do have some inmates who die within our institutions.

Another goal is to minimize the adverse impact of HIV/AIDS on individuals in communities by ensuring that programs and services are appropriate for incarcerated population and adapted to meeting the needs of aboriginal and women offenders, and that our policy framework addresses issues of stigma and discrimination related to AIDS. We have also minimized the adverse impact of HIV/AIDS of individuals in the community by continuing to advance our national surveillance of infectious disease to determine what the trends are, to evaluate the effectiveness of prevention and harm reduction strategies, and to add to the empirical body of knowledge of HIV/AIDS in Canada.

As I have previously indicated, some of these activities have been specifically accomplished with strategy funds. These include the support of the working group on infectious disease of the federal-provincial-territorial heads of corrections. This has provided a valuable forum for the exchange of knowledge and best practices on the management of infectious disease and for the continuity of care between our jurisdictions.

Another specific activity funded by the strategy has been the development, implementation, and evaluation of a peer education and counselling program for federal offenders, including components for aboriginal and woman offenders.

A further activity that is funded is the development and implementation of a reception awareness program for all offenders entering CSC facilities, which provides information on infectious disease and substance abuse, including services available during incarceration.

The implementation of an anonymous HIV testing program in a certain number of institutions has also been funded. We're piloting and evaluating this program now.

Most recently, CSC has completed palliative care training for many CSC front-line staff, which was also partially funded through our AIDS money.

The provision of HIV/AIDS services to federal offenders must occur within a framework of good public health practices and recognize that CSC institutions are part of the Canadian community. In the next month, we will hopefully be releasing a report on our first infectious disease surveillance within CSC.

We recognize that in order to be responsive to the HIV epidemic, there is a requirement to build and maintain strong partnerships with other government departments. To this end, CSC and Health Canada are currently finalizing a memorandum of understanding, which details Health Canada's provision of services to CSC to accomplish technical work relating to infectious disease in correctional facilities. We are also going to continue maintaining local and regional relationships with public health offices to ensure institutional and regional public health practices are in place within our institutions.

We believe there are distinct advantages to CSC being a formal partner under the current CSHA, as it recognizes that offenders are a high-risk population for the acquisition and transmission of HIV/AIDS. This annual allocation of $600,000 permits the initiation of some specific program or activities specifically oriented to our offender population. But one of the primary advantages is that being a formal partner under the strategy has provided CSC with the leverage to advance program and policies to respond to the HIV/AIDS of offender populations.

¹ (1555)

Belonging to the Canadian AIDS strategy enables CSC to mainstream community HIV/AIDS programs into the context of a correctional environment. It basically gives us a place at the table.

We also recognize that although we have made important advances during the past number of years, there's still much work that needs to be done. This is a significant problem. We must continue to enhance our surveillance capacity for infectious diseases, including HIV/AIDS; hepatitis A, B, and C; sexually transmitted infections; and tuberculosis. For us, addressing AIDS cannot be done in isolation of the other infectious diseases within our environment.

We also must continue to encourage offenders to come forward for screening and testing, especially those who continue to engage in high-risk activities such as injection drug use.

Perhaps most importantly for us, we must continue to examine all viable options to reduce the transmission of infectious disease through the sharing of injection drug paraphernalia and tattooing equipment. I'm referring here to offering offenders access to sterile tattooing services and the consideration of piloting access to needle exchange programs in a few selected institutions. Within CSC we are grappling with this problem, and we need help. The environment in which we operate is a correctional environment and there are various perceptions of what this environment should look like.

However, we believe CSC is in a very good position to provide leadership both domestically and internationally on this issue and suggest future direction and guidance within the framework of the strategy, as well as to contribute to the body of knowledge related to providing a comprehensive response to the issue of HIV/AIDS within incarcerated populations. CSC health services view incarceration as an excellent public health opportunity to implement interventions for a population that does not necessarily access health services in the community.

We need to continue the emphasis on vulnerable populations. We also need to strengthen partnerships and collaborations between corrections and the public health system, especially Health Canada and Correctional Services.

In closing, I would like to restate that CSC values its role as a partner under this Canadian strategy. We will continue to strive to meet the policy direction and goals of the strategy, achieve the CSC mission and mandate as it relates to the strategy, and be an important element of the Canadian response to HIV/AIDS.

Thank you for this opportunity. I welcome any questions.

º (1600)

The Chair: Thank you very much.

I'm going to beg your consideration while the committee examines the budgets that will be attached to our study on prescription drugs.

I believe you have them in front of you. I think it's more than one.

We can do it in two motions. The first budget is for $73,400. That is the operational budget for when we are working here in Ottawa. Are there any questions on that one?

Seeing none, I'll accept a motion.

Moved by Mr. Ménard that we pass this budget for $73,400.

(Motion agreed to)

The Chair: The next two budgets have to do with travelling. One is for travel to Victoria, Edmonton, and Winnipeg, for the sum of $105,000. The next one is for Halifax, Quebec, and Toronto, for the sum of $89,800.

Are there any questions on those two travel budgets?

Mr. Rob Merrifield (Yellowhead, Canadian Alliance): Those budgets do not allow the entire committee, just eight. Is that right?

The Chair: Well, what we have found so often is that when it comes time to leave, people, with their other committee responsibilities, often try to back off from the trip. So we thought eight was a fairly good guess as to how many would want to go and would be able to go.

The other way we could do it is to send half the committee in one direction and half the committee in the other direction.

No? I'm not crazy about that either.

Mr. Rob Merrifield: One of the concerns I have is it looks like there are four government members and one from each of the opposition. The official opposition doesn't have any more than any other opposition, and I'm concerned that's not reflective of the House.

The Chair: So would you like to amend this budget to change it to nine?

Mr. Rob Merrifield: If you want to change it to nine, that would be fine, or reallocate the numbers.

The Chair: I think it would have to be ten, because we'd have to have equal numbers of government and opposition. But if you wanted one more from the official opposition, then we'd have to have one more government member. That will up the price.

Mr. Rob Merrifield: Bring it to ten?

The Chair: Yes, from eight to ten.

Yes, Mr. Ménard.

[Translation]

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): I think we need to find out who wants to take part in the trip. At any rate, we cannot vote on motions while we are travelling unless there is advance notification. So the game played by the opposition and the government is not quite the same, and that is perhaps less important.

What really counts is that we all receive the same information, because if we divide the committee, half will have access to some of the information and the other half to the remaining part. But we can agree that no motions will be debated in committee. So we have to first of all determine who is interested, so that we don't vote on a budget for 10 when in fact only 8 will be going. We never have 10 members attending our meetings. Unless there are votes, we normally have seven or eight members attending this committee. Obviously, these are some of the best members, but we do not need to have 10. That includes you, Madam Chair.

[English]

The Chair: Okay, but there is a more practical consideration, which is to get this budget into the liaison committee tomorrow, when they are meeting, as opposed to waiting another few weeks. If we're too slow, the money for the year will be gone before we get our budget in.

So my question to you is twofold. If somebody wants to amend this and increase the number of participants, we could pass a motion approving the budget with the addition of two people and ask the clerk to prepare revised numbers for tomorrow to reflect those added expenses. Or if you think it's more realistic to talk about eight, we could pass it this way.

I'm at your service.

Mr. Svend Robinson (Burnaby—Douglas, NDP): Madam Chair, I think the representative of the official opposition does make a valid point. In the interest of getting this thing in quickly, why don't we agree to submit a budget that would increase the numbers by two, ask the clerk to modify the budget accordingly, and get it in. My concern is that if we don't get it in quickly, we might lose out.

So with that amendment, I would move that the budget be adopted.

º (1605)

The Chair: Mr. Robinson is moving an amendment to change the number of members from eight to ten.

(Amendment agreed to)

The Chair: The budget now requires ten members.

I think Mr. Robinson is also moving the approval of this budget--he tried to do it in one, but I think we have to do it in two--with the ten members and whatever monetary number will reflect that addition, and that this budget be submitted to the liaison committee tomorrow.

Are there any questions on that motion?

(Motion agreed to)

The Chair: Thank you.

And thank you for your indulgence, those of you who are witnesses here today.

We will now come back to the substance of the meeting and move on to the representatives of the Canadian Institutes of Health Research.

I believe it's Dr. Singh.

Dr. Bhagirath Singh (Scientific Director, Institute for Infection and Immunity, Canadian Institutes of Health Research): Thank you.

Good afternoon, ladies and gentlemen.

CIHR started its existence in the year 2000, and I am part of one of the thirteen institutes that were created.

I'm also a professor of microbiology and immunology at the University of Western Ontario in London and a scientist at the Robards Research Institute in London, Ontario.

Research has been the focus of how HIV, as a disease, was identified, the cause of the disease, and its potential prevention. CIHR is committed to a long-term goal of prevention and treatment of HIV as a disease. CIHR is proud to be partnered with other federal departments since 1990 when the CIHR, in a previous incarnation as MRC, initiated a collaboration of research within the federal initiative in this area.

CIHR is very supportive of the goals of the strategy as presented. A majority of our effort in this area is directed to research and the application and translation of the results to the prevention of HIV.

When CSHA started in 1998 we were administering $4.6 million of that funding through biomedical and clinical HIV research. The national health research and development program, the NHRDP, which is a predecessor of some of the programs that CIHR inherited, in fact, formed the basis of a number of the new initiatives that were taken over.

In 1998, $4.6 million was our research contribution, which included the basic biomedical research, but the NHRDP contribution included several other areas such as clinical trials, epidemiological research, and community-based research. And in the year 2001 we signed an agreement with the Department of Health to in fact transfer the epidemiological component of research to CIHR.

CIHR itself, and previously MRC, had made a commitment not only to simply administer the fund that came from our federal partners, but also in fact to put funding directly into this research. So we committed $2 million over a period of five years in 1998. And when we signed the agreement in 2001, this funding was in fact increased to $3.5 million per year.

So that's the minimum we will contribute to the research in this area, in addition to the funding that comes through the partnership program. In fact, the research effort has led to a point where CIHR is contributing close to $5 million a year on top of the funding we receive through the partnership program.

In 2000 we contributed $3.8 million, in 2001-02 we contributed $5.1 million, and this fiscal year, which is descending, we'll be close to $4.5 million in our contribution to this research.

The CSHA allowed not only the creation of knowledge through biomedical and clinical research, which in the first component was around $4.6 million, but it also allowed us to put an effort into health services, the population's health. And that $2.4 million that was allocated to us is part of the new research program that we are working on.

In relation to the clinical trial network--and you heard from Dr. Schechter--that program currently in existence at CIHR is contributing, through our partners, $3.2 million to that program. That program is in fact being reviewed for continuation in the coming years, and in relation to our contribution to that program, we are assured that the existence of that program and the way it has performed certainly needs a lot more contribution towards the program in the future.

Now, how does CIHR administer the funding we receive and the funding we put into this program? Basically it is a strategic program. My institute, CIHR, is one of the institutes that has identified HIV/AIDS as a priority area. So we basically decide on and design research programs around that theme.

Currently there are two streams of funding within CIHR for HIV/AIDS research. One is the investigative program, where researchers come forward with their ideas to work on an area where they would like to do research. And that pool of funding we call the open competition.

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The other competition is where the CIHR institutes basically decide where the priorities will be, so we decide on HIV as a priority area. We come forward with programs where we will be then jointly putting funding within that program.

So if you look at slide 5, on the two programs we have currently listed, most of our funding is on the left side. The biomedical, clinical, and health services programs are funded through that initiative.

Since the institutes were created we now have an opportunity to in fact decide how that funding envelope should either continue in the present form or in fact evolve so that we are able to not only fund the funding coming through that study but in fact also evolve the program so that all the excellent research that is done is funded through our regular CIHR programs.

The CIHR excellence in research, where the operating grants, clinical trials, and collaborative programs are funded, is listed on slide 6. And as you will see, the number of grants we are funding have in fact continuously been increasing, both in the knowledge creation area as well as in the clinical trials area. The group grants, the training awards, the salary awards are all contributing to create the capacity to do these kinds of research.

My colleague here, Dr. Karl Tibelius from the research capacity development program, CIHR, is in fact leading many of the initiatives in this area, and he will be delighted to answer any questions you may have.

Coming back to the institutes and what our role is in designing the priorities, my institute has taken a lead in coordinating the research for our CIHR in this area. So it's not only the CSHA component of research, but also whatever research CIHR does in HIV/AIDS is where we come in. We have in fact created an advisory group, a health care administrative advisory committee, which includes several of the communities and researchers. Our goal is ultimately to have a uniform planning process where we in fact use those priorities to make sure that the needs of the community and the researchers as well as the patients and health charities are met.

So we champion that area within CIHR, and I'll be happy to answer any questions regarding that program, which is just being launched.

What happens in the next round of the open competition? Where the investigators are putting grants and the institutes are designing programs, they will basically come together in the sense that we will exactly know how that piece of program should be monitored and launched.

Before I close, I would like to thank the committee for identifying areas where CIHR can in fact work with our partners. The future for HIV/AIDS research...and my colleagues have given a clear indication that this is a global epidemic. There are issues that are beyond Canadian borders. We need to have a Canadian strategy where we in fact link with the international efforts going on. The treatment, as I see it, the needs of the community, new vaccine development, complications that arise because of drug toxicity are all areas of research. Research is not only doing research on the bank and applying it, but also building the capacity, because we have, over the last twenty years, learned that Canada needs to build this research capacity.

We started with very little research capacity. CHSA, MRC, and CIHR have continuously built that research effort.

We are competitive at the international level. To keep that commitment going, CIHR is committed, and my institute is committed, to a long-term investment into the research in this area.

There are social, psychological, and behavioural issues. There are one or two child transmission-of-disease issues. There are IV drug user issues. We heard about many of those around the table. I don't want to go into all the detail.

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The fact is that there has to be a partnership, and we are really proud of the partnerships we have with Health Canada. They have been very good partnerships, where we have not only designed programs but launched many of the joint programs. We look forward to that opportunity.

In closing, CIHR within CSHA has made a major effort to fulfill the mandate that was given to us. We will be happy if that mandate is renewed. Whatever mandate the federal government gives us, we will be there for the challenge, and we look forward to that opportunity.

I'll be happy to answer any questions, and my colleague Karl will be happy to receive any input from you. Thank you.

The Chair: Thank you very much, Dr. Singh.

We'll move now to the question and answer portion of the meeting. We'll begin with Mr. Merrifield.

Mr. Rob Merrifield: Thank you for your presentations. They were informative. We had another day of witnesses, I believe it was on Monday, and I found that their presentations were also very informative.

One of the questions I have is with regard to the CIHR and the research side of this whole area. Treatments, vaccines, and prevention are where we're going. Looking ahead, how close are we to vaccines or other treatments that right now we don't know whether they're going to work? Can you tell us how far along you are and what kind of optimism you have?

Dr. Bhagirath Singh: I must say that we have come a long way from where we were 20 years ago. A lot of it has to do with anti-retroviral therapy. It is now a chronic disease, which really needs a lot of management and care.

Having said that, we are not really anywhere near finding a cure. In terms of vaccine development both at the international level as well as some Canadian efforts in this area, it is really very promising. Several clinical trials are going on. CANVAC, which is a centre of excellence in this area, is one of the groups that is involved in these clinical trials. I think it is premature to say that we have a very promising lead. A number of candidate vaccines are being tested. All of the results are not out, but it looks promising. That is not the only approach one can take. There are several other areas of research that CIHR is championing. But we would certainly like to see a vaccine because it's something that can be administered at a much larger level and will provide the best possible long-term cure for the disease.

Mr. Rob Merrifield: Do you have an optimistic timeline on when we'll reach the point where we'll know whether or not they're going to work?

Dr. Bhagirath Singh: I think the next five years are crucial. Some clinical trials have already started and some are being planned. There are not that many candidate vaccines, but some are being tested. I'd say at least four are being tried.

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Mr. Rob Merrifield: I understand that of the $42.2 million that comes from the federal government, the CIHR makes up about $13.5 million of that per year. Is that correct?

Dr. Bhagirath Singh: We get $10.2 million through the strategy, and CIHR is putting in close to $5 million directly and another $5 million indirectly for research programs related to HIV. So roughly an equal sum of money is being put in by CIHR in this area.

Mr. Rob Merrifield: On Wednesday we talked about the fact that CIHR has a fairly significant budget. The question from us as laypersons is this. In your estimation, is the amount of money you're putting into research in this area proportionate to the intensity of the problem? Should more money be allocated?

Dr. Bhagirath Singh: Obviously, I'm not here to plead that we should get more money. But I must say that at my institute, which is involved in the whole area of infection immunity, close to $75 million of overall CIHR funding goes toward research in this area. That includes HIV/AIDS. We are putting 20% of that money into HIV/AIDS, which is the largest single block of research dollars from my institute in this overall funding.

Unfortunately, there are many infectious diseases. We hear of them everyday, such as the West Nile virus and SARS. So the reality is that we must prioritize. As I said, HIV is at the top of our priorities. Our institute has identified eight priorities, and HIV is one of the top priorities within that program.

Mr. Rob Merrifield: We've seen all sorts of numbers come in as far as the epidemic goes and how it's increased, up to 4,000 a year now who are contracting HIV in Canada. I think those are the numbers; I saw them in here somewhere as well.

I'm just wondering something. I look back ten or twenty years ago at the projections at that time as to what it would be in the year 2000 and beyond. It seems to me that it is spreading, but is it spreading to what was projected at that time, or have we significantly reduced the projected spread?

Dr. Bhagirath Singh: I think I'll defer to our colleagues from Health Canada. They might be able to give you the numbers.

Mr. Steven Sternthal: It's been on the file for many years. Predictions were made years and years ago but certainly have not been realized.

The key thing the committee heard on Monday as well was around the changing nature of who has been infected, and it has changed dramatically over the last several years. Although the 4,000 number is about what it was in 1996 and was about the same in 1999, it's a very different situation that's on the ground. I think that was made clear on Monday as well.

Dr. Howard Njoo: As I mentioned earlier in my report, initially it was mostly men having sex with men, so the projections of the day back then would have just taken that into account. But the epidemic has changed over the past decade or so, and now it's going more to injection drug users and heterosexuals. In terms of projections it was difficult at the time to recognize what could have happened. Now we are seeing that's it's evolving and becoming more complex.

Mr. Rob Merrifield: I heard two different things there, one that now it's the heterosexuals who are really on the incline as far as contracting the disease. Even back then we understood that was likely going to happen and the projections were significantly higher at that time, were they not, as to actual numbers who would be contracting it in Canada?

Dr. Howard Njoo: I'll give you an example. Back in 1996 the proportion of cases that were heterosexual was about 17%, and it turns out that by 1999 it had increased to 21%. For men having sex with men, in terms of the incidence of new cases per year, it was at 30% in 1996 and 38% in 1999. For injection drug users it has also changed from 47% in 1996 to 34% now. So you see that things change, and one of the things we need to do is more research in terms of understanding the determinants and epidemiology as to why it appears there are more cases happening in a certain vulnerable population as compared to another one.

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Mr. Rob Merrifield: That's fair enough. The real answer isn't so much in whether the numbers are right, it's in how we're going to find the cure. Hopefully, CIHR and the research will move us in that direction.

The other question I have is with regard to prisons. You may have mentioned it in your presentation, but I might have missed it. You were suggesting that prisoners are contracting it through tattoos and needle exchange, dirty needles. I think clean tattoo needles are what you were suggesting should happen. Is that within the institution? Is that what you were suggesting?

Dr. Françoise Bouchard: We cannot establish the rate of transmission within our institution. We know that a large proportion of inmates come already infected from the community. However, we also know that there is injection drug use existing in our prisons still. We know that because of the seizures of paraphernalia within our institutions, so we cannot turn a blind eye to this; it is occurring.

What was your question?

Mr. Rob Merrifield: The question is, were you saying that maybe one of the solutions was to have clean needle exchanges within the prison?

Dr. Françoise Bouchard: The solution from a public health perspective is to look at all the harm reduction measures, including the capacity to look at exchange of needles and providing clean needles. Also, tattooing as a risk factor has not been clearly established, but in the case of hepatitis C, because we also have important problems with hepatitis C, we certainly think that tattooing is also a risk factor within the institutions.

Mr. Rob Merrifield: That's what I found rather interesting.

Dr. Françoise Bouchard: It's part of the subculture of our prisons.

Mr. Rob Merrifield: I can understand that. I just didn't think it was that prevalent within the institution, nor the needle exchange within the institution. We're looking at that, certainly. I think Vancouver is going through an experiment with that in communities, but I wasn't aware of it being pursued within the institutions.

Thank you.

The Chair: Dr. Fry.

Ms. Hedy Fry (Vancouver Centre, Lib.): Thank you very much, Madam Chair.

My questions are for Health Canada and for Dr. Bouchard.

One of the questions I wanted to ask Health Canada concerns the fact that we heard from our witnesses on Monday that the cost of services, especially under the heading of drug costs, is going up. As new drugs come forward, as the number of cases grows each year--by 4,000 new cases a year now--and as people are living longer, the drug costs for provinces are increasing to the extent that this is becoming a real cost problem for them.

My question is, what does Health Canada feel they might do about this? Health Canada does not contribute specifically and directly to the cost of drugs; that's the first bit. The second bit is, what is your plan, if any, to ensure that all provinces provide treatment for persons with AIDS? At the moment this is not pan-provincial. That's my first question for you.

The second one has to do with the use of drugs in prisons. I was a member of the special committee on the non-medical use of drugs. As you know, in our report we clearly identified that as a major problem, that in fact people are using drugs. Obviously, it's very difficult, it seems, to stem the flow of needles and drugs coming in and out of the prisons. Our concern is that...we know that bleach obviously doesn't seem to do the trick; nobody seems to want to use it.

My question is, do you intend...and have you read the SNUD committee report, specifically with regard to corrections? We suggested that in corrections you should be providing the same harm reduction facilities that are available in the community.

A lot of people in prisons are intravenous drug users. They come in and out of prisons, and when they get back in, they may be HIV-positive. Of course, they exchange needles when using the drugs they bring in illegally. I know this is a conundrum because you're not supposed to support the illegal use of drugs, but it is there.

Then they go back out into the community; they spread it into the heterosexual community, into the intravenous user community, and into the gay community as well. There is this spread because people come in and out of prisons so rapidly now, especially drug users, that you're really feeding the population over and over. My question therefore is about needle exchange and other harm reduction treatment facilities you can use.

The second one we talked about was access to a drug-free environment. It was felt that some people who came in saw their time in prison as an opportunity to detox and to go into a treatment regime, but it's difficult to do it when drugs are coming in and out of the prisons. Therefore, we have heard from certain people within corrections that we should provide one or two drug-free facilities across the country, where prisoners can opt to go and get the kind of treatment they need to have a better chance of being successful. I want your response to both of those in terms of stemming the flow of this problem.

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Dr. Howard Njoo: We'll start with Health Canada with respect to your question on drug costs. One important thing to notice under the strategy is that as one of the mechanisms we have to work with the provinces and territories from a Health Canada perspective, we have an FPT committee on HIV/AIDS. We meet with provincial and territorial representatives on a monthly basis by teleconferencing, and every few months we even have face-to-face meetings. This forum mechanism is a great opportunity for the various jurisdictions, including Health Canada, to share information, best practices, some of the challenges, and so on.

In the area of drug costs, one of the things we're looking at is a common drug review, to look at pricing across the various provinces and at what certain provinces have been able to accomplish and achieve through various mechanisms, things that may be of benefit to other provinces and useful for them to also undertake. But it's been recognized by all that in terms of jurisdiction, at the end of the day health care is a provincial jurisdiction, and drugs are strictly within that jurisdiction.

Ms. Hedy Fry: I realize that, but the costs are exorbitant, and unless the federal government begins to cost-share for those drugs, you cannot mandate it or make it happen in all the provinces. You're going to find that provinces are going to be coming to you every year for more money, because it's a bottomless pit for them at this point in time, sir. I just think that sharing best practices is nice, but it doesn't help with the costs.

Thank you.

Dr. Françoise Bouchard: Regarding your first questions on harm reduction measures, especially needle exchange programs and tattooing, CSC has been much aware of those recommendations, and I think decisions have to be made regarding moving forward. That's one of the issues, that CSC looks at the strategy as support and help to move forward on these things. Because of the environment of corrections, this is not a decision that's going to be easily implemented.

So yes, we're very much aware. As a public health person myself, I'm very much aware of those recommendations.

On the other issue, access to a drug-free environment, in each institution now this is not under health care; this is mandated under the substance abuse treatment programs within CSC.There are drug-free living units, and they have been fully implemented across all our institutions now in the last year, where inmates can live in a drug-free unit with the objectives you just stated.

Ms. Hedy Fry: Is that in theory or is it in practice?

Dr. Françoise Bouchard: I cannot respond, as I'm not a coordinator. I understand it's the practice right now in every institution.

Ms. Hedy Fry: I know correctional institutions are supposed to be drug-free, but it hasn't actually worked out. Drugs are coming in and out.

Dr. Françoise Bouchard: This is the unit, not all of the institution. One unit within the institution, one range, is supposed to be a drug-free unit so that the offender has a choice to go on it.

Ms. Hedy Fry: And there's no mixing?

Dr. Françoise Bouchard: No mixing.

Ms. Hedy Fry: Thank you.

The Chair: Thank you.

Ms. Skelton.

Mrs. Carol Skelton (Saskatoon—Rosetown—Biggar, Canadian Alliance): I thought Svend would go next.

The Chair: I didn't have Svend's name.

Mr. Robinson, then.

Mr. Svend Robinson: Thanks very much.

The Chair: You have to indicate, Mr. Robinson, or I don't put your name on the list.

Mr. Svend Robinson: I assumed that on the first round—

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The Chair: No, we always indicate here. Some of us sometimes pass.

Mr. Svend Robinson: I'm new to the committee. That wasn't the practice in my previous committee, but I will certainly follow the rules here.

I want to, first of all, join in welcoming the witnesses to the committee. I have a number of questions and not a lot of time. I'll try to be brief in my questions.

I'm sure the witnesses who are here, and I address this particularly to Health Canada witnesses, are aware of the fact that this committee heard moving, eloquent, and powerful evidence from those who are on the front lines in the struggle against HIV/AIDS and this epidemic about the fact that the current levels of funding are simply grossly inadequate to do the job that has to be done.

We heard from Martin Schechter and others. We have a list here of key Canadian partners. Without exception, I think it's fair to say, all of the non-governmental partners have made the point that the current levels of funding are not adequate. They've joined together in seeking a significant increase in that level of funding.

In the material Health Canada has provided to the committee, Madam Chair, I note that Health Canada acknowledges the level of the epidemic has deepened. The number of people who are living with HIV/AIDS has increased, by their own numbers, from about 27,000 in 1989 to nearly 50,000 in 1999. New HIV infections are continuing, and the face of the epidemic is changing. Yet the level of funding, remarkably—and I would say shamefully—remains the same as it was at the start.

Given the fact, as I understand it, that the mandate of CSHA expires this year and is coming up for renewal, how do you respond to concerns that we can't fight this epidemic effectively without a major increase in the level of funding?

Mr. Steven Sternthal: I think that's an excellent and very direct question. The first thing, just to clarify, is that the Canadian strategy of HIV/AIDS actually has ongoing funding. In 1998 the funding was made on an ongoing and permanent basis as long as there's an epidemic. In fact, we're not coming to the end of a five-year cycle and seeking renewal at all. The funding is committed for the long term. That's important always to remember, because the previous AIDS strategies were time-limited and had time limits.

To respond to your question around the funding level, clearly in 1998 there was a recognition that a long-term approach to the epidemic was needed. The commitment was made to have the $42.2 million provided for the long term on an annual basis.

We have been working, and rightly so, with the partners who are in the handout and who have been presenting to the committee, both on Monday and next week, to review the strategy. It's been five years since the strategy was put in place.

Recognizing some of the questions I heard on Monday from the committee about whether the allocations are in the right areas and whether the funds are being directed to the appropriate places, we need to really look at that now—and have been doing so for the last couple of months—with our partners to try to reframe our response for the strategy for the next five years, to try to clarify what our priorities really should be.

Mr. Svend Robinson: Perhaps I could just interrupt the witness for one second.

With respect, the issue the witnesses presented to us wasn't reallocation and whether the priorities were correct, and so on. I hope you were listening to what they said. That's not what they said. What they said is that the level of funding is totally inadequate to meet the needs in fighting this epidemic.

They pointed out that the level had been flat-lined for many years. It wasn't a question of trying to juggle within that figure: they need more money; they desperately need more funds to respond. They pointed out that if we spend the money wisely now, we're going to save an awful lot down the line. That's the issue, with respect.

I mean, $600,000 for Corrections Canada is peanuts, frankly; it's appalling. I know that in a number of other jurisdictions they're spending an awful lot more than that.

Again, I have to ask you—and I appreciate that we don't have the minister here; these are public servants—how do you respond to these criticisms?

Dr. Howard Njoo: What we can say is that the Minister of Health has asked us as Health Canada officials to do the five-year review. We are doing that. In a sense we're going to look at what our achievements are—what we have accomplished—and also at some of the challenges; in a sense, we'll do an assessment to see if the funds have been used wisely, and maybe also point to possible future directions.

Mr. Svend Robinson: You say “if the funds have been used wisely”. The minister is going to ask you for advice. You've consulted—I hope with the partners out in the field. What I'm asking is not just a question of whether the funds have been used wisely. I still hear these words, and that troubles me. Do you recognize and do you support the argument we're hearing from these partners, including partners in CIHR, that we need a significant increase in the level of funding?

Dr. Howard Njoo: The review will be finished by June, and basically we'll take the results of the review and present them to the minister for consideration.

Mr. Svend Robinson: Is one of the elements you're looking at the absolute level of funding and the possibility of a significant increase in it?

Mr. Steven Sternthal: Certainly the issue of the adequacy of funding is part of the review; it's one of the questions being looked at with our partners. A number of those who have presented to the committee are on our committee and are doing the review with us directly.

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Mr. Svend Robinson: One of the other concerns is the suggestion, and I know it's been on the table from time to time, that Health Canada might try to roll this strategy into the overall population health strategy. I know there was some suggestion this might happen, I believe back in 1997, and it was headed off then. Is that off the table now? Is it clearly recognized that it would be inappropriate to roll it into the population health strategy?

Dr. Howard Njoo: At this point we're really only in a position to speak on this particular strategy. Rolling it into other types of strategies is not really something we can comment on.

Mr. Svend Robinson: So you wouldn't support rolling it in as part of a general population health strategy?

Dr. Howard Njoo: It depends what you mean by general population health strategy. I'm not sure exactly what elements or components you'd be describing in such a strategy.

Mr. Svend Robinson: At this point, there's a specific targeted strategy for HIV/AIDS, and there was some suggestion it perhaps might be part of a broader strategy that dealt with population health issues. I'm not sure whether your colleague might comment on that, if he's aware of it.

Mr. Steven Sternthal: Yes, certainly in our current context we're working with the strategy as it's been laid out back in 1998. That's the current framework we're working in, and I don't think that issue has been introduced in a major way into our current work in the review.

Mr. Svend Robinson: The last question is with respect to the issue of clinical trials of drugs. You're obviously aware that there's been some recent concern raised in a documentary by CBC Marketplace and some important work by David McKie of the CBC around the issue of clinical trials of new drugs in Canada and the question of whether those participating are in fact given the full information they should have and whether their consent is fully informed before they participate.

One particular example given by the CBC was of an individual who participated in a clinical trial of a particular drug that in fact had led to the deaths of many people in Japan. He didn't find out about that until CBC told him about it, and it took five months for him to get a revised informed consent form.

What is Health Canada doing to respond to these very serious concerns that, in our rush to open Canada up to become a major centre for clinical trials—and we've been pushing this aggressively; I've seen some of the material—we do not lose sight of the profound importance of protecting the rights of patients and consumers and ensuring that consent be fully informed?

Dr. Bhagirath Singh: In relation to CIHR, we are fully committed to a complete ethical review of all the procedures and programs and the institutional advisory board review of all the clinical trials CIHR runs.

Clearly this is an area that will take a lot of effort and scrutiny, to make sure patient rights are all respected; that they are put into a framework that is ethically and legally binding on people involved in the trials and on those who are conducting trials.

We certainly will not rush into any of these trials unless they have been fully endorsed by people who are part of the trial.

Mr. Svend Robinson: What about Health Canada? What's your role in ensuring that these trials in fact are conducted in a way that ensures fully informed consent?

The Chair: It will take the representatives of Health Canada to answer that question.

Mr. Svend Robinson: In terms of drug trials and HIV/AIDS, there are no clinical trials of drugs then. That's what I'm looking at.

Mr. Steven Sternthal: The specific ones are actually administered by CIHR, so the answer to your question from our colleague here is that the ones that are funded through the strategy and are AIDS-specific have that ethical review process. But CIHR administers the clinical trial funding.

Mr. Svend Robinson: I won't take any more time, but perhaps you could get back to the committee, through the clerk, and clarify who exactly is responsible. And perhaps the CIHR representatives could indicate what guidelines are in place on the issue of clinical trials to ensure fully informed consent. Could you get back to the committee with that information?

Dr. Bhagirath Singh: There is a large component of trials beyond $2 million, and we'll have an oversight committee on that at CIHR.

Mr. Svend Robinson: Thank you very much.

The Chair: I'd like to add a question to that line of questioning.

The CIHR would certainly have those kinds of controls in place for the projects they fund. But are there not also clinical trials run solely by the drug companies testing their own new products?

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Dr. Bhagirath Singh: They are not run through CIHR.

The Chair: No, no, that's not what I'm trying to say. To me, you're the public sector, but there's the whole private sector. Is anybody checking on their clinical trials, on their consent forms?

Mr. Svend Robinson: That's why I was asking--

The Chair: Yes, I think I understood where you were going, but in one way you weren't talking private sector.

Maybe they could get back to us from Health Canada and tell us who supervises that private sector clinical trial and what are the controls in place to ensure the safety of Canadians who are being the guinea pigs for those drugs.

Next we have Dr. Castonguay.

[Translation]

Mr. Jeannot Castonguay (Madawaska—Restigouche, Lib.): Thank you, Madam Chair.

Since this disease first appeared, the infection rate, as it has been mentioned on several occasions, continues to climb. Unfortunately, we do not yet have any miracle drug to cure this disease, we do not have an effective vaccine. We also know that we are investing a great deal of energy to try and beat this disease.

Now, I would like to know how Health Canada, Correctional Service Canada or the research institutes are measuring the effectiveness of their efforts. It's all well and good to make an effort, it is all well and good to invest, in terms of money or time, but I think, at one point, we all understand that we need to know the results of our efforts. What are you doing to measure these results? I am interested in this matter.

We have a 10-program strategy, and if we realize that some of these programs are not effective, perhaps that is telling us that we should be doing things differently. I would like to hear your comments on these points.

[English]

Mr. Steven Sternthal: Perhaps I can answer from Health Canada's perspective, and then my colleagues can answer.

As you've indicated, there are a number of different programs and areas within the strategy and within Health Canada. Each one has some evaluation and monitoring components that take place each year. We have an annual report that is presented by the minister on World AIDS Day, on December 1, that highlights the progress within each year.

Secondly, we have also hired in the past evaluation-independent consultants to work with both ourselves and with our partners to look at various aspects of the different program components within the strategy. So there are ongoing yearly pieces checking to make sure our objectives are being met, as well as some periodic reviews taking place.

[Translation]

Mr. Jeannot Castonguay: If this assessment is being done on an ongoing basis, could you tell us whether or not, currently, you are satisfied with the results of your efforts? If you have come to the realization that some things could be improved, are you making the required adjustments as you go along?

[English]

Mr. Steven Sternthal: Certainly, the intent of our annual monitoring processes and our regular ongoing process is to make changes along the way, so that we're not waiting three, four or five years later to realize that we've gone off in some directions that are inappropriate.

In terms of the bottom line, as Howard presented earlier, the overall rate of infections within Canada is still remaining at about 4,000 per year. Although we continue to try to improve the number and the types of interventions that we are funding, and working with our partners, clearly, those infection rates remain the same, as they have for several years now.

Perhaps I can ask my colleagues if they want to comment about that.

Dr. Bhagirath Singh: All the funding that comes through CIHR usually has three- to five-year timeframes. At three years we usually have a review of the progress that has been made in the research for which money was allocated. So we have a continuous monitoring of these programs.

The CTN--Dr. Schechter appeared before you in his role as director of the clinical trials program--has been peer reviewed by an external international committee, and they have recognized that the work performed is at the level that has delivered results and should be continued.

In fact, that's one of the programs, but for any grant we provide there is evaluation of the results that come out of those trials.

º (1650)

[Translation]

Mr. Jeannot Castonguay: Given your answers, am I to conclude that, currently, you are satisfied with the strategy and the various programs, which are effective? Does that mean then that if we were to invest more money, we would be able to make some inroads into something that we do not seem to be able to do right now, namely, deal with this infection rate that is either staying at the same level or climbing?

[English]

Mr. Steven Sternthal: I'll answer from Health Canada's perspective.

Certainly, there have been areas of improvement over the past several years, and we continually need to improve. Given the complexities of the epidemic in terms of the different populations that are now affected, we are certainly looking at that question as part of the five-year review we're doing right now. As Howard mentioned earlier, we are looking at it in terms of whether all of our efforts are on target, whether there are areas that we need to change, as well as whether there are weaknesses that we need to address to make further progress. As well, we are looking at the issue of the adequacy of the funding.

[Translation]

Mr. Jeannot Castonguay: Did you say that we could expect to receive that report in June?

[English]

Mr. Steven Sternthal: Yes. The review is partway through. It started in the winter and will be completed by June. We're working with our partners, some of whom you've met already here at the committee, to undertake that review together.

[Translation]

Mr. Jeannot Castonguay: If the report concludes that increased investment would lead to better results, could that become part of the recommendations?

[English]

Mr. Steven Sternthal: As Howard has indicated, the findings of the review we presented to the department and the minister's office, and whatever the recommendations are, will need to be looked at by the department.

Dr. Howard Njoo: In response to your question and also your earlier questions, the minister is on record as saying that she does recognize the needs and the points put forward by various community groups and so on. She wants to work hard collectively, so that we can build a case to see if there are requirements for additional funding for the strategy.

The Chair: Thank you.

The next person is Ms. Skelton.

Mrs. Carol Skelton: Thank you, Madam Chairman.

I have two questions and I'll start out with Madam Bouchard.

You get $600,000, and you state in your presentation that you support the federal-provincial-territorial heads of Corrections' working group on infectious diseases. You also mention the development, implementation, and evaluation of a peer education and counselling program as well as development and implementation of a reception awareness program. How much do those three programs take of your budget?

Dr. Françoise Bouchard: I'm going to ask Sandra to respond directly to you.

Ms. Sandra Black (National Infectious Diseases Program Coordinator, Correctional Service Canada): I think what's important to indicate is that very often we will use the strategy funds for the initial component to do the work. So very often we will use it for the design and the development of a program.

The strategy funds would never permit us to implement those programs comprehensively across 53 institutions, so very often we will use the strategy funds for the initial work that's required. But in order to implement a program such as the reception awareness program and all of the institutions of the peer education and counselling program, we have to find either internal resources or reallocate resources, or indeed go to Treasury Board and make a business case that we require these resources in order to implement this program in a comprehensive fashion.

In some cases, we would take strategy dollars to do such things as, perhaps, the evaluation of the program. If we've had the program in place for a number of years, we may want to do a process evaluation to see what are the best practices, what are the lessons learned.

It's more difficult to look at outcomes in some of these programs and do an attribution that is related directly to that program. The federal-provincial-territorial working group on infectious diseases would not exist if we did not have strategy dollars. I think it's a very good example of one process that is in place, because we do receive those strategy dollars. Quite frankly, the provinces don't have money to travel and come to meetings, and if we didn't support them, that whole activity would not occur. It's my personal opinion it is one of the most valuable structures we have within CSE and the strategy, because it allows us the opportunity to share best practices among jurisdictions.

The Correctional Service of Canada is really rich compared with a lot of provincial correctional jurisdictions. We have 700 nurses; they might have seven. So we have the ability to take the products we create through strategy dollars and our own dollars and share them with the provinces. For them, I think they feel that's very important.

º (1655)

Mrs. Carol Skelton: How much do those programs take of your budget?

Ms. Sandra Black: We usually have two to three federal-provincial-territorial meetings a year, and each meeting costs about $25,000. We try to hold them in conjunction with something else that would be going on at the same time. For example, we know one of the really good things that happens around that committee is to do an educational session. So if there's a conference that's happening somewhere in the country, we would try to coordinate having an FPT committee meeting in conjunction with it, because then the participants could go.

The peer education and counselling program is our priority for next year. Out of the $600,000, I would estimate $400,000 will go to nothing but trying to get peer education and counselling in all of our institutions. We just evaluated that program, and we know it's only in 50% of our institutions. We believe the value is such that it should be in all of our institutions.

It's different in different years.

Mrs. Carol Skelton: So basically there's only $200,000 going to treatment.

Ms. Sandra Black: No.

Mrs. Carol Skelton: I want definite figures from you.

Ms. Sandra Black: Okay.

We use none of the strategy dollars for treatment. We spend about $4 million a year in HIV-related treatment, which we get from Treasury Board as a CSC department. Because we have a legislative mandate to provide services to federal offenders, we have to have the ability to do that, so we have gone to Treasury Board and asked for additional funds for a whole lot of different things related to infectious diseases, including HIV care, treatment, and support.

In the notes you have in front of you, you'll see we spend approximately $4 million a year. That's for drugs, diagnostics, clinical support, trips to see outside specialists, and that type of thing.

Mrs. Carol Skelton: I still have some time.

I'd like to ask the Health Canada officials a question.

You said you started talking last year to stakeholders. From what you have discussed with them so far, are you seeing inadequacies in the program at the present time?

From what we heard from the excellent presentations we had the other day, it sounds to me that there are some great inadequacies in the program...or the money the people are receiving.

Where do you see the inadequacies so far, and where are you looking at putting additional money, or do you feel it's adequate?

Mr. Steven Sternthal: Just to be clear, the five-year review, which is our current review and has been going on for the last several months, is partway through. So we don't have the answers to the questions in terms of the adequacy of resources at this point in time. We should have that by June, as I've stated earlier.

We have been working with the partners for many years, not just the last few months, in terms of implementing this and the previous federal strategies. There have been some strengths and weaknesses identified so far in the review, and I'm sure there will be some additional ones identified over the coming months.

The question of resources is part of that mix in terms of the work over the next little while. So I don't have specific answers for you to the last part of your question.

The Chair: Thank you.

We'll now go to Mr. Lunney, who hasn't had a turn yet, then to Mr. Ménard, who hasn't had a turn yet. Then for the second round, we'll start with Ms. Fry, and then Mr. Robinson.

Mr. Lunney.

Mr. James Lunney (Nanaimo—Alberni, Canadian Alliance): Thank you, Madam Chair.

I'll just go back to one of the presentations, the CIHR.

You mentioned the two different streams of research direction, some that come from the investigators initiating them themselves and others that are institute directed. I missed the proportion--one was much heavier weighted. Was that from the institution or from individuals?

Dr. Bhagirath Singh: At this moment all of the funding is going through the investigator-initiated research. Since we started last year, there have been two programs launched by the institute, and they are small--at this point, I would say around $500,000. But it is just starting.

Mr. James Lunney: Thank you for clarifying that.

On the research end, perhaps you can help us understand something. We know that when people become HIV positive, they don't always develop full-blown AIDS, and it often takes quite a while. Is there any change in the trends from infection to developing full-blown AIDS, or is that just related to treatment? Are people seeming to develop resistance? Is there any study going on as to why some people's immune systems seem to handle it better? Is it the quality of their immune system? Is it vitamins, nutrients, lifestyle, or other factors that keep them from developing full-blown AIDS?

» (1700)

Dr. Bhagirath Singh: From the scientific perspective, there are many studies around the world, some of them in fact led by Canadians. Dr. Frank Plummer, from Winnipeg, has led an international study in Kenya showing there are people who can become immune to the virus. But there are so many other variables that it's hard to pinpoint. That is one of the examples where we know that some people will in fact become naturally immune, and that is the strategy that may potentially work for the vaccine. I think that's where the potential lies for the future.

In terms of other factors, lifestyle, diet, all those factors are not well evaluated. They potentially have an impact, but I don't think we know very much about that.

Mr. James Lunney: A little bit has been said about the complications and coming up with a vaccine strategy and the difficulty in establishing, in spite of several trials under way right now, the complications arising from drug toxicity, and so on. Is there anything being done through CIHR, or are you aware of studies regarding other approaches that are non-drug or non-vaccine, such as electrical therapies?

Dr. Bhagirath Singh: As far as I know, there are many potential alternate therapies, but they are not evaluated to a level where one is able to say they will be effective.

In fact, Health Canada has initiated some programs to evaluate alternate therapies, and maybe they will be able to answer that.

Dr. Howard Njoo: We can get back to you with that. We don't have that information ourselves. It's not within the scope of our study.

Mr. James Lunney: That would be very helpful. I would be quite interested if you are doing any studies, particularly on electrical therapies. I've heard there is some evidence that viruses that are notoriously resistant to drugs in fact can be quite vulnerable to low-grade electrical currents in the micro-current range, so I would certainly be interested if you have anything on that.

Going back to the comments earlier about the shift from male sex to intravenous drug use, and so on, could somebody clarify the statistics? I'm not sure who said it; I think it was Health Canada that gave us some statistics, from 1996 to 1999, the heterosexual shift in that time period, male-male sex and then intravenous drug use. I didn't quite get those figures down. I don't think they're in the notes. Could you repeat them for us?

Dr. Howard Njoo: Sure. In terms of new infections, in 1996 there were a total of 4,200. If you look at the risk group or exposure, for men having sex with men, the total reported was 1,240, making up 30%; injection drug use was 1,970, which is about 47%; and heterosexual transmission was 700 cases, about 17%.

In 1999, the total was 4,190--so it's pretty similar. For men having sex with men, it was 1,610; injection drug use, 1,430; and heterosexual, 880.

If you want to go further, I can give you some more data with respect to gender. In 1996, women constituted 950 cases, and in 1999, 917 cases. If you look at aboriginals, there were 310 cases in 1996 and 370 in 1999.

Mr. James Lunney: Okay. If I understood the percentages right, for heterosexuals it had increased from 17% to 20%, and males had increased from 30% to 38%?

Dr. Howard Njoo: Yes.

Mr. James Lunney: What I guess I was trying to get at is, is it some 30% to 34% for intravenous drug use? I didn't get the percentage.

Dr. Howard Njoo: It was 47%, going to 34%.

Mr. James Lunney: Oh, so that's a decrease, from 47% in 1996, down to 34%. Or do I have that reversed? That doesn't sound right.

Mr. Steven Sternthal: My understanding is that prior to 1996 there was a significant increase among injection drug users. Between 1996 and 1999 there was a decrease, but prior to 1996 it had been increasing significantly. So during that time period there was a change.

Dr. Howard Njoo: It was more an increase in injection drug use early in the 1990s.

What has happened more recently in the trends is that it's increasing, as noted in the figures, in terms of men having sex with men. One of the hypotheses is that, as we mentioned before, there may be sort of a complacency within certain populations in terms of high-risk sexual behaviours, and that may be contributing to a more recent trend, as far as men having sex with men becoming more of a proportion of cases per year is concerned.

» (1705)

Mr. James Lunney: I see. Thank you for clarifying that.

For a final question I'd like to go back to our prison representative here, to Dr. Bouchard.

I was not a member of the committee on the non-medical use of drugs that travelled the country, and I did not consider this question of prisons and so on. I'm curious, because Dr. Fry mentioned an opportunity for two drug-free institutes. Then I heard you mention having drug-free units across the country.

As I am someone who hasn't been engaged in this, perhaps you could explain to us, as someone who works for Corrections Canada, how it is that we have such a problem with needles and drugs in a prison institute where we're supposed to have people incarcerated. How is it that these drugs and needles come and go so easily?

Dr. Françoise Bouchard: First of all, I think it's important to note that among inmates who come in, 70% are identified as having a substance abuse problem; this includes alcohol and illegal drugs. So we are dealing with individuals already belonging to a population with high-risk behaviours.

Now, I'm not responsible for security and corrections. However, there are a lot of measures that are in place. It's hard for any visitors to get into a jail. But through our seizures reports, we know there are regular seizures of illegal drugs and paraphernalia among inmates within our institutions. But CSC--and again, I think those questions should be directed to our security people--has put in place a wide range of measures over the years to counteract the illegal entry of drugs. There are, for example, the drug dogs. There are very many measures to prevent the entry of drugs, but it's a global issue with all our prisons, even the provincial corrections systems.

And your question was...?

Mr. James Lunney: I'd like to know that somebody is asking the question, whether it's directed at security or someone else. Since you're the closest we have to a Corrections Canada official here today, it unfortunately falls to you to try to explain this.

It seems to me that when you're talking about going a harm reduction way and minimizing risk by giving safe needles to prisoners in the prison context for illegal drugs and for illegal use, there's something that strikes many Canadians--and I hear from them--that what is wrong with us in Canada in terms of our ability to control our institutions is that we're allowing illegal activities to go on within prisons.

Dr. Françoise Bouchard: Nobody's allowing illegal activity. It's a fact of life in our prisons. I can give you examples from European countries and European prisons where this is also a fact of life. The implementation of harm reduction measures in those prisons has in fact been shown to have a positive impact not only on drug and substance use but on security incidents within those prisons.

It's a choice and a decision to make at one point when we have consequences from these activities going on. One of the consequences has been the infectious disease risk for other inmates who are not infected and also for our staff. We have to be concerned about that when you enter into searches. You can be pricked by needles, you can be pricked by different instruments, and you can be exposed. Our infectious disease prevention programs within our system also address education, and there are programs for our staff.

But the harm reduction measures are not only to address the issue of illegal drugs--this is not to deny that there's illegal drug use--but to minimize the consequences because we have a mandate of health protection too. Within that context, what we are trying to say is that if we want to check the example of our communities, the decision is in where we have implemented harm reduction measures. The question is, is that a valuable option for prisons dealing with a high prevalence of those problems?

The Chair: I would ask you, if you want to continue, not to go down this path. It's another subject totally, about security in the prisons and all that sort of thing. We have people who are experts in the HIV/AIDS thing here today, and they are here for that purpose only.

» (1710)

Mr. James Lunney: Thank you.

I just have one last question. On the peer education and counselling, a figure was mentioned in terms of new initiatives. Could you go over that? I missed the figures again.

Ms. Sandra Black: Well, once again it's one of those areas where it's hard to attribute what we've spent from Canadian strategy funds and what came from CSC funds. You'll remember what Dr. Bouchard talked about, that when we build infrastructure, it means putting infectious disease nurses in all the institutions. The infectious disease nurses help support the peer education and counselling program in the institution, but their positions are funded by CSC. We would use the strategy funds for such purposes as doing program design and evaluation to take the program and adapt it to women and aboriginal offenders. If there are specific initiatives we can utilize the funds for, we do that.

We've taken it and adapted it to our reception institution so that when all inmates come in they get a program, a reduced program, from the peer program. It talks about: this is what infection diseases issues are like in prison, this is what substance abuse issues are like, and this is how you can access those resources. It's trying to provide them when they come in with, if you will, a toolkit of things they absolutely need to know to progress through the first few months while they're with us. Then they could have the ability to be exposed to the larger program.

That program review is really important, because it's well documented in the literature, not only in correctional environments but in any culture, that peers providing information to peers is one of the most effective forms of education you can give, especially when it's related to these very sensitive issues.

The Chair: Mr. Ménard.

[Translation]

Mr. Réal Ménard: Thank you, Madam Chair.

To begin, in 1998, when it was time to renew the strategy, Health Canada had an independent firm assess the results of the strategy. On the whole, the conclusion was that, when compared with the memorandum presented to cabinet, the strategy's objectives were almost all fulfilled despite the fact that it was under-financed. If some members are still not convinced, I think that it might be useful for Health Canada to leave a copy of the evaluation with our researcher.

What concerns me is that I am hearing more and more from community groups which, for me, are the heart and soul of the strategy. Obviously, institutional partners were not able to produce all the results you set out. But community groups working in the field can help people change their habits and are in a position to reach out to people who are marginalized.

As for ACAP, I would like you to first produce a list of the financial commitments taken under this program and of the groups which were subsidized across Canada. People have also been telling me that you are becoming increasingly picky and bureaucratic, and that you are requiring extremely complex evaluations from community groups which already do a lot with very little money. I find this extremely unfortunate.

As a member of Parliament, every month the Canadian HIV/AIDS Legal Network sends me a document which helps me in my job and which addresses issues like prostitution or vaccinations. I read everything this organization sends me and it helps me do my job as a member of Parliament. However, the network receives very little funding.

I would like you to reassure me that you will not become even more bureaucratic and picky when it comes to your dealings with community groups. I hope that you will increasingly recognize the role played by community groups and that you will increase their funding. That's my first question and I would like a brief answer, if you don't mind, because I have two other questions.

[English]

Mr. Steven Sternthal: I think ACAP, the AIDS community action program, is the English equivalent. That's the local funding program for the over one hundred community groups across the country this strategy supports at any point in time.

There's a fine balancing act between ensuring the funding we provide through contributions goes out to the communities in a timely manner--in fact, we monitor those expenses. The organizations meet the objectives at the local level and then we meet the accountabilities that are placed on us by central agencies and others. It's a really difficult balancing act.

We certainly try to keep the application processes and the reporting requirements to a minimum, and I'm sure they can be streamlined further. However, that certainly is what we're trying to do, and not have the organization at the local level spend all their time filling out paperwork and not do their work on addressing the epidemic.

» (1715)

[Translation]

Mr. Réal Ménard: Fine. I would like to speak of one of those challenges. When my partner died of AIDS in 1997, AZT and saquinavir had just appeared on the market. Since then, there has been a huge increase in the number of drugs available.

At the time, pharmaceutical companies controlled the Canadian HIV Trials Network. I remember being at a research seminar in Vancouver, a beautiful city where everyone would like to live, of course. I learned that the Canadian government basically invested nothing in these clinical trials. Has that changed? I'm not only talking about the Canadian Institutes of Health Research, but are other organizations involved in directing the research of the Canadian HIV Trials Network, other than pharmaceutical companies?

[English]

Dr. Bhagirath Singh: There's no question that the clinical trial program within CIHR is a program that often looks at drugs that are not really within the mandate of a particular company. If there's a clinical trial funded by a company, usually that is mandated among hospitals, universities, and the company under whose terms the research is conducted.

CIHR certainly has partnerships with the industrial sector in many of the areas where we like to do joint development of knowledge, knowledge creation ideas. The funding of clinical trials or drug company research by CIHR is not really mandated to us at this point.

[Translation]

Mr. Réal Ménard: I have a final question. I may be mistaken, but I think that the major difference between the 1990s and the year 2003 is not that there are fewer infections, but that the groups affected have changed. Do we have a better idea of the way seroconversion is happening today?

For instance, I was told of studies which showed that in some large cities, such as Montreal, the people involved in high-risk behaviour were not 20 to 25-year-olds anymore, but rather men aged 40 or over. Do you have a better understanding of why people are involved in high risk behaviour? I was told, for example, that the Cohorte Oméga in Montreal had carried out a longitudinal study. It would be interesting for the committee to learn more about behaviour models explaining why, in 2003, people are still involved in high-risk sexual behaviour, despite awareness campaigns discouraging such behaviour.

If I have time, I would like to ask a question of the representatives of the Correctional Service of Canada, but I don't want to take up too much time.

[English]

Dr. Howard Njoo: I think the easiest way to answer your question is to say that it's very complex. What we are prepared to do is give you an actual report with details.

Mr. Réal Ménard: I'll discuss it over lunch with you.

Dr. Howard Njoo: Sure, that could be arranged as well, but certainly we could give you more detail in terms of trends, numbers, figures, and so on. It would probably be more efficient to actually give you a written report that can answer your question. Would that be okay?

[Translation]

Mr. Réal Ménard: Yes.

I have a final question. In 1995, I asked a question of Herb Gray, who was then responsible for Canada's Correctional Service, but he never gave me an answer. I understand why there are drugs in prison; it is something the government cannot prevent, but this does not mean it should become legal. I was worried because I was told that prisoners could not obtain condoms and I thought this was unbelievable, for public health reasons. Is that still the case? Just because sexual relations are forbidden does not mean they do not happen; I hope we can agree on that.

[English]

Dr. Françoise Bouchard: In federal institutions there are condoms available for distribution now.

[Translation]

Mr. Réal Ménard: You seem happy about that.

[English]

Dr. Françoise Bouchard: I think it's part of the prevention measures that need to be in place, so yes, it is there. Is there more to the question?

[Translation]

Mr. Réal Ménard: With regard to the public health strategy, it is now possible to have safe sexual relations in prison. Is that what you are telling the committee?

Dr. Françoise Bouchard: Yes.

Mr. Réal Ménard: Very well.

[English]

The Chair: Thank you.

Dr. Fry.

Ms. Hedy Fry: I wanted to ask Dr. Bouchard if there have been any studies done on the use or take-up of preventative measures, methods such as condoms and dental dams. If you can't do anything to stem the availability of drugs in the prisons, the use of those kinds of barrier methods would prevent the spread of disease. Obviously, they're not being used as well. Is there any study that tells us about the usage and the availability?

» (1720)

Dr. Françoise Bouchard: I'll ask Sandra to respond.

Ms. Sandra Black: I'll speak to two different studies. Perhaps the easier one to speak to is the methadone maintenance treatment program. When it was initiated a number of years ago there was an initial evaluation of the program done. Now I have to put the caveat that the sample size was very small at that time, and it did not so much particularly look at health outcomes but recidivism outcomes and criminogenic outcomes. The finding from that particular program was that inmates who were discharged to the community who received methadone had less recidivism, and if they did return to prison it usually was with violating the condition of their parole but not with a new sentence. So I think that was a very important finding for us.

We are currently evaluating the program as it stands, and that's a Treasury Board requirement, because we have gone to them and asked for so much money that they're saying to us, show us the proof. So we're in fact evaluating our methadone program again, and that evaluation is expected to be in September.

To speak of the issues of condoms, dental dams, and the availability of bleach, which are the other harm reduction measures we have in place, our performance assurance branch of Correctional Services did evaluate those programs, and the bottom line is that the tools are there, that they exist, but they're not always used.

You have to look at the nature of the environment we have. The reality is that they may have bleach available to use in a syringe or to clean tattoo equipment, but those are covert, illicit activities in their environment, so you may not have the time to do it. If you have one syringe with a drug in it and six people waiting to share it, you're not going to bleach the syringe in between.

So I think you have to look at the reality that the harm reduction measures are important to have in place, they are there and they are accessible, but the environment itself is not always conducive to utilizing those tools. That's why it's important that we have to look at every possible measure that we can possibly put into place and provide access to it.

Ms. Hedy Fry: Can I have one more question please, Madam Chair?

The Chair: Yes.

Ms. Hedy Fry: That leads me to the other question I wanted to ask. That is, as you know, there is a proposal out that I understand the CIHR has looked at and that has gone through Health Canada successfully, to look at methadone-resistant addicts. If, for instance, you have someone who's out in the community, has been out of prison and is now methadone resistant and is in the heroin assistance program, if they happen to go back into prison at that time, would they be allowed to continue on that program? That's a very real question to be asked if the program is going to be successful. The whole project is going to be void if you can't do that.

Dr. Françoise Bouchard: Nobody has come to discuss that with us. I would think that if this is the case, the people who are doing that study of the implications will have to discuss it with us, because I cannot give you an answer on this. We have not been involved in any of those discussions on this project.

The Chair: Mr. Robinson.

Mr. Svend Robinson: I'll be very brief because I know our time is just about up.

I wanted to, in a sense, follow up on Ms. Fry's question, and my question is directed to Health Canada in particular but also to CSC and to CIHR. There is this five-year review process that's under way now, and I assume you must have asked for a number of independent appraisals, or evaluations, of the success of the strategy to date, each of you at this critical time. This committee is looking at these issues as well. I wonder if you have indeed asked for those appraisals and evaluations, and if so, are you in a position to share those with the committee to assist us in our work as well?

Mr. Steven Sternthal: Certainly there are some specific individual evaluations on specific little bits of the strategy. In addition to that, the five-year review committee has developed some background technical papers that are looking at what are some of the strengths and weaknesses, what are the challenges, what areas have gone well and haven't gone well, how has the funding been spent, etc. So those are papers that are part of the five-year review process and can be made available to the committee at an appropriate time, as long as they have been reviewed as being technically accurate.

» (1725)

Mr. Svend Robinson: So you'll share those documents with the committee?

Mr. Steven Sternthal: Sure.

Mr. Svend Robinson: CIHR?

Mr. Karl Tibelius (Director, Research Capacity Development, Canadian Institutes of Health Research): I think the documents my colleague has talked about would be the most relevant because the research part of the strategy is being looked at there as well. The evaluation that CIHR has taken on is of some of our different programs, and the HIV/AIDS grants get funded through these different programs, so it would be difficult to collect that data and make it specific to HIV/AIDS.

Mr. Svend Robinson: Presumably you could share with us the elements of those studies that looked at the issue of HIV/AIDS. It wouldn't be that difficult.

Mr. Karl Tibelius: We could try to do that for you.

Mr. Svend Robinson: Good.

Ms. Sandra Black: With respect to CSC's participation and the strategy of the documents that Health Canada has, we'll talk about how we participate in the strategy and the outcomes related to that. As I said to Dr. Fry, we do individually look at and evaluate independent programs that may or may not be part of the strategy. For us, in Correctional Services, it's very difficult to look at HIV in the absence of other blood-borne diseases, especially hepatitis C. Our prevalence for hepatitis C is close to 40%, that we know of, so we very much need to look at HIV within the context of a blood-borne disease strategy, which I know is a bit different from the response you heard for your question, do we participate in a population health approach?

With respect to the population and the environment, that's the most pragmatic way for us to approach it, so very often when we look at HIV-related issues, they're also going to be within the context of how do we approach infectious disease strategies within Corrections.

The other big one, obviously, is tuberculosis. Although it is not blood-borne, it is very important in our environment.

Those types of activities we also do in coordination with Health Canada, but we also look at other partners such as the Centre for Addiction and Mental Health, CAMH.

We're in the business of corrections; we're not in the business of health. So when we do evaluation of programs from a health perspective, we very much rely on the expertise of other partners and colleagues.

Mr. Svend Robinson: Can you share the evaluations you've done focusing on HIV/AIDS? You will do that.

Ms. Sandra Black: Absolutely, yes. Definitely.

Mr. Svend Robinson: All right.

The Chair: I want to ask the representatives from the CSC about the statement in their presentation that said 69% of all new positive HIV test reports in 2001 were discovered in a CSC reception unit. Do you mean that 69% of all the new cases in the country were discovered there?

Dr. Françoise Bouchard: No. First of all, we can only report on the inmates who accept being tested. That's the first thing of any surveillance system.

The Chair: It is voluntary.

Dr. Françoise Bouchard: It's voluntary, and it can be repeated any time during the incarceration, so for any inmate, on the advice of a health professional, who would want to be tested, we would offer the testing.

What we're saying right now is that over the course of a one-year report that we'll be publishing, of the new cases of HIV that were tested among the inmates who accepted testing, 69% were at the time they came in--at the time of entrance. A reception centre is where they spend their time when they arrive from the community or the provincial system.

The Chair: Did 40% have hepatitis C?

Dr. Françoise Bouchard: No--among the general population. We distinguish between the inmates when they first come into CSC and spend time at the reception, where they are assessed, evaluated, and will be assigned to an institution. That's where they are seen then, and when they are assigned to an institution, we call them part of the general population.

The Chair: What is the HIV rate in the general population if this 69% is at the entry level?

Dr. Françoise Bouchard: It's the rest of the other cases that have been found in the general population. Overall, we have a 1.7% prevalence of HIV in CSC.

The Chair: That is 1.7%--less than 2%.

Dr. Françoise Bouchard: Yes, but it's more than the general population in Canada, which is 0.2%.

The Chair: That doesn't make sense to me--69%.

Dr. Françoise Bouchard: It is 0.2 % of the general Canadian population who will have AIDS overall.

The Chair: I have one other question for the representatives from the CIRH. The thing that's concerning me is this business that there are 29 new research grants for a total of 87. There are 14 training awards out of a total of 39, but there are zero new clinical trials, and there are a total of 6. Does that suggest that there are zero new clinical trials because there are zero new treatments or zero new drugs?

» (1730)

Dr. Bhagirath Singh: The clinical trials usually are ongoing programs, so if people have already been in the program for five years, they are not going to come back. That's why you see six, which means they've already been in the program for those four or five--

The Chair: I understand that, but why are there no new ones this year? Why is that number zero?

Mr. Karl Tibelius: It just happened that in 2002-03 there weren't any that were funded that year. We could, say, get two or three funded next year. It just depends on when the applications come in and when they get funded.

The Chair: So my question then would be, did you have applications by people who have new drugs they want put through clinical trials or did you have applications that you did not fund? What worries me is that I'm hoping that the stream of new products coming forward has not dried up.

Dr. Bhagirath Singh: That's exactly the point. I think there....

Mr. Karl Tibelius: We know in our most recent competition--and we have at least three of these a year--there were three clinical trial applications that didn't get funded because they have to be of a high enough quality to be funded, but we're not sure whether they were for new drugs or for some other sort of treatment or study.

The Chair: Or vaccine or something.

Those are my questions. I want to thank you very much for sharing your information with us. I want to say that the researchers, when they write a little report on this subject, may wish to call you. I hope you will welcome their calls. And I want to thank you for the work you're doing, particularly those people from the Corrections Service, because we understand that the people who come to you, and need your help so badly, come with sometimes a lot of despair. In my view, those are only the criminals who get caught; there are a lot of healthy ones out there living good lifestyles who aren't infected with any of these things. But these are the people who are often sick and full of despair, and they get caught, and then you're expected to patch them up. So thank you very much for dealing with what I consider to be one of our most vulnerable populations.

Dr. Françoise Bouchard: Thank you very much. Our professionals take pride in their work.

Mr. James Lunney: Did the clerk remind the officials of the commitments they made to provide us with some information?

The Chair: Yes. I'm going to ask the clerk to read the list of things that the Health Canada people said they would find out for us, just to make sure your list corresponds to his.

The Clerk of the Committee (Mr. José Cadorette): I just took notes. I would ask for guidelines on clinical trials on HIV/AIDS. Also, who supervises private clinical trials--

The Chair: Private sector.

The Clerk: Private sector, yes, sorry. Information on electrical therapies,

[Translation]

Health Canada's evaluation, the report on high-risk sexual behaviour,

[English]

CIHR studies, and also from Corrections Canada following Mr. Robinson's question, again, I'm going to rely on the blues to--

[Translation]

Mr. Réal Ménard: We should also get the APAC projects and the evaluations Health Canada had done in 1998. Those are two documents. The Special Committee on the Non-Medical Use of Drugs received a copy. I can also bring some, but these are extremely important documents, because those evaluations were done independently of government.

[English]

The Chair: Thank you very much, Mr. Clerk. This meeting is adjourned.